Maternal Care During Labour and Post-Birth
Having a baby is the most wonderful, terrifying, elating and difficult experiences and I speak from first-hand knowledge! I don’t think I have ever experienced such a range of emotions at once. All the time, from the first confirmed pregnancy test to the emergency caesarean section that was ultimately required all I could think of was seeing my child safely into the world. All thought for myself was secondary which is entirely natural. However, as a mother, you are owed a duty of care too. Of course, all hands are on deck to ensure the safe arrival of your child, but you are also to be cared for and protected.
I have previously commented on the care of the mother during pregnancy. I now turn to care during labour and after you have given birth. Seeing a child safely into the world is no easy task for either the mother or the doctors and midwives helping her. Every birth is different. If you speak to 10 different mothers, you will have 10 different birth stories. Sometimes, these have the saddest of outcomes. It is often necessary for the family to feel if something has gone wrong, that all was done as reasonably possible to help and treat. This blog is intended to give a snapshot of negligence in this area rather than an in-depth analysis. Keep an eye out for future blogs for more specific analysis.
It is important to remember that every mother has a choice as to the mode of delivery and on the care she receives through delivery. Though emergencies happen which ultimately mean decisions have to be made on the spur of the moment in order to protect the child and the mother, consent still needs to be given. Most, if not all, mothers would have some birth plan in place. Doctors and midwives should pay heed to the plan as far as they are able to as this would have been made when the mother was calm and thinking clearly and there was time to consider all options presented. Of course, birth almost inevitably does not follow the plan and decisions have to be taken quickly which veer from the agreed path, but the original plan should be considered when consenting a mother to these emergency measures. For example, arguably, if a mother has said that under no circumstances that instrumental delivery be undertaken, this should be considered if urgent delivery is required but there is a choice of c-section or instrumental delivery.
Every mode of delivery carries a risk. Each risk should be identified and steps are taken to minimise the chance of the risk/ damage it could cause. I mention some below, but this is by no way an exhaustive list.
Caesarean sections are not to be taken lightly with long recovery times and the risk of infection quite common. As such, prophylactic antibiotics are usually now given. Failure to recognise early signs of infection can lead to wound dehiscence and additional complications such as sepsis. The infection may not be avoidable, but early treatment is usually possible if all are aware of the signs and symptoms. C-sections carry the general risk of iatrogenic injury in surgery – again these may be unavoidable, but surgeons should be aware of the risk and delay in diagnosis can result in avoidable injury. After surgery there should be no retained swabs, etc that can cause ongoing issues.
Assisted delivery (also known as instrumental delivery) is used in about 1 in 8 births. This can increase the risk of avoidable injury. It is likely that an episiotomy is needed (a cut that increases the space for the instrument to be used). Failure to perform the cut, or doing so incorrectly, could well lead to tearing which would have otherwise potentially been controlled or avoided. The person undertaking the instrumental delivery should have experience in using the instrument to avoid additional risk of injury to the baby or the mother. There is a higher risk of blood clots in assisted deliveries so this should be discussed in the consenting process. Incontinence is also more common.
Induction is the term used when you are given ‘sweeps’ or hormones administered either by gel, pessary or by IV drip, to encourage your body to go into labour. It is very important to properly consent a mother as to the increased risk of assisted delivery when discussing this. It is also vital to properly monitor a mother following induction to ensure that the labour is progressing and to identify any early signs of distress for either mother or baby that should then be addressed.
Other areas of potential negligence during labour include, but are not limited to:
Failure to monitor a mother through labour. It is a very tiring process and puts immense strain on the body. Failure to take into account a mother’s blood pressure, heart rate, infection markers, etc can result in a severe injury to both her and the child.
Following delivery, in whichever form this took place, it is the clinician’s duty to ensure that the ‘after birth’, also known as products of conception are passed or removed. Sometimes, small pieces may be retained and these will pass naturally over time. However, large retained products of conception can cause infection which left untreated can be devastating for the mother resulting in sepsis and even infertility.
It is also arguably negligent to fail to take into account the mother’s pre-existing conditions that may have a direct effect on the considerations of treatment and risk. For example, heart disease, bleeding disorders, asthma, etc can all increase risk during labour and steps should be taken to manage this before any complication occur.
After you are discharged from hospital with your baby, you should then be followed up in the community by Health Visitors who should follow up on any issues that arose during birth, such as checking stitches following suturing, checking for infection for any broken skin such as c-section wound, and to not only check on the baby, but also the mother’s general health and wellbeing. Failure to do so can lead to a missed opportunity to treat.
Ultimately, If you feel that you have been incorrectly managed through labour or post-partum and this has led to an injury to you, please do contact our specialist team who can offer advice and do what we can assist. Please call us on 0300 303 3629.