I Think I Should Have Had An Emergency C-Section
If your vaginal delivery resulted in you or your baby being harmed, you will want to know whether doctors should have reverted to an emergency caesarean section.
If an emergency C-section was needed but medical practitioners persisted with a vaginal delivery, there may be a breach of duty. If this caused either you or your child wrongful injury, there could be a case of medical negligence.
For more information on making a claim for medical negligence compensation, please contact us at Glynns Solicitors. We are a niche clinical negligence law firm and will be able to offer expert legal advice.
Warning signs that mandate C-section
Sometimes a vaginal birth is planned, yet complications arise that mean a C-section is needed instead. Medical practitioners must be aware of the clinical signs that mandate an emergency C-section.
When complications develop, no time should be wasted in transferring the patient to theatre for the procedure. This could save both the mother and the baby from suffering injury. Such injuries can be serious in nature, including brain damage, physical impairment and severe perineal tearing.
There are various concerning signs that warrant an emergency C-section, both before and during labour. We explore some these below:
Premature rupture of membranes
When someone says their waters have broken, it means that in medical terms their membranes have ruptured. This is natural part of giving birth. However, medical attention is needed if it happens too early in the pregnancy, or problems could develop.
This is because the premature rupture of membranes can trigger labour, meaning the baby will be born prematurely. If the labour does not begin, the baby will remain inside the uterus but will be at significant risk of infection. The amniotic fluid is sterile and helps to ward off infection. Without it, both the mother and the unborn baby can contract an infection, which can make each gravely unwell.
Therefore if there is a premature rupture of membranes and the labour does not commence shortly afterwards, medical practitioners must remain vigilant and look out for signs of infection. Furthermore, the benefits of expediting labour must be weighed up against the dangers of infection. If it is considered safer to deliver the baby, rather than give the preterm foetus more time in the uterus, the labour should be induced. Alternatively, a C-section should be carried out.
Bleeding and placental abruption
Vaginal bleeding during pregnancy is a concern as it can be a sign of placental abruption. This is when the placenta become partly detached from the uterus. It is also associated with abdominal pain.
There are varying degrees of placental abruption, and the severity will determine the clinical course of action. If the abruption is thought to be minor, it is acceptable to monitor the patient for the duration of the pregnancy, particularly if the baby is premature. But if the abruption is severe, the baby will need to be born immediately. A C-section may be needed. If action is not taken, the impact of the detachment on the foetus can be very damaging. A detachment of 30% or more can be fatal for the unborn baby.
Abnormal CTG traces
During labour, cardiotocography (CTG) readings are taken. These measure the baby's heart rate and the mother's uterine contractions.
The medical practitioners responsible for reading the CTG traces must recognise any signs of foetal distress, such as significant decelerations of the foetal heart rate. If suspicious or pathological indicators are detected, action must be taken straight away, as they could be a sign of foetal hypoxia. This is when the baby is not receiving enough oxygen, which can lead to severe brain damage.
If the CTG traces reveal a worrying picture, it necessitates an urgent caesarean section. The CTG results must therefore be properly interpreted and an appropriate response carried out – namely, transferring to an emergency C-section rather than continuing with a vaginal delivery.
Maternal distress
Similarly, if the mother is showing signs of distress during labour, consideration should be given as to whether it would be safer to expedite the delivery with a C-section.
The second stage of labour (the pushing stage) should be completed within two to three hours, depending upon whether the patient has given birth before. If the second stage is not progressing, the patient should not be allowed to labour on and action should be taken to speed up the process. If a vaginal delivery is not possible, a caesarean section should be recommended.
Larger than average baby
When an unborn baby is larger than average, it is called macrosomia. If ultrasound scans reveal the baby to be extremely big – meaning 10lbs or more – medical practitioners should discuss with the options with the patient.
There are risks associated with giving birth to a large baby, including severe perineal tears and shoulder dystocia. Severe perineal tears such as 3rd and 4th degree tears can affect the mother's long-term continence. Faecal urgency and incontinence can be particular problems. Shoulder dystocia is when the baby's shoulder gets stuck behind the mother's pubic bone. This can contribute towards perineal tears, and if the baby is stuck for too long, can cause hypoxia. The baby will then be born with catastrophic injuries such as cerebral palsy.
Macrosomia is more common amongst diabetic women. Because of this, diabetic patients must be advised of the risks of vaginal delivery and the alternative option of a caesarean section. If this is not done, the patient will not have been properly consented for the birth.
This was the focus of a recent case (Montgomery vs. Lanarkshire Health Board) heard in the Supreme Court. The mother was diabetic, and she argued that had she been made aware of the risks of shoulder dystocia, she would opted for a C-section. This would have avoided her son being born with cerebral palsy, which occurred after his shoulder became stuck for 12 minutes.
C-section would have avoided injury
If there is evidence of deterioration of foetal/maternal well-being, medical practitioners should mandate a caesarean section as a matter of urgency. Or if serious complications are like to occur with a vaginal delivery, an elective caesarean section should be arranged.
Although a natural birth is preferred wherever possible, if the mother or baby is in sufficient danger, a C-section must be performed. If there is a failure to heed clinical signs which indicate the need for a caesarean section and the mother or baby is injured, fault will lie with medical practitioners.
If you believe you should have undergone a caesarean section, and this would have avoided any injury occurring, you need to speak to a solicitor.
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