This blog was co-authored by Phumla Zitha, Candidate Attorney.
Time is of the essence in cases of shoulder dystocia during childbirth. Shoulder dystocia is a medical condition that occurs when one or both baby’s shoulders become stuck behind the mother’s pelvic bone after the head has been delivered. Immediate medical intervention is required as a form of management for shoulder dystocia when it is identified.
The matter dates back to 2017 when the claimant instituted action against the hospital in her authority and on behalf of her minor son (then 6 years old) arising out of the treatment administered to the claimant during her pregnancy and the birth of their son on 19 December 2010. Essentially, the question before the court was whether the hospital staff’s conduct was negligent, particularly concerning the management of shoulder dystocia – a complication which arose during the delivery.
The hospital contended that the complication of shoulder dystocia and the injury which resulted was not foreseeable as the claimant was reasonably regarded as a low-risk patient. However, the court held a different view, agreeing with the claimant that they had successfully established on a balance of probabilities that the hospital was negligent in failing to assess the patient’s risk factors timeously for an alternative procedure to be applied. Further, the hospital was negligent in failing to perform the McRobert’s manoeuvre correctly or any manoeuvre at all according to the appropriate protocols. Finally, the hospital’s conduct was negligent in failing to keep detailed hospital notes.
The evidence presented in court dealt with critical aspects related to complications during childbirth and the duty of reasonable skill by the attending medical staff. It was established that the delivery was complicated by shoulder dystocia which caused significant injuries to the claimant’s newborn son, that led to the claimant’s newborn presenting with both nerve damage and brain injury. The claimant’s testimony – supported by expert witnesses – indicated that the medical staff failed to implement appropriate procedures when the shoulder dystocia became apparent. Specifically, the McRobert’s manoeuvre, a recognised technique for managing this complication, was either not performed or incorrectly applied. This failure to act appropriately during the critical eight-minute window between the delivery of the baby’s head and body was pivotal in establishing the negligence claim.
The risk factors associated with the patient were multifaceted. The claimant was classified as obese and had a history of anaemia, both of which are known to increase the likelihood of complications during childbirth. Further, the claimant was 34 years old, a factor that should have prompted closer monitoring and potentially earlier intervention.
The case turned on whether the correct procedure was performed to establish negligence and liability. The nursing staff’s documentation was described as woefully inadequate, lacking critical details about the labour progression and the manoeuvres attempted during delivery. Notably, the application of the incorrect procedure and no indication of the McRobert’s manoeuvre performed was cited as a major medical procedural error. This misapplication likely exacerbated the situation, contributing to the injuries sustained by the infant. The absence of comprehensive medical records during the crucial moments of delivery further complicated the hospital’s defence and instead created the improbability that the actions taken by the hospital staff were of a reasonable standard.
The court found the hospital’s staff attending to the claimant liable for damages due to the injuries sustained by the claimant’s newborn during their birth. The judgment reaffirms the importance of adhering to established medical protocols and maintaining comprehensive medical records. Relying on foreseeability to avoid negligence may not be sufficient in cases where inadequate medical records and a lack of evidence to support the argument is not convincing.