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13 December 2024

Emergency caesarean sections, birth injuries and the urgent need to improve UK maternity care

4 mins

A new Care Quality Commision (CQC) report published in November 2024 looked at the experiences of pregnant women and new mothers in February 2024. The report, which suggests entrenched problems with communication and postnatal care, highlights several areas that need significant improvement, including more care, more training and, very likely, additional funding. Sadly, as medical negligence lawyers, we see the same mistakes happening over and over again.

The CQC received nearly 19,000 responses and while there are some positive aspects of care flagged in the report, there were many more areas where improvement is required. The areas of poor experience suggest that there are entrenched problems when it comes to communication and postnatal care which have not been improving over the last five years, despite various reports and surveys flagging these areas as problematic.

The CQC report is 78 pages long so there is a huge amount of information and lessons that can be learnt. Interestingly, although somewhat unsurprisingly, there were disparities in how different groups experienced maternity care, for example, those who had an emergency caesarean birth had a poorer than average experience across nearly all questions asked. These women experienced poorer than average care when it came to:

  • communication from midwives
  • being given the help they needed when contacting the midwifery team
  • being able to get a member of staff to help them when needed during labour and birth
  • their concerns being taken seriously during antenatal care
  • being treated with respect and dignity
  • having trust in the staff providing antenatal care
  • being involved in decisions during antenatal care.

Emergency caesarean births increased from 21% in 2023 to 23% in 2024. These results are disheartening, especially given that a large proportion of the birth injury cases we take on involve an unplanned and emergency caesarean section so we know all too well the potentially catastrophic consequences of poor care here. We have dealt with cases where:

  • despite a foetal heart trace suggestive of a maternal haemorrhage (sinusoidal CTG trace), birth was delayed until an emergency caesarean section was required
  • there were failures to act following a sustained low foetal heart rate (acute bradycardia) resulting in an emergency caesarean section, and
  • there was a failure to respond to rising Anti-D levels resulting in an emergency caesarean section

These are but a few examples and in all of these cases the children suffered significant and permanent neurological injury which we say was negligently caused and avoidable with the right level of care.

The CQC’s 2024 report also has quite stark findings when it comes to postnatal care. Over the last five years women reported being worse off at being able to get a member of staff to help them when needed, being given information or explanation when needed and being treated with kindness and compassion. Women were no better or worse off for discharge from hospital being delayed, or a partner being able to stay with them for as long as the mother wanted. These statistics suggest there has been no improvement in postnatal care.

Our experience also reflects this as we have seen a significant increase in the number of cases we have taken on which involve missed hypoglycemia in the baby post birth, causing seizures and permanent neurological injury. Often in these cases there is a failure to feed which is flagged by the mother and ignored by the care team until it is too late.

The cases we deal with highlight how critical it is that the government and NHS grapple with these problems. Birth injury cases and the associated litigation have cost the NHS £4.1 billion over the last 11 years, that is nearly £373 million a year. It is easy to see how these figures are reached because individual birth injury cases that we have dealt with settle for more than £10 million. Birth injury cases tend to be of the highest severity where the child claimant is injured during or shortly after birth, going on to require 24-hour care and support for the rest of their lives. They will offen never regain capacity to manage their lives or finances, or to work.

The government has put in place various recommendations and additional funding for maternity care over the last few years but the CQC report shows that there are several areas that need more care, more training and probably more funding. The real scandal is that we as clinical negligence solicitors see the same mistakes happening over and over again. There seems to be little joined up thinking or learning from these mistakes so it remains to be seen whether new recommendations will resolve the problems.

Find out more about our birth injury services here.

Read: Jon Crocker shares his thoughts on Birth Injury Inquiry in Law Society Gazette

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