How Maternity Failings Result In Life-Changing Birth Injuries

Maternity failings at Shrewsbury and Telford Hospital NHS Trust

An in-depth report by senior midwife, Donna Ockenden, has found that catastrophic failures at Shrewsbury and Telford NHS Trust (the Trust) led to the death of more than 200 babies, nine mothers, and left many other infants with life-changing birth injuries. The enormity of the scandal and the findings of clinical negligence which caused or contributed to maternal injury and death, birth injuries, and stillbirths means that expert evidence may be required by potential claimants and the defendant.

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Why was the report on maternity deaths at the Shrewsbury and Telford NHS Trust commissioned?

The tragedy that unfolded at the Trust has a history going back many years. In the early 2000s concerns were raised regarding the number of babies being born by Caesarean. With approximately one in five mothers in England delivering via C-section, a Parliamentary Inquiry was told that childbirth was being over medicalised. The Trust, however, was praised for having low Caesarean rates. It told the inquiry that it had a culture of low intervention and attracted midwives and obstetricians who were “like-minded”.

Outside of Parliament, despite the approval of low intervention rates, parents and healthcare professionals began raising concerns about the standard of care at the Trust. The Week reported that a former consultant obstetrician and gynaecologist who worked at the Trust for almost 30 years told the BBC’s Panorama programme that he sent emails to the hospital’s senior management on several occasions highlighting “incidents of dysfunctional culture, of bullying, of the imposition of changes in clinical practice that many clinicians felt was unsafe”. He also commented that the unit’s “resources were scarce”, and former employees had also highlighted that a lack of midwives and consultants had been a problem for some years. The obstetrician concluded that “there was a tendency to blame individuals for not following guidelines rather than look at the underlying factors which may have led to a particular problem, and in particular staffing levels in the midwifery department.”

How was the Ockenden investigation commissioned?

The affected parents who, despite their grief, conducted their own investigations into the Trust’s failings and successfully prompted the Ockenden investigation. The final report from the Independent Review of Maternity Services at Shrewsbury and Telford Hospital NHS Trust demonstrated that little was done to listen to bereaved parents and the families of children who sustained birth injuries.

What did the Ockenden Report find?

The Ockenden report reviewed 1,486 family cases. It found:

  • In the 12 cases of maternal death, none of the mothers had received care in line with best practice at the time and, in three-quarters of cases, the care could have been significantly improved.
  • In a quarter of stillbirth cases there were significant or major concerns in maternity care that, if managed appropriately, might or would have resulted in a different outcome.
  • Concerning birth injuries such as hypoxic ischaemic encephalopathy (HIE), in two thirds of cases there were significant or major concerns about the care provided to the mother.
  • Staff were overly confident in their ability to manage complex pregnancies and babies diagnosed with foetal abnormalities during pregnancy. Furthermore, there was sometimes a reluctance to refer mothers and babies to a tertiary unit to involve specialists such as paediatric surgeons and geneticists in care.
  • Repeated failures to escalate concerns in both antenatal and postnatal environments.

The report also found major failings in terms of staff resourcing and training and that the Trust leadership team up to board level was in a “constant state of churn and change”.

The Trust board also lacked oversight of any investigations into maternal and birth injuries and deaths, meaning that “lessons were not learned, mistakes in care were repeated, and the safety of mothers and babies was unnecessarily compromised as a result.”

What is the role of expert evidence in cases of stillbirth, maternal death, and birth injuries?

To establish negligence, the Claimant must prove that, on the balance of probabilities:

  • a duty of care was owed to them, and
  • the duty of care was breached, and
  • they suffered harm as a result of the breach

In cases of catastrophic birth injuries caused by lack of oxygen or failure to monitor the mother and/or baby’s vitals during labour, expert evidence is often required to establish the extent of the injuries and the long term prognosis of the infant.

In clinical negligence cases, compensation is there to put the Claimant back in the same position as if the cause of the injury had not happened. Expert witnesses are often instructed to provide “quantum reports” to help the court calculate the amount of the compensation award.

How can Expert Court Reports Ltd help?

At Expert Court Reports, we have several experts who may provide expert evidence in claims arising from birth injuries. Jayne Utting, has over 23 years of experience as a midwife and is an accredited expert witness. Dr Kshitij Mankad, a paediatric neuroradiologist, is another expert whose expertise is often required in such cases. We also provide experts who can comment on orthopaedic-related injuries, including Mr David Bryson and Mr Matthew Henderson.