Abstract
The Fs' baby, R, was conceived by IVF. She was the first child of Mrs F. Mr F had children by a previous marriage and had had a vasectomy.
In March 2005, Mrs F was admitted in labour at 41 weeks. Early decelerations were noted on the CTG and a registrar was asked to assess. She noted deflexed right occiput posterior (ROP) position, thick anterior lip and Mrs F was not to bear down. A fetal tachycardia and early decelerations were noted, and her contractions noted to be very poor. Syntocinon was started but discontinued when variable decelerations were noted on the CTG. She was, therefore, to be transferred to theatre for trial of instrumental delivery.
Two attempts were made to deliver R by forceps. At the inquest into baby R's death, Mr F gave evidence that, in attempting forceps for the second time, the registrar put her left foot up on the bed to increase traction. The fetal heart rate fell to 70 bpm and a decision was made to convert to a Caesarean section. Mr F testified that the SHO then made a fist and pushed it forward as if to push R back up the birth canal.
R was delivered by Caesarean section. She was floppy and pale with no signs of breathing. She was bradycardic and noted to have gasped. Cardiac massage was commenced by the midwife and paediatric SHO while the paediatric registrar was paged. The paediatric consultant was called, by which time no heart beat was heard. The decision was then made to stop resuscitation.
At postmortem, baby R was found to have multiple skull fractures, blood on the surface of the brain and haemorrhage in the white matter. The pathologist concluded that the perinatal asphyxia alone could have accounted for R's death, and whereas the physical damage on its own was not sufficient to cause her death, it could have contributed to the asphyxia. He noted it takes a considerable degree of force to fracture the skull.
At the inquest, the staff present at the delivery did not recall the foot being put up on the bed and said the disimpaction of R's head was no more forceful than usual. They accepted that under the NICE guidelines a fetal blood sample was indicated where there is a pathological CTG or that delivery should be expedited.
Following the inquest, the Claimants' solicitor invited the hospital to make an open admission of liability. They replied that this was a case where they wished to explore settlement, and they made an interim payment of damages.
The effects of baby R's death on the Fs were devastating. Both developed a psychiatric illness as a result of events around the delivery and both contemplated suicide. Mrs F continued to visit R's grave every day. Both managed to retain their jobs through understanding employers and a need to have a break from each other's pain. An expert psychiatrist advised that a prognosis for them could only be given when the outcome of their attempts to conceive another child were known. The couple had a further three cycles of IVF, two unsuccessful and the last ending in miscarriage, causing further extreme distress. Mr F then underwent a further attempt at reversal of vasectomy. However, after a year the couple had not conceived and could not contemplate further fertility treatment and were, therefore, seen again by the psychiatrist for a final report.
He concluded Mrs F had benefited from the counselling she had attended but continued to suffer from a reactive depression. He considered that with continuing therapy for 1 or 2 years she should make further progress but continue to be readily distressed by issues around pregnancy and children. He felt Mr F had moved on from his reactive depression, did not require treatment but continued to have some residual symptoms.
The claim was settled in the sum of £65,000 plus costs. A rough breakdown of the settlement is as follows:
£22,500 £10,000 £10,000 £1706 £1000 £12,620 £1523 £2586 £1893