Prospective mums should be armed with all the facts before they give birth
Last month a Welsh mother was awarded a settlement from Gwent Healthcare NHS Trust following the death of her baby daughter in June 2005 as a result of injury sustained during the course of her delivery. As this two year legal fight comes to an end, Yvonne Agnew, Head of Clinical Negligence at leading South Wales law firm, Leo Abse and Cohen, and the solicitor representing the mother asks whether prospective mums across the country are being given all the facts about the risks associated with different child birth options so as to enable them to make informed decisions about child birth.
"Giving birth is an exciting daunting prospect for any mother and regardless of whether this is their first time or they are a dab hand, prospective mums want to embark on their pregnancy safe in the knowledge that they are armed with all the facts to enable them to make informed choices in terms of their delivery.
"Guidelines published by the National Institute for Clinical Excellence (NICE) in April 2004 state 'pregnant women should be offered evidenced based information and support to enable them to make informed decisions about childbirth'. However, as this recent case exemplifies, it seems not all new mums are being given the vital information they need to make decisions that could ultimately affect both them and their babies.
"My client Pauline Williams gave birth to her second child in 1999 by way of elective caesarean section following medical advice in relation to an unrelated condition. She then went on give birth to her third child Nia by emergency caesarean section at Nevill Hall, Abergavenny in September 2004, following a uterine rupture after an attempt at natural birth. Tragically just nine months later, Nia died after experiencing considerable difficulties throughout her young life reported to be caused during her traumatic delivery.
"The question that has arisen out of Nia's birth is whether or not, like many prospective mothers, Mrs Williams was made aware of the accepted risk or implications of future pregnancies and birth after previously having undergone a c section. According to the hospital notes, the mode of delivery for Nia's birth was discussed with Mrs Williams but no further information is provided in these notes as to what was discussed and certainly there is no indication that the risks and benefits were discussed as per the NICE guidelines.
"The guidelines state that 'the risks and benefits of vaginal birth after caesarean section compared with repeat caesarean section are uncertain. Therefore a decision about mode of birth after a previous caesarean section should take into consideration maternal preferences and priorities a general discussion of overall risks and benefits of caesarean section, the risk of uterine rupture, the risk of perinatal mortality and morbidity'. But are Welsh mothers being given appropriate information in accordance with these very clear guidelines?
"I should stress that uterine rupture is a very rare complication. What interests me however is that the incidence of this extremely rare complication occurring is increased in women having a planned vaginal birth (35 per 10,000) compared with 12 per 10,000 having a planned repeat caesarean section. Moreover, whereas the risk of an intra partum infant death is small for women who have a planned vaginal birth (about 10 per 10,000) this is ten times higher than for a repeat elective c section (1 per 10,000).
"We are therefore left with a report that recommends that women should be specifically told about the increased risk of uterine rupture following an attempt at vaginal birth and that quantifies it as being three times higher than having a planned repeat caesarean section - and although the risk of intra partum infant death is small with an attempted vaginal birth is it nevertheless still ten times higher than for a planned repeat caesarean section.
"We may be talking about a small risk but for Mrs Williams and the thousands of women who give birth every year in Wales and across the UK it is vital that they are properly equipped with the statistics to enable them to make a proper and informed decision about how they wish to give birth.
"Adverse incidents may be rare but when they do occur, as in Mrs Williams' case, one can fully understand any distress or anger felt as a result of a belief that not all the information is necessarily being provided at the outset of pregnancy.
"I know Mrs Williams would support me in saying that, every mother, regardless of age or experience, should make sure that they are armed with all the facts at the very start of their pregnancy. We rarely make major decisions in life generally without ensuring that we are aware of all the effects and consequences of our choices. Surely therefore, a woman should be entitled to expect that, when it comes to making one of the most important decisions she will ever make, she has all of the information to which she is entitled?"