Maternal autonomy in childbirth: settlement for excruciating suturing ordeal following vaginal delivery

In the landmark case of Montgomery v Lanarkshire, Lady Hale made the following concluding remarks in her judgment: “It is now well recognised that the interest which the law of negligence protects is a person’s interest in their own physical and psychiatric integrity, an important feature of which is their autonomy, their freedom to decide what shall and shall not be done with their body.”

This principle of autonomy over one’s body is also enshrined in Article 8 of the European Convention on Human Rights. Pregnant women have the right to autonomy over their bodies during pregnancy and childbirth in the same way as everyone else. Sadly, for some mothers, their experiences do not reflect this at a time when they are at their most vulnerable.

Many mothers who approach us for advice when something has gone wrong feel that their needs and wishes have been overlooked during the birth of their baby. At the extreme end of the spectrum, the disregard for a mother’s autonomy during and following childbirth can have devastating and life-changing consequences.

We recently settled a case for a client who suffered one such devastating ordeal following the birth of her baby daughter. Our client gave birth at St Peter's Hospital, Chertsey, in November 2013. She had a vaginal delivery, during which she sustained extensive vaginal tearing. Two midwives initially started suturing the tears at the bedside; they struggled with the repair and continued their attempts for 45 minutes, during which time our client was in signficant pain, without adequate pain relief. Finally, they called for the obstetrician to assist.

Before the obstetrician arrived, our client was led to believe that the procedure could be completed under spinal block in theatre. Rather than discussing our client’s options with her, the obstetrician took over from the midwives and began suturing the tears. Our client suffered from immediate and excruciating pain and screamed out to the doctor, repeatedly begging her to stop. Her pleas were ignored and the obstetrician continued until the procedure was completed, offering no further pain relief. There was no medical emergency and no reason why the repair had to be carried out at the bedside. Our client was signficantly traumatised by the experience and found it akin to torture. She felt that her needs had been completely overlooked. She subsequently developed severe post traumatic stress disorder (PTSD) from the trauma, as well as depression, both of which have affected every aspect of her life. Despite treatment, she continues to suffer signficant symptoms and is currently unable to work.

Our clinical negligence specialists obtained evidence from experts in midwifery, obstetrics and psychiatry, all of whom supported her claim against the hospital. We put our case to the hospital trust, alleging that both the midwives and the obstetrician were negligent in the treatment provided. We alleged that the midwives had been negligent in failing to provide adequate pain relief, failing to recognise that the help of an obstetrician was needed at an earlier time, and failing to advocate for the health, safety and wellbeing of our client.

It was our case that the obstetrician was negligent in proceeding with a bedside repair without properly consenting our client and failing to offer the option of the repair being carried out in theatre under spinal anesthetic or epidural which was warranted by our client’s significant pain. We also alleged that there was a failure to obtain consent for use of a speculum, to heed our client’s extreme, worsening pain and repeated requests to stop, and to provide her with any pain relief during the procedure. Had our client been given adequate pain relief, or offered the option of repair in theatre, she would not have been traumatised and would not have suffered from PTSD or depression.

The hospital trust admitted that our client should have been given adequate pain relief and the option of a theatre repair. Fortunately, we managed to negotiate a significant settlement without the need to go to trial. Despite the settlement, our client is still affected by the trauma of what happened to her. She states: “The doctor treated me as if I did not exist and I think this betrayal of trust when I was so vulnerable post birth is one of the hardest things to face. That a doctor who is trained and should be helping and protecting me could do the opposite is beyond comprehension. What is very difficult is that you are already in such a vulnerable situation when you give birth and afterwards. I hope that my case can be used to help and educate those who support women during and post birth to retain the autonomy they should be afforded.”

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