The Midwife’s Duty of CareNov 25, 2020
When considering the nature of the duty of care owed by a midwife to their patient the law applies a number of legal principles. One is called the Montgomery Test.
What is the Montgomery Test?
This comes from a 2015 Supreme Court case which emphasised that clinicians including midwives owed a duty to take reasonable care to give information to their patients. This is so patients can understand the options open to them and the various “material” risks which they faced when making their decisions. The idea of this is that by giving them this information they can make a fully informed choice. On some occasions the patient’s choice may be contrary to the recommendations of the midwife or doctor. However, the law recognises that it is important that patients have the choice; so long as they are provided with all the relevant facts and can assess the risks themselves.
What was the case?
The Case of NKX V Barts Hospital concerned a baby who sustained serious hypoxic brain injury due to a uterine rupture which occurred during labour. There was a risk of this occurring in this particular pregnancy as the mother had previously had her first child via caesarean section. However, she was keen to have the second child naturally. The mother also wanted it at a midwifery led birthing centre rather than in a maternity ward in a general hospital. Although the parents were critical of the hospital in relation to the information they were given during antenatal counselling, the Judge found that the hospital and its staff had not been negligent. The Judge decided that the mother was aware that there was a risk of scar rupture and she believed that she would be closely monitored in that respect.
However, one of the interesting aspects of this case was that the Court decided that the care and counselling during the labour process was inadequate and was negligent. As is all too frequently the case these days, the birthing centre was extremely busy when she went in. There wasn’t really enough time for her to discuss her birthing plan with the midwives. One of the problems with a water birth is that it is not possible to monitor the baby as closely as should have been, especially when it was busy. The Judge decided that if a proper discussion had taken place with the mother at the time of her admission there was a good chance that she would have changed her mind. By not proceeded with the water birth it would have meant that she could have had continuous fetal monitoring.
What were the results?
The Judge found that if there had been continuous fetal monitoring, delivery of the baby would have occurred 5 minutes earlier. Whilst the baby would have had mild brain injury, the baby would not have suffered the severe injuries which he sadly developed by the 5 minute additional delay.
The level of compensation for the child will be assessed at a future date when more medical evidence will be available.