- Doctors warned during pregnancy that the baby was too large for vaginal delivery.
- Hospital staff failed to properly assess the mother or plan a caesarean section.
- Traumatic birth left the mother with severe injuries and the child with permanent nerve damage.
A high-risk pregnancy that should have been delivered by caesarean section instead ended in a traumatic vaginal birth that left the mother permanently injured and her newborn son with a serious nerve injury.
The High Court in Polokwane has found that the negligent management of the pregnancy and delivery caused devastating injuries to both the mother and the child.
Acting Judge EJ Burnett ruled that the MEC for Health in Limpopo is liable for the damages suffered by the two patients after medical staff failed to properly assess the risks associated with the pregnancy and delivery.
The case arose from the birth of the child on 1 May 2018 following the mother’s antenatal care at Tshidimbini Clinic, Tshaulu Clinic, and Donald Fraser Hospital.
Pregnancy already identified as high risk
Medical records before the birth showed that the pregnancy carried clear warning signs that required careful management.
The mother was diagnosed with gestational diabetes at around 30 weeks of pregnancy. This condition is well known to increase the likelihood of foetal macrosomia, meaning that the baby grows significantly larger than average.
Clinic records also showed that by the later stages of pregnancy, the baby was measuring unusually large. At one point, the uterine fundal height measured far ahead of the expected gestational age.
At 37 weeks of pregnancy, the mother was informed that she would require a caesarean section because the baby was too big for a safe vaginal delivery. Despite that warning, the delivery plan was not followed when she was admitted to Donald Fraser Hospital on 30 April 2018.
Critical assessments not performed
When the mother arrived at the hospital, she was already in labour. The court heard that crucial assessments that should have been performed on admission were either not done or not properly recorded.
These included measuring the symphysis fundal height and estimating the baby’s weight. The labour assessment record even stated incorrectly that there were “no antenatal problems and no risk factors identified.”
Obstetric specialist Dr Ndjapa Ndamkou told the court that this information was plainly wrong because the mother had gestational diabetes and was already considered a high-risk patient.
He testified that proper assessment of the baby’s size would have revealed that a caesarean section was necessary. “Had the appropriate assessment been performed, including ultrasound during the intrapartum period to assess the foetal weight gain, the Plaintiff would have been offered a caesarean section as a preferred method of delivery,” he said.
Instead, the labour was allowed to continue, and the mother ultimately delivered the baby vaginally the following morning.
Traumatic birth causes severe injuries
The baby was born weighing just over 5.2kg, confirming that he was far larger than the average newborn. During the delivery, the birth became complicated by shoulder dystocia, a dangerous situation where the baby’s shoulders become stuck during labour.
As a result of the traumatic delivery, the baby suffered Erb’s palsy, a nerve injury that can cause weakness or paralysis in the arm. The mother also suffered devastating injuries during the birth. She sustained a fourth-degree perineal tear, the most severe form of childbirth tearing, as well as an open-book pelvic fracture.
According to specialist urogynaecologist Dr Paul Swart, the perineal tear was among the most serious injuries that can occur during childbirth. “The perineal tear that she sustained was the worst of the worst,” he told the court.
The injury was initially misdiagnosed as a minor tear and was incorrectly repaired in the labour ward by a midwife rather than in theatre by a senior doctor.
The mother remained in hospital for two weeks before the severity of the injury was fully recognised and she was transferred to Polokwane Hospital for surgery. “It took three weeks before she was properly diagnosed and sent to Polokwane Hospital for repair,” Swart said.
“The delay in repairing the injury exacerbated the injury and caused further harm.” The mother continues to suffer severe urinary incontinence because the structures responsible for bladder control were destroyed during the traumatic delivery.
Court finds negligent medical care
Judge Burnett accepted the evidence of the mother and her expert witnesses and found that the medical care provided by the hospital staff fell below the required standard.
“The court is satisfied that the staff at the defendant’s facilities were negligent in the medical care that they administered to the mother and the child,” the judge said.
The court further concluded that the injuries suffered by both patients were directly linked to the negligent care they received. “The court is also satisfied that there was a causal nexus between the negligence of the hospital staff and the injuries sustained.”
The judge found that the Limpopo Health Department is therefore vicariously liable for the conduct of the medical staff who treated the mother.
Damages still to be determined
The court ordered that the MEC for Health in Limpopo is liable for 100 percent of the damages suffered by the mother and her son.
The case before the court dealt only with the question of liability. The determination of the amount of compensation that must be paid to the mother and child will be decided at a later stage.
The department was also ordered to pay the plaintiffs’ legal costs for the liability trial, including the costs of expert witnesses.
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