- The High Court in Cape Town overturned an order holding the Western Cape health department liable for injuries a baby sustained during birth in 2010.
- The appeal judges found that the mother’s contradictory evidence did not establish that clinic staff had mishandled the obstetric emergency.
- The court ruled that poor clinical record-keeping did not, by itself, prove that the staff had provided negligent care.
A mother’s medical negligence claim against the Western Cape Department of Health has been dismissed on appeal after the Full Court found that the evidence did not establish that clinic staff had negligently managed her son’s complicated birth.
The judgment overturned an earlier order holding the department liable for 100% of the damages the mother, identified as NZ, could prove.
The baby was born at the Mitchell’s Plain Maternity and Obstetric Unit in December 2010. During delivery, his shoulders became trapped after his head had emerged, a complication known as shoulder dystocia. His body was delivered eight minutes later, and he required resuscitation, intubation and hospitalisation.
He was subsequently diagnosed with hypoxic-ischaemic encephalopathy, a form of brain injury associated with insufficient oxygen, and Erb’s palsy affecting his right arm.
Mother alleged clinic staff mishandled emergency
NZ instituted proceedings in May 2017, alleging that clinic staff had failed to recognise pregnancy-related risk factors and had mishandled the emergency during delivery.
She argued that she should have been referred to hospital for a caesarean section and that staff had failed to perform the McRoberts manoeuvre correctly. She also alleged that they had applied fundal pressure to her upper abdomen instead of suprapubic pressure, which helps release an impacted shoulder.
The department denied negligence, arguing that shoulder dystocia could not reliably have been predicted and that the delivery had progressed normally until the complication occurred. The trial judge found the department liable, concluding that staff had failed to follow appropriate procedures and that their conduct had contributed to the baby’s injuries.
However, the Full Court, comprising Judge J Cloete, Judge CN Nziweni and N Mayosi, found that the trial judge had misdirected herself when assessing the evidence.
Appeal judges question mother’s account
The appeal judges found that NZ’s evidence about what happened during the critical eight minutes was contradictory. She gave differing accounts of where pressure had been applied and struggled to recall details of the delivery more than 13 years later.
The trial judge had described her testimony as unequivocal while failing to give proper consideration to Sister Renel Faro, the senior midwife on duty at the clinic.
Although Faro had no independent recollection of the birth, she described the established procedures used to manage shoulder dystocia and her extensive experience of the emergency. Her evidence about the clinic’s routine practices had not been materially challenged.
Faro explained that the McRoberts manoeuvre was the first step in her usual procedure, followed by suprapubic pressure if necessary. She also testified that staff knew fundal pressure should never be applied. The appeal court found that this evidence should have been weighed against NZ’s recollection rather than disregarded.
Experts did not support caesarean section allegation
The judges also rejected the finding that NZ should have been referred to hospital for a caesarean section. Her own expert, obstetrician and gynaecologist Dr Charles Davis, conceded that a caesarean section had not been indicated after her admission to the clinic.
He also agreed that predicting shoulder dystocia was difficult and that maternal obesity alone did not require hospital delivery under the applicable maternity care guidelines. The department’s expert, Dr Michael Wright, similarly testified that a caesarean section was never indicated and that attempting to transfer NZ once the emergency had developed would have been hazardous.
The experts agreed that the McRoberts manoeuvre could fail even when correctly performed and that serious injuries could occur despite appropriate management. The court therefore found that the eight-minute delay did not, on its own, prove that staff had performed the manoeuvre incorrectly or negligently managed the emergency.
Poor record-keeping did not prove negligence
The absence of detailed clinical notes about the emergency was a significant concern. However, the appeal judges distinguished inadequate documentation from proof of negligent treatment. The court emphasised that NZ carried the burden of proving, on a balance of probabilities, that the clinic staff had failed to exercise the required skill and care.
Finding that the trial judge had not properly assessed the evidence as a whole, the Full Court upheld the appeal and dismissed NZ’s claim against the department, with no order as to costs.
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