Pregnancy can sometimes be fraught with difficulty and does not continue to term. It is a devastating time for the parents of the unborn child and often unexpected. One such event is that of stillbirth.
A stillbirth happens when a baby dies in utero and is born dead after 24 weeks of pregnancy. If this event happens prior to the 24 week period it is known as a miscarriage or late foetal loss.
Causes of Stillbirth
These may be related to:
• Problems with the placenta
• Bleeding before or at the time of labour
• Pre – eclampsia ( this causes high blood pressure during the pregnancy)
• Cord prolapse (umbilical cord wraps around the baby’s neck or exits the womb prematurely)
• Obstetric cholestasis/intrahepatic cholestasis
• Maternal diabetes
• Genetic defect
• Multiple pregnancy
• Restricted growth in utero
• Maternal Age
• Maternal drug; alcohol abuse
• Maternal smoking
• Eating uncooked meat or poultry or foods that are not to be eaten during pregnancy
Antenatal checks will be made at various times during the pregnancy and these antenatal appointments will be carefully organised. At each antenatal appointment, a midwife will carry out various tests and investigations to check the mother’s health and to ensure that the pregnancy is going to plan. Blood tests are carried out at some of these antenatal appointments, blood pressure, weight are checked and urine samples are tested. The girth of the abdomen is also checked to ensure that the baby is growing as it should.
It is usual during a woman’s first pregnancy to have up to 10 antenatal appointments. If it is not the woman’s first pregnancy she will have 7 antenatal appointments.
Scans will be carried out at between 8 – 14 weeks of the pregnancy to checking the estimated date of delivery of the baby. Further scans are carried out between 18 – 21 weeks to check the physical development of the baby but it cannot pick up every condition. It can estimate the size of the baby and if any conditions are found at the time of this scan then a further scan can be organised.
Other than that, the only other checks made during the antenatal period to ensure the baby is healthy is if the mother notices any changes during her pregnancy, such as reduced fetal movements after 24 weeks, vaginal bleeding, ongoing headaches, dizziness or vomiting and it is for her to alert her GP or midwife to any concerns that could relate to stillbirth. If a baby is smaller than it should be or stops growing at any point of the pregnancy this should be a significant finding as well.
Potential Stillbirth Claims
If these issues are raised by the mother and no action is taken by the midwife, GP or hospital and a stillbirth occurs that could have been prevented then there is potential for a stillbirth claim to be instigated by the mother.
Stillbirth claims can be harrowing and the parents of the stillborn child will have to relive the events leading up to and at the time of the stillbirth again. It is very traumatising and yet it is something that sometimes needs to be done so that further information can be gleaned about why the event happened. An investigation may be carried out by the NHS trust where the stillbirth occurred and answers to parental concerns will be sought.
Negligent Medical Care
If it can be shown that the stillbirth occurred due to negligent medical care then a claim can be investigated and pursued. Any claim must be pursued within 3 years of the date of the stillbirth. Claims outside this timeframe will be statute barred.
It is always prudent to pursue stillbirth claims as soon as possible after the negligent medical care as the medical records, doctors records, nursing records and other relevant records will be more difficult to trace the longer it is since the events, especially if the treating doctor has retired or moved hospital. This also makes it harder for the Defendant to obtain witness evidence and may make it difficult for the case to be pursued.
At Osbornes Law we have acted for many families, in clinical negligence obstetric/antenatal claims and stillbirth claims. It can often be very stressful for the parents of a stillborn baby to cope with the aftermath of the injury and to deal with the litigation at the same time as dealing with day to day issues such as caring for other children they have, and taking the decision to become pregnant again.
Cases involving the death of a baby can be devastating and we recognise the need to provide support and empathy as well as straightforward and sensible legal advice at such a time. We are very experienced in dealing with these types of stillbirth claims.
Healthcare Safety Investigation Branch
In addition to NHS complaints procedure and the civil litigation, there is HSIB. (https://www.hsib.org.uk/)
Basically if a complaint is investigated and a Serious Untoward incident/Root Cause Analysis investigation is started. The hospital trust can refer the matter to the HSIB for them to investigate and then the HSIB will take about 6 months to investigate the incident and report back to the NHS Trust. Their purpose is to improve patient safety and provide an effective and independent investigation that does not apportion blame or liability. The make independent judgements and are funded by the DOH & Social Care and hosted by NHS England and NHS improvement.
An investigation is started when they receive a notification via a safety awareness form and only applies to incidents after 1 April 2017 that occur in England and are within NHS funded care. They look at:
The area we look into is the impact on both people and services. This is to make sure that we’re focusing on those safety issues that are having or have had the most serious impact. We’ll look at the physical and emotional impact on patients, family members, carers or members of staff. In terms of services, we look how difficult the issue/s are making it to deliver safe and reliable care. We also take the wider view and public perception. We consider whether there is evidence that there has been a broader loss of confidence in that area of healthcare.
We always look at the wider system risk associated to the safety issues – effectively how common or widespread is it, and does it span different areas of healthcare and different locations. Some of the areas we consider include:
• do various care settings or organisations have to change the way they work in order to address a safety issue
• have the issues taken a while to be recognised and are they recognised at the right level
• has the issue existed over a long period time, and are concerns about that issue consistently raised
• will it get worse or spread into different areas of the system if not addressed
We aim to put learning at the heart of everything we do. HSIB wants to drive positive change to improve patient safety and part of that is being able to clearly show that our investigations will produce new information about safety issues. We always look at whether we have a new perspective so that we can develop meaningful, influential and effective recommendations that benefit all of those working in or being cared for by the health service’.
The HSIB involve the family in their investigation as well as the investigative team and the NHS staff involved with the patient care as well as carers.
From 1 April 2018, HSIB became responsible for all patient safety investigations of maternity incidents occurring in the NHS which meet criteria for the Each Baby Counts programme.
In September 2017, the Government published the Health Service Safety Investigations Bill (HSSIB) in draft. The legislation will allow HSIB to become a fully independent investigations body responsible for finding answers, giving safety recommendations and embedding new practices across the NHS. The HSIB bill was mentioned in the Queens Speech on 14 October 2019. A step closer to independence.
All reports are published on the HSIB website and sent to the NHS trust and family and it will contain safety recommendations.
If you have concerns relating to the antenatal or obstetric care you received or your baby has received. We are here to help whatever the issue may be. For a confidential discussion call 0207 485 8811 and ask for Stephanie Prior or Nicholas Leahy.
Stillbirth Claims & Our Promise to You
• We will review your stillbirth claim potential by advising you on the NHS complaints procedure or other alternative procedures if your case does not relate to NHS care and treatment.
• We will not charge a fee for our time in reviewing your case.
• We can assist you with any issues that you may have regarding the complaints procedure or that you encounter in obtaining copies of your medical records.
• We will advise you of the best course of action in respect of your case.