The Royal College of Gynaecologists (RCOG) have released new guidelines in relation to assisted vaginal birth. The guidelines provide further clarity and guidance for practitioners on the use of forceps and vacuum extraction for vaginal births.

Some of the new guidelines include;

  1. Organising an ultrasound assessment prior to any assisted vaginal birth where uncertainty exists following clinical examination about the baby’s position;
  2. Informing women that epidural analgesia may increase the need for assisted vaginal birth;
  3. Ensuring written consent is obtained for a trial of assisted vaginal birth in the operating theatre;
  4. Informing women of the high probability of a spontaneous vaginal birth in subsequent labours following an assisted vaginal birth

It is clear from the Guidelines set out above that one of the key messages to practitioners is the need to ensure open communication with patients and ensure valid consent is obtained. The RCOG recognise that the consenting process requires good communication and shared decision making alongside continuous support for expectant mothers.

We hope these new guidelines will improve patient treatment and reduce the number of complaints, but as at present, there still remains issues surrounding consent and communication as we continue to be instructed on a variety of claims including obstetric claims.

Freeths recently acted on behalf of a mother whose requests for a caesarean section - in light of her concerns about the welfare of her baby - were ignored despite her training as a paediatric intensive care nurse. Expert evidence from an Obstetrician was clear that in the context the mother's past professional experience, her numerous requests for a caesarean section at an earlier stage should have been accepted.

The importance of patient autonomy is also clear from the Judgment in the case of Montgomery v Lanarkshire Health Board 2015 which quoted guidance from the General Medical Council;

' approach based on the informed involvement of the patients in their treatment, rather than their being passive and potentially reluctant regarded as an integral aspect of professionalism in treatment'.

The landmark case of Webster v Burton Hospitals NHS Foundation Trust 2017  further illustrates the need for open communication and the issues surrounding consent. Freeths acted on behalf of the patient. The Court of Appeal held that the obstetrician had been negligent in failing to discuss with the patient’s mother the presence of excessive fluid in the womb and the patient’s restricted growth. There was a risk that these findings could cause harm. The Court of Appeal held that the patient’s mother should have been advised of the risks, even though there was evidence to suggest that the risk of harm was small. The Court of Appeal concluded that had the mother been made aware, she would have asked for an earlier delivery and the patient would have avoided harm, which has resulted in the patient requiring lifelong care and assistance.

For further information about the RCOG Guidelines on assisted vaginal birth, please see the RCOG’s website;

Our specialist medical negligence solicitors have vast experience in supporting patients with claims arising from the malpractice of practitioners. If you are concerned about any treatment which you or a loved one have received, please contact our team:-

Karen Reynolds, Partner (Derby/Stoke on Trent/Birmingham) on 0845 274 6830

Carolyn Lowe, Partner (Oxford/Milton Keynes) 0186 578 1019

Jane Williams, Partner (Leicester/Nottingham) on 0845 272 5724

Although we are, for the time being, not able to meet clients in person, our specialist clinical negligence team at Freeths is here to support and advise clients. We are available for meetings and consultations via telephone, email, FaceTime, WhatsApp, Skype and any other digital platform that works for you.

If you or anyone else you know is in need of support and guidance relating to clinical negligence matters, then do get in touch by phone or email.

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