AM against Lothian Health Board
| Jurisdiction | Scotland |
| Court | Court of Session |
| Judge | Lady Hood |
| Judgment Date | 30 April 2026 |
| Neutral Citation | [2026] CSOH 42 |
| Date | 30 April 2026 |
| Published date | 30 April 2026 |
| Docket Number | A114/18 |
OUTER HOUSE, COURT OF SESSION
[2026] CSOH 42
A114/18
OPINION OF LADY HOOD
In the cause
AM
Pursuer
against
LOTHIAN HEALTH BOARD
Defender
Pursuer: Smart KC, Swanney; Anderson Strathern LLP
Defender: Doherty KC, E Campbell; NHS Central Legal Office
30 April 2026
Introduction
[1] On 11 September 2010, at the Royal Inrmary of Edinburgh (RIE), the pursuer gave
birth to her son, who I shall refer to as L. The RIE is under the defenders’ management.
When L was born, the umbilical cord was wrapped around his neck. The pursuer’s case
against the defenders is that shortcomings in their care caused the medical diculties from
which L now suers. The pursuer brings this case on L’s behalf.
[2] It had been determined that a proof before answer should be held, limited to the
issue of whether the defenders were in breach of their duties to the pursuer, with issues of
causation and quantication of loss considered at a later date if necessary. Evidence was led
2
over 11 days, with submissions then delivered at a later date (and supported by wrien
submissions, prepared by each side in advance).
Agreed or uncontroversial facts
[3] The pleadings, in the normal way, reect the extent of agreement and dispute
between the parties. In addition, parties helpfully entered into a number of Joint Minutes, as
well as preparing an agreed Chronology of Events, a Glossary of Terms, and a Summary of
the Background Facts and Issues. Parties were agreed that the copy medical records lodged
were what they bore to be, and that copy productions should be treated as equivalent to
principals. The uncontroversial factual maers may be summarised as follows.
[4] On 10 September 2010, the pursuer contacted the midwifery team at the RIE, and
told them that she suspected that her waters had broken. She was advised to put on a
maternity pad, and to telephone later with an update. The pursuer did telephone again, and
reported that her pad was soaked through: she was advised to aend the hospital. The
pursuer did so, and arrived at the hospital that evening, with her arrival time at maternity
triage recorded as 2335 hours. The pursuer was assessed by Midwife Beth Turner at or
around 0215 hours on 11 September 2010. The pursuer was 40 weeks pregnant.
Midwife Turner saw evidence of meconium on the maternity pad, which she recorded as
“meconium light”. Cardiotocograph (CTG) tracing of the fetal heart rate and maternal
contractions was commenced by Midwife Turner at around 0220 hours. At 0245 hours,
Midwife Turner noted that the CTG was non-reassuring, noting the presence of reduced
variability and late decelerations. At 0255 hours, Midwife Turner arranged for the pursuer
to be transferred to the labour ward for continuous monitoring and obstetric review.
3
[5] After the pursuer’s transfer to the labour ward, the CTG was re-commenced at
around 0315 hours. The trace was reviewed by Dr Rajive Joy at 0321 hours, and he decided
that close monitoring of the CTG should continue. At 0348 hours Midwife Margaret
McMahon noted that the CTG was unreassuring, with reduced variability, few accelerations
and one deceleration: she noted that she would ask for a review. At 0410 hours the trace
was reviewed by Dr Sarah Martins da Silva, Senior Registrar. She noted that there was
acceptable variability, no real accelerations, and “2 x?late unprovoked decelerations”. The
baseline heart rate was normal. Dr Martins da Silva carried out a vaginal examination, and
the fetal heart accelerated in response. The pursuer’s cervix was 3 cm dilated. A plan was
made to commence the pursuer on syntocinon to advance labour, and to continue to monitor
the CTG. It was noted that the pursuer had been made aware that a caesarean section might
prove to be necessary if the CTG was unreassuring and she was still in early labour. At
0455 hours Midwife McMahon noted that the pursuer’s position in the bed had been
changed. Midwife McMahon observed that variability was reduced, and some accelerations
were present, but that there had been no further decelerations. Because of high activity in
the labour ward, it was decided that the commencement of syntocin should be delayed.
Reduced variability on the CTG caused Midwife McMahon to ask for a review, and Dr Joy
reviewed the CTG at 0532 hours. He concluded that close monitoring of the CTG should
continue, and recommended that there should be a position change, and iced water or ice
cubes should be given. This was actioned. At 0546 hours, Dr Joy again reviewed the CTG.
His overall impression was that the CTG was satisfactory, and he decided to continue with
the plan in place. Midwife Sally Haldane took over the pursuer’s midwifery care at
0605 hours, and at 0610 hours syntocinon was commenced. At 0638 hours, Midwife Haldane
recorded a late deceleration, a brief recovery, then bradycardia. Syntocinon was stopped,
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