Montgomery v Lanarkshire Health Board and the Rights of the Reasonable Patient
| Date | 01 September 2015 |
| DOI | 10.3366/elr.2015.0295 |
| Pages | 360-366 |
| Published date | 01 September 2015 |
| Author |
Mrs Montgomery was seeking damages from the Health Board on behalf of her son, Sam, in respect of injuries he sustained at birth on 1 October 1999 at Bellshill Hospital in Lanarkshire. Sam was Mrs Montgomery's first baby, and she had been identified during pregnancy as being at risk because she was diabetic and not very tall. Diabetic mothers are more likely to have large babies, with weight concentrated in particular around the shoulders. They are therefore vulnerable to a difficult labour and to a 9–10% risk of shoulder dystocia, whereby the baby's head can be delivered, but the shoulders cannot pass through the pelvis. Although shoulder dystocia presents an emergency that may be distressing for the mother, it is almost always managed without significant injury to mother or baby. However, there is a concomitant 0.2% risk of damage to the brachial plexus – the nerve root that connects the baby's arm to the spinal cord; there is an even smaller risk of around 0.1% that the umbilical cord becomes trapped, causing hypoxia which can result in cerebral palsy or the baby's death. In this case shoulder dystocia occurred at the end of an arduous vaginal delivery, and both risks came to fruition. Injury to the brachial plexus resulted in paralysis of Sam's arm, and the umbilical cord became trapped, depriving him of oxygen, so that he was clinically dead at birth. Sam was resuscitated, but suffered renal damage and epileptic seizures, and cerebral palsy affected all four limbs.
Mrs Montgomery's pregnancy had been closely monitored at a combined obstetric and diabetic clinic, under the supervision of her consultant obstetrician, Dr McLellan. By the thirty-sixth week it became apparent that the baby's estimated weight placed him within the ninety-fifth centile, and from at least that time Mrs Montgomery had questioned Dr McLellan about the prospects of being able to deliver such a large baby naturally. Dr McLellan responded by reassuring Mrs Montgomery that vaginal delivery should be possible, but that if difficulties were encountered during labour then they might resort to caesarean section. She did not tell her of the chance of shoulder dystocia and associated risks. Dr McLellan testified that Mrs Montgomery had not asked her about particular risks and that, had she been so questioned, she would have informed her about these specific possibilities. However, it was not her practice to volunteer such information when a patient was expressing more general concerns because:
Noted at para 14.
if you were to mention shoulder dystocia to every [diabetic] patient, if you were to mention to any mother who faces labour that there is a very small risk of the baby dying in labour, then everyone would ask for a caesarean section, and it's not in the maternal interests for women to have caesarean sections.
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