The High Court has dismissed a negligence claim brought by a woman who said an artificial rupture of membranes during her labour at Kerry General Hospital caused a frightening emergency and later psychiatric illness.
In a judgment delivered on 31 July 2014, Mr Justice Ryan found that midwife Claire Kelliher acted in accordance with good medical practice when she performed the procedure. The court accepted that she had examined the baby’s position, judged its head to be fixed and obtained the woman’s consent. The judge also found that the midwife responded competently after discovering the cord prolapse.
The woman’s experts argued that there was no clinical reason to perform the procedure, that the baby’s head was not safely fixed, and that the midwife should have sought an obstetrician’s advice. They said rupturing the membranes in the ward exposed the baby to an avoidable risk of cord prolapse. The defendant’s experts said the afternoon heart trace was not reassuring and that the midwife reasonably sought to check for signs of fetal distress.
The judge considered the competing expert evidence under the legal test in Dunne v National Maternity Hospital. He found that Irish practice allowed a qualified midwife to perform the procedure and that it was ordinarily carried out in or near the labour ward, rather than the operating theatre. He accepted the defendant’s experts’ evidence that the baby’s head was not mobile, despite its recorded station of -2, and found that the midwife was entitled and qualified to make the decision.
The procedure was followed by a cord prolapse. Staff raised the alarm, held the baby’s head away from the cord and moved the woman to theatre for an emergency caesarean section. The baby was born in good condition. The judge said the prolapse was a rare but known complication and did not, by itself, prove that the procedure had been negligent.
The judgment records disagreement between psychiatric experts about the cause and diagnosis of the woman’s depression and whether she had post-traumatic stress disorder. The court’s conclusion on liability was that the midwife and hospital were not negligent. It dismissed the claim.