The High Court dismissed a negligence action brought by Sophie Everard, a minor suing through her mother, Lisa Everard, over a brachial plexus injury identified after her birth at Our Lady of Lourdes Hospital in Drogheda in January 2011.
The claim against the Health Service Executive alleged that excessive traction was applied to the baby’s head after shoulder dystocia arose during delivery. It also alleged that staff failed to follow the hospital’s shoulder dystocia procedures and that the registrar was inadequately supervised. The HSE denied that shoulder dystocia had been diagnosed as alleged and disputed that the delivery caused the injury.
The court heard that the baby was delivered by vacuum at 10.43am on 23 January 2011. Her head had been delivered two minutes earlier. Staff placed the mother in the McRoberts position as a precaution; the judge found that suprapubic pressure was not applied and that no shoulder dystocia emergency was called. The baby was later found to have limited movement in her left arm. A paediatric neurologist confirmed brachial plexus palsy with weakness of the left elbow.
The plaintiff’s experts considered that shoulder dystocia had occurred and that excessive traction caused the injury. The defence experts disputed that account and said brachial plexus injuries can also result from maternal pushing forces, including without a clinically recognised shoulder dystocia. The medical notes recorded that the baby was delivered “with pulling the head”, but the judge said that wording alone did not establish excessive traction, as “pulling” had also been used to describe traction in maternity practice.
The judge found that the description “very tight around the perineum” did not establish shoulder dystocia requiring the emergency protocol. He accepted that precautionary use of the McRoberts position was not uncommon and that waiting for the next contraction before delivery was appropriate. He also found that abdominal palpation could reliably indicate which side of the mother the baby’s back was on, but did not establish the position of the baby’s head or which shoulder was anterior at delivery.
The judge said he could not rule out that the doctor had failed to identify shoulder dystocia and used improper traction. However, he rejected the claim that excessive traction was the only reasonable cause of the injury. He considered other causes possible and found injury when the left shoulder was posterior in the womb more likely. Applying the balance of probabilities, he dismissed the action.