The High Court has found the National Maternity Hospital liable for failing to detect a significant anal sphincter tear after Sophie Warnock’s forceps delivery in 2004. The court found that careful examination at the time should have revealed the injury, allowing prompt treatment.
President of the High Court Kearns delivered judgment on 12 January 2010 in a claim arising from the birth of Warnock’s first child at the hospital on 20 July 2004. The parties agreed that liability would be decided first, with damages left for later.
The injury occurred during a forceps delivery after an attempted ventouse delivery. Warnock’s case included allegations that excessive traction caused the tear and that the hospital should have chosen a different delivery approach, including a caesarean section. The hospital disputed negligence. Dr Sharon Sheehan, then a specialist registrar, said she used no excessive force and examined Warnock twice after the birth, finding no defect.
The judge rejected the allegation of excessive traction, finding that the delivery was achieved after two contractions and that the evidence did not establish that excessive force had been used. He also found Dr Sheehan sufficiently experienced to decide on and carry out the sequential instrumental delivery. The court rejected the claims that she should have used a trial delivery in theatre or that the hospital’s practices fell below an appropriate standard. It also found that choosing an instrumental delivery rather than a caesarean section was within reasonable professional discretion in the circumstances, given the risks of an emergency caesarean late in labour.
The court accepted the plaintiff’s evidence on whether the tear should have been detected. It found the injury was at the front of the anal sphincter and was not “occult”, or undiscoverable. The episiotomy provided an opportunity for a more effective bidigital examination, and the judge concluded that a careful examination would or should have revealed the external sphincter tear. Discovery of that injury should also have alerted the doctor to damage to the internal sphincter.
The judge found that the failure to diagnose and promptly treat both injuries breached the hospital’s duty of care. He did not find that a visual inspection would necessarily have revealed the damage. The ruling concerned liability for the failure to detect and treat the injury; the court said it would proceed to assess damages.