The High Court awarded H.M. €87,400 in damages after finding that the Health Service Executive’s North Eastern Area failed to put procedures in place to apply guidance on diagnosing and repairing anal sphincter injuries after childbirth.
Mr Justice Charleton found that the hospital should have circulated or discussed guidelines issued in July 2001 by the Royal College of Obstetricians and Gynaecologists. They called for systematic examination after vaginal delivery and repair of anal sphincter injuries in an operating theatre under regional or general anaesthetic. The hospital introduced the guidance in 2002, but the judge found it should have been implemented before H.M. gave birth in October 2001.
The judge said the recommended examination and anaesthesia would have helped identify and repair the torn muscle ends. He found that, on the balance of probabilities, applying the guidance in 2001 would have produced a better outcome, with no compromise to the anus. Responsibility lay with hospital management and organisation, he said, rather than with the doctor who attended the birth.
H.M. had alleged that labour was accelerated with oxytocin and that the drug was not stopped soon enough, leading to forceps delivery and the injury. The court found insufficient evidence that earlier discontinuation would have avoided instrumental intervention. It concluded that forceps delivery would probably have become necessary later in labour in any event, and found no failure of ordinary care in labour management.
The judge also found insufficient evidence to establish that the episiotomy was cut too close to the midline. He rejected the HSE’s argument that H.M.’s bowel problems were caused by pudendal nerve neuropathy, finding that the anal sphincter injury was capable of causing her symptoms.
On limitation, the court found that H.M. first learned she had suffered a third degree tear at a consultation in 2006, probably in August. Her proceedings, issued on 29 May 2008, were therefore in time.
The award comprised €40,000 in general damages to date, €40,000 for the future, €2,400 in special damages and €5,000 for future psychotherapy. The judge did not consider vagal nerve stimulation therapy a probable future need.