Forth degree tear not negligent
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Recently I read an interesting article relating to clinical risks. This stated that a fourth degree tear during labour may not always be a negligent occurrence as the seriousness of the degree of tear would suggest. Clinical Risk 2014, Vol.20(6) 129-133, November 2014.
This article was a case study about a woman, who was progressing steadily in labour. At some point the foetal heart rate slowed down and a registrar was called to assess the situation. Having assessed the circumstances he decided to perform an instrumental delivery by using Neville Barnes forceps. The procedure was going well and the registrar had performed two pulls. The registrar was about to perform the episiotomy, when a contraction came and the head was born quickly, causing the fourth degree tear.
The case proceeded on liability only and it was heard at Nottingham County Court. The discussion between experts narrowed to answer the question whether the registrar should wait until the head was at the perineum before attempting to make the episiotomy cut. The hospital's guidance said to make a cut before the head reached the perineum, however the same guideline did not indicate what was and what was not a negligent practice.
The court agreed that the registrar was not negligent and the fact that the Claimant suffered such an extended tear was in fact an unfortunate event, as she had a further unexpected contraction. In this case the Bolam test applied. The registrar's plan to deliver the baby was in a line with a recognised body of professional opinion.
This case report shows that sometimes what seems to be a case with good prospects of success; can in fact, after deeper analysis, highlight an unfortunate situation where damage is caused but no compensation can be obtained.
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