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Medical Negligence Case Study

Traumatic delivery resulting in Grade 4 perineal tear

A – v – Norfolk and Norwich University Hospital NHS Foundation Trust

This claim was managed by David Gabell (specialist medical negligence solicitor at Fosters).

The Claimant, aged 33 at the time, suffered a fourth-degree perineal tear during the birth of her first child in April 2018.

She had been admitted for a caesarean section. However, due to the deteriorating condition of the baby, an emergency forceps delivery ensued.

The obstetric clinician attempted to make an episiotomy incision, however the specialist episiotomy scissors used were blunt. As a result, an incomplete incision was made, and the Claimant suffered a fourth-degree (maximum severity) perineal tear. This required specialist surgical repair following the birth.

The injury caused considerable pain and suffering and left the Claimant with an ongoing deficit in anal/sphincter strength and tone. This meant she had ongoing issues with flatus incontinence and urgency with bowel movements. Thankfully she made a very good recovery (somewhat atypical given the nature of her injury) and did not suffer any long-term physiological damage.

She also suffered psychologically as a result of her ordeal, with features of PTSD and depression requiring therapy. Her marriage has also suffered considerable strain due to the impact of the injury on intimacy with her husband.

The primary allegation of negligence in this claim was that the Trust had failed to comply with the manufacturer’s guidelines to ensure the scissors were sharpened at specific intervals. As a result of that failure, when the scissors came to be used on the Claimant, they did not cleanly slice the skin, meaning an uncontrolled perineal tear occurred.

The Trust accepted liability following service of the Letter of Claim, but initially denied causation – arguing that the efficacy of episiotomies was debatable and that the tear would have occurred in any event. On behalf of the Claimant, David obtained expert causation evidence from an independent Consultant Obstetrician. The expert was able to confirm that, on the balance of probabilities, an appropriately administered episiotomy would have significantly reduced the risk of a perineal tear. This resulted in the Defendant conceding causation and settlement negotiations ensued.

The claim was settled out of court for the sum of £75,000.00.

A word from the client:

“David was a pleasure to deal with – very professional, patient and understanding on a sensitive and long case. I was kept updated at every stage and would highly recommend him.”

This article was produced on the 11th December 2019 by our Medical Negligence & Inquests team for information purposes only and should not be construed or relied upon as specific legal advice.