Spencer v NHS North West

A midwife’s conduct is judged by the standard of a reasonably competent midwife performing the relevant functions in the post-natal ward of a district general hospital. The question is whether the conduct fell below that standard in the circumstances known, or reasonably available, to the midwife. A newborn’s intermittent crying or unsettled behaviour does not, without more, require examination for infection or referral to a paediatrician where the child settles promptly and presents no other concerning signs. A proven opportunity to prevent injury does not establish negligence without breach of duty. The claim therefore fails where the alleged delay was within the range of competent midwifery practice.

The claimant, Ashley Spencer, suffered severe disability after developing early-onset Group B streptococcal septicaemia and meningitis shortly after birth at the Royal Oldham Hospital. She alleged that the defendant’s midwifery staff negligently failed to recognise signs of infection at about 00.30 on 6 August 1994 and failed to call a paediatrician.

The central issues were Ashley’s condition and history as reasonably known to the midwife, whether a reasonably competent midwife should have sought paediatric review, and whether earlier treatment would have avoided the neurological injury.

The claim was dismissed.

1. The appropriate standard was that of a reasonably competent midwife carrying out the functions expected on the post-natal ward of a district general hospital, applying Bolitho v City & Hackney Health Authority [1998] AC 232.
2. The midwife’s 23.00 examination was properly carried out and disclosed no raised respiratory rate or other clear sign of infection. The evidence did not establish that he knew, or ought reasonably to have known, the alleged maternal risk factors.
3. At 00.30 Ashley’s cry was within the normal range. Her unsettled behaviour was not equivalent to irritability or evidence that she was going off. She settled almost immediately after being swaddled and placed with her mother. On those findings, there was no reason for a reasonably competent midwife to suspect infection, undertake a further examination or call a paediatrician.
4. If a paediatrician had been called, the history would probably have led to precautionary antibiotic treatment. The court also found that treatment at that stage would, on the balance of probabilities, have avoided the neurological injury.
5. Those causation findings did not establish liability. The claimant had failed to prove that the midwife’s conduct fell below the required standard. The illness was preventable, but it was not caused by negligence.

not stated in the judgment.