MC v Birmingham Women's NHS Foundation Trust

Informed consent requires a patient-centred discussion of material risks and reasonable alternatives. Materiality is fact-sensitive and depends on the particular patient, the nature and consequences of the risk, the benefits sought, and available alternatives. A claimant alleging inadequate consent must also prove that, with proper information, the treatment would have been declined. In clinical negligence, the standard is that of the reasonably competent practitioner exercising the relevant skill. National and local clinical guidelines may provide a safe starting point, but their application remains subject to clinical judgment. A claim fails where the alleged departure from reasonable practice or the causal link between breach and injury is not proved on the balance of probabilities.

The first claimant, M, underwent induction of labour at Birmingham Women’s Hospital and later gave birth to J, who suffered cerebral palsy following oxygen deprivation. M suffered a severe postpartum haemorrhage and underwent an emergency hysterectomy. They claimed damages from the defendant NHS foundation trust, alleging inadequate advice about induction and negligent care during labour.

The court considered whether M gave informed consent, whether the care after induction fell below the required standard, and whether any breach caused the injuries. The claim was tried at first instance before Mr Justice Turner.

1. The court applied the approach in Montgomery v Lanarkshire Health Board [2015] 2 WLR 768. A doctor must take reasonable care to ensure that the patient understands material risks and reasonable alternatives. The assessment is fact-sensitive and requires comprehensible dialogue. Even if the information given had been inadequate, the claimants had to prove that M would probably have refused induction. They failed to do so.

2. The court accepted that the clinical negligence standard described in Sardar v NHS Commissioning Board [2014] EWHC 38 applied. The relevant question was whether the doctors and midwives acted within the range of reasonable practice expected of competent practitioners exercising the relevant skill.

3. The national and local guidance provided a sound basis for assessing the care. The court rejected the contention that continuous cardiotocography was required from the outset. Under the applicable guidance, a low-risk induction required continuous monitoring when labour became established, defined as regular painful contractions with progressive cervical dilatation from 4 cm. The evidence did not establish that labour had become established before the vaginal examination at about 05.00.

4. Midwife Smith was entitled to exercise clinical judgment within the guidance. The delay in performing a further vaginal examination was reasonable, particularly because M resisted examination, the previous examination had been recent, and the earlier findings did not indicate rapid progress. The defendant therefore did not breach its duty in the care provided after induction.

5. The causation claims also failed. The likely cervical dilatation at 02.05 was speculative. The court could not determine on the balance of probabilities whether earlier monitoring would have detected the relevant abnormality or whether earlier transfer would have avoided the injuries.

6. The claims of both M and J failed on breach of duty and causation.

First-instance judgment. No earlier or appellate decision is stated in the judgment.