ML (A Child) v Guy's And St Thomas' National Healthcare Foundation Trust

A request for caesarean section made by a woman in extreme labour pain must be understood in its clinical context. The appropriate response may be to address the pain and then review whether the request persists, rather than immediately treating it as a fully considered choice requiring a detailed comparison of delivery methods.

Where fetal heart-rate abnormalities prompt fetal blood sampling, a normal result is a strong indication that the existing management may continue, provided monitoring continues and further sampling is undertaken when indicated. Earlier abnormalities, thick meconium and cord compression do not, without more, require discussion of caesarean section where the labour is progressing and fetal wellbeing is reassuring.

ML suffered severe brain injury following an acute hypoxic-ischaemic episode shortly before his delivery by emergency caesarean section. The claim was brought against the defendant healthcare trust for damages arising from the circumstances of his birth.

At trial, the claimant abandoned allegations concerning the response to the terminal bradycardia and delay in obtaining an operating theatre. The defendant conceded that an earlier caesarean section would have avoided the bradycardia and injury. The remaining issue was whether ML’s mother requested a caesarean section during labour and, if so, whether failing to accede to that request constituted a breach of duty.

1. The claim was dismissed. The court found that the mother’s remark requesting that the baby be delivered by caesarean section was motivated exclusively by extreme labour pain. It was not a considered request arising from concern about fetal wellbeing.
2. A request for caesarean section during extreme labour pain differs qualitatively from an antenatal request. The appropriate clinical response is to address the pain and then review whether the request persists. It would be irresponsible to attempt a full risks-and-benefits discussion with a woman who is not thinking coherently because of severe pain.
3. The court preferred the defendant’s obstetric evidence. CTG abnormalities and thick meconium were poor predictors of the later acute cord occlusion. A fetal blood sample provided a more definitive assessment of fetal wellbeing. The normal results at 10.50, together with good cervical dilatation and descent, justified continuing the existing management while maintaining monitoring and taking further samples when indicated.
4. There was therefore no obligation, before the terminal bradycardia, to raise caesarean section because of fetal-wellbeing concerns. The hospital’s decision-making was consistent with normal obstetric practice and the claimant failed to establish breach of duty.
5. The decision in Tasmin v Barts Health NHS Trust [2015] EWHC 3135 (QB) was treated as materially distinguishable because the present case involved a completed fetal blood sample with reassuring results and substantially more advanced labour.