Guidelines for obstetric cases

Update to main text para 10.20, page 324

Re CA (Natural Delivery or Caesarean Section) [2016] EWCOP 51, 8.12.2016

In another application made very late in the pregnancy, Baker J lamented the applicant Trust’s failure to follow the FG guidelines which meant there was very limited time for the Official Solicitor to make proper enquiries on behalf of the woman concerned. Even though the application was made less than a fortnight before CA was due to give birth, the Judge refused the immediate order sought, and instead granted a four day adjournment to enable the Official Solicitor to visit CA and carry out some limited investigations. He expressed the hope that those responsible for managing the case within the Trust would carry out a proper investigation as to the causes of the delay, and went on: “Hereafter, all NHS Trusts must ensure that their clinicians, administrators and lawyers are fully aware of, and comply with, the important guidance given by Keehan J in respect of applications of this sort.” The Judge was also unhappy that CA’s medical records were not available to the Court.

CA had suffered previous abdominal cutting (said to be possibly ‘tribal’) which meant that for her, a forcible C section might be particularly traumatic; however, she was also thought to have suffered genital mutilation, which meant that vaginal delivery carried additional risk.  At the final hearing The Trust provided “a detailed plan for the use of procedures for controlling and restraining CA as necessary during the delivery, incorporating an assessment prior to the use of restraint; the use of medical or chemicals sedation if CA became extremely restless or agitated or frightened, both before and after the operation; the use of physical restraint by trained personnel if, as a last resort, in exceptional circumstances and if so directed by the clinical lead, it proved necessary to restrain her in order to prevent from causing immediate harm to herself or others; the full preparation of staff to ensure that any use of restraint is fully documented and accounted for; and that clinical staff monitored vital signs at all times.” The application was ultimately granted.