Standard of Care in Birth Injury Cases

Conclusion

Proving that a birth injury was the result of medical negligence requires careful examination of the medical records and an understanding of what the medical records cannot and will not show. Successfully bringing a claim of medical negligence may also require detailed discussion with medical experts about the strengths and limitations of guidelines relevant to the care provided. Patient factors may also impact upon the standard of care and, specifically, whether informed consent was obtained when a decision is made to intervene or not in labour. Ultimately, the unique nature of labour and delivery creates considerable uncertainty for malpractice lawyers, even where guidelines and the medical records suggest that the healthcare professional failed to meet the standard of care.

1. Miller, Robert D., Slater v. Baker and Stapleton (C.B. 1767): Unpublished Monographs by Robert D. Miller (Madison WI: By Author 2019), Monograph #3 – Page 19 of 21
2. Ibid, Monograph #3 – Page 2 of 21
3. Ibid, Monograph #4 – Page 8 of 22
4. Ibid, Mongraph #13 – Page 13 of 57.
5. Medina v. Wong, 2018 BCSC 292, para 107
6. See for instance, https://kidshealth.org/en/parents/natural-childbirth.html
7. Beck CT, Watson S, Gable RK. Traumatic Childbirth and Its Aftermath: Is There Anything Positive? The Journal of perinatal education. 2018;27:175-184.
8. Çalik, K.Y., Karabulutlu, Ö. & Yavuz, C. First do no harm – interventions during labor and maternal satisfaction: a descriptive cross-sectional study. BMC Pregnancy Childbirth 18, 415 (2018).
9. Saraswathi Vedam et al., “The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States,” Reproductive Health 16, (June 2019),
10. Institute of Medicine, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, (Washington, DC: Institute of Medicine, March 2002), and Elizabeth A. Howell et al., “Race and Ethnicity, Medical Insurance, and Within-Hospital Severe Maternal Morbidity Disparities,” Obstetrics & Gynecology 135, no. 2 (February 2020): 285-293.
11. Oribhabor GI, Nelson ML, Buchanan-Peart KR, Cancarevic I. A Mother’s Cry: A Race to Eliminate the Influence of Racial Disparities on Maternal Morbidity and Mortality Rates Among Black Women in America. Cureus. 2020 Jul 15;12(7):e9207.
12. Braveman P. What are health disparities and health equity? We need to be clear. Public Health Reports. 2014;129(1_suppl2):5–8.
13. Geller SE, PhD, Koch AR, MA, Martin NJ, AA, Rosenberg D, PhD, Bigger HR, MD, Illinois Department of Public Health Maternal Mortality Review Committee Working Group. Assessing preventability of maternal mortality in Illinois: 2002-2012. American journal of obstetrics and gynecology. 014;211:698
14. Para 1
15. Ediger (Guardian ad litem of) v. Johnston, 2013 SCC 18, para 4
16. Ibid, paras 4 and 6
17. Ibid, para 16
18. Ibid, para 42
19. Ibid, para 44
20. Ibid, para 49
21. Ibid, para 17
22. Ediger (Guardian ad litem of) v. Johnston, 2011 BCCA 253, para 52.
23. Supra, note 15, para 17
24. Lothian JA. Choice, Autonomy, and Childbirth Education. The Journal of perinatal education. 2008;17:35-38.
25. Supra, note 1, Monograph #1 – Page 3 of 8
26. Goldberg HB, Shorten A. Patient and provider perceptions of decision making about use of epidural analgesia during childbirth: a thematic analysis. J Perinat Educ. 2014 Summer;23(3):142-50.
27. Heath, N. We need to change the way we deal with informed consent during childbirth. Voices. 27 Aug 2021. Available online via https://www.sbs.com.au/topics/voices/health/article/2019/07/11/we-need-change-way-we-deal-informed-consent-during-childbirth
28. Kotaska A, Informed consent and refusal in obstetrics: A practical ethical guide. Birth Issues in Perinatal Care. 7 March 2017. Vol 44(3): 195-199
29. Brodeur (Litigation guardian of) v. Provincial Health Services Authority, 2016 BCSC 968, para 1
30. Ibid, para 18
31. Ibid, para 20
32. Ibid, para 42
33. Ibid, para 45
34. Ibid, para 44
35. Ibid, para 87
36. Ibid, paras 45 and 92
37. Ibid, para 95
38. Supra, note 16, para 55
39. Ibid, para 58
40. No. 376-Magnesium Sulphate for Fetal Neuroprotection
41. Canadian Institute for Health Information. Caesarean Section Rate [indicator]. Accessed October 27, 2022
42. Rahim A, Lock G, Cotzias C, Incidence of second-stage (fully dilated) caesarean sections and how to best represent it: A multicentre analysis. International Journal of Gynecology & Obstetrics, 2022: 156(1): 119-123.
43. Murphy DJ, Liebling RE, Patel R, Verity L, Swingler R. Cohort study of operative delivery in the second stage of labour and standard of obstetric care. BJOG. 2003;110:610-615.
44. Medina v. Wong, 2018 BCSC 292, para 81
45. Ibid, paras 208, 209, 216, and 219
46. Ibid, para 187
47. Ibid, para 272
48. Ibid, paras 162 and 165
49. For a more fulsome discussion of “two schools of thought” see Donaldson, A. Defences to a Medical Malpractice Claim – Navigating the Minefield, The Verdict, Fall 2020, Issue 161: 28-22.
50. Ibid, para 97
51. Ibid, para 272
52. Ibid, para 241
53. Ibid, para 99
54. Ibid, para 272