Claim
The plaintiff alleged that the vacuum extraction was negligent, as the catheter balloon was not removed before attempting to deliver the baby. As the bladder neck was crushed between the babies head and the balloon, an unusually severe stress urinary incontinence (SUI) developed.
The plaintiff also alleged inadequate counselling for the continence procedure of Tension-free Vaginal Tape (TVT). She alleged the mesh TVT had led to chronic pain and mesh exposure. The severe recurrent SUI subsequently required an autologous fascial sling procedure that led to irreversible avoiding dysfunction requiring regular self-characterisation, recurrent urinary tract infections requiring long-term antibiotics and refractory overactive bladder condition likely to require Botox bladder injections. All adverse events have caused loss of sexual function.
Defence
The defendant admitted substandard care in failure of removing the catheter before applying the vacuum extractor. The defendant denied such injury was due to the catheter balloon, but was rather due to the “other factors” such as big baby and head malposition.
The defendant admitted inadequate counselling for TVT, but denied direct causation in relation to chronic pain or to recurrent SUI requiring further interventions.
Advanced Arguments
The “other factors” are very common in obstetrics, while the Plaintiff’s injury is unusually severe.
In the joint expert report, we unpacked the degree of injury the Plaintiff presented with and that due to the confounders / “other factors”. A table to distinguish and compare the two injury types was proposed:
The injury the Plaintiff presented with was simply too severe to be explained by the common “other factors”. Therefore, such injury was highly likely to be due to the failure to remove the catheter balloon.
Outcome
Settlement outside court, without admission of liability, two working days before trial.
Lessons Learned
Stark reminder to young obstetricians: Do not attempt to deliver the baby by vacuum or forceps before removing the mother’s bladder catheter.
For Expert Witnesses: Unusually severe maternal childbirth injury requires forensic approaches. Unpacking is not only the essence of academia, it is also the essence of effective medicolegal opinion.