Maternity triage: did negligent assessment lead to cerebral palsy?

A recent court case in London (PXW v Kingston Hospital) heard that a baby was born with cerebral palsy, allegedly because of a midwife's negligence when assessing the mother in the maternity assessment unit—referred to in court as ‘triage’.

The multiparous mother (RXF, who was 39 weeks' pregnant) attended triage at 17:55 on the day in question, having walked more than half a mile to the unit. The midwife who assessed her concluded that she was in early but not established labour, and, following the unit protocol, advised the woman to return home. RXF and her husband left the unit at 18:20.

According to the defence, when RXF returned to the unit at 20:41, she gave:

‘A history of more intense contractions since 19:30, good fetal movement, no vaginal loss and no rectal pressure, suggesting that she was still in the active first stage of labour and without any complications.’

Having gone to the bathroom to provide a urine sample, RXF quickly called the midwife because her membranes had ruptured; clear liquor was noted. On returning to the assessment room, the midwife attempted unsuccessfully to auscultate the fetal heart. The vertex was first seen at 20:50, the head was born at 20:55, with the body following at 20:57.