A review of medical negligence claims concerning pregnancy and childbirth in the State has found major faults in the care given to mothers and babies in Irish hospitals.
The review, carried out by the Medical Defence Union (MDU), which insures hospital consultants, found that almost half of the claims related to brain-damaged babies, over a quarter to stillbirths, and one in five for injuries to the mother. Almost two-thirds of the mothers who made claims said they had suffered psychological injury.
In many cases a breakdown in communication was shown, with midwives failing to seek medical advice when it was needed, and doctors failing to respond to their concerns. In some cases there was no medical supervision during complex births, such as the delivery of twins. An inability to contact senior medical staff on call in hospitals for emergencies was also cited.
The review showed that in 75 per cent of the claims involving stillbirths and brain-damaged babies complications or risk factors had been identified to show the mother was more at risk than during a "normal" pregnancy. These included hypertension, bleeding during pregnancy and diabetes.
The claims involving stillbirths and brain-damaged babies showed prolonged labour in 45 per cent of cases, more than 24 hours in the initial stage for a first-time mother.
In almost 70 per cent of cases monitoring of the baby's heartbeat showed abnormalities, and in slightly fewer cases significant signs of foetal distress were present.
Examining the time between babies first showing signs of distress and the delivery, the review showed that they were often "distressed for quite a long time" before the birth, according to Dr Stephen Green, head of risk management services at the UK-based MDU.
Dr Green said people should not be alarmed. "These are a relatively small number of unfortunate cases over a long period of time. There are lessons to be learnt but we must also remember that obstetric practice has changed over the past 20 years."
Dr Green said he could not give the number of cases involved. "We have a confidential relationship with our members. We don't want them to be identifiable."
He said a "relatively small" number of Irish cases were involved, but said that when problems occur during pregnancy and childbirth the result can be "disastrous and very often result in a brain damaged baby".
The MDU reviewed all of their files from Ireland involving obstetric management over a 20-year period. Some of those claims involved medical negligence in the management of both the mother and baby.
It also found inadequate screening of high-risk patients, those who have had problems in previous pregnancies including high blood pressure, a baby asphyxiated when born, or a stillbirth. It highlighted the failure to undertake certain procedures such as a scan or blood test to check anaemia, and the failure to warn expectant mothers of the relevance of abnormal signs and symptoms to enable them to seek medical attention.
There was a poor standard of medical records, which were often non-existent for private patients, particularly "most crucial" labour and delivery records.
Consultant obstetricians were implicated in a third of cases, junior doctors in one in 10 and midwives in a smaller percentage of cases.
General management issues for hospitals where babies were delivered included an inadequate number of midwives, according to a report in the Irish Medical News, or the presence of untrained midwives on the ward. It also highlighted the problem of junior doctors covering two or more sites in a hospital where babies are being delivered. In some cases essential equipment was not available.
Dr Green said the findings were similar to those reported in a similar study in the UK, published in 1995. "The commonest criticism of obstetricians was failure to act appropriately, whereas midwives were more likely to have failed to recognise problems. All professions were criticised for poor communication," he said.