The recent ruling by the UK Supreme Court confirmed women’s right to autonomy when it comes to childbirth. On 1 October 1999 Nadine Montgomery had a vaginal delivery. However, Ms. Montgomery’s son had shoulder dystocia, during the birth. This deprived him of oxygen, which led to him being born with cerebral palsy. After the birth she brought a claim against Lanarkshire Health Board, stating the case that the obstetrician had not met the standards that should be expected during the birth of her child.
Shoulder dystocia is rare, but can occur during birth if one of their shoulders gets stuck. This can be caused by a number of factors including a small pelvis, having a large baby, and the position of the baby before birth. Another factor that increases the risk of shoulder dystocia during birth is when the mother is diabetic. In this case Ms. Montgomery was a diabetic. Prior to the birth, it had been agreed that there was a 9-10% chance that shoulder dystocia could occur.
In this case the doctor decided against mentioning the risks of shoulder dystocia and did not or discuss the alternative option of having a caesarean. The reasons the doctor gave for not explaining the risks to Ms. Montgomery was that the risks of shoulder dystocia were low and it was not in her best interests to have a caesarean. It is also worth noting that shoulder dystocia can also cause serious medical issues for the woman, including hemorrhage and perineal tear.
The Supreme Court ruled in favour of Ms. Montgomery’s appeal against the dismissal of the claims that she had brought on behalf of herself and her son, Sam Montgomery.
According to Supreme Court Justice Brenda Hale: “In this day and age, we are not only concerned about risks to the baby. We are equally, if not more, concerned about risks to the mother. And those include the risks associated with giving birth, as well as any after-effects. One of the problems in this case was that for too long the focus was on the risks to the baby, without also taking into account what the mother might face in the process of giving birth.”
Key outcomes from the case include:
- Disclosing information to patients is more than just an aspect of medical care.
- Therefore the amount of information disclosed is not determined by the judgement of the clinician.
- It is the courts not the clinicians that determine a person’s rights.
- Doctors must take reasonable care to inform patients of material risks involved, and the availability of any alternatives.
- Materiality of risk needs other consideration outside of just percentages of that risk occurring.
- The facts, and the individual circumstances of the patient determine the materiality.
- A doctor must engage in dialogue with the patient to advise properly.
A doctor should only withhold information from a patient if the information could be very damaging to the health of that patient, or where the patient is not conscious.