2.1 Impact of litigation claims

The NHS Litigation Authority (NHSLA) report Ten Years of Maternity Claims (NHSLA, 2012) identified that maternity claims were the second largest group of claims and accounted for the highest value (49%) of the total value of claims under the Clinical Negligence Scheme for Trusts (CNST). A significant proportion of the more costly litigation claims made against UK ambulance services arise from pre‐hospital obstetric incidents. Although in a 10‐year period, obstetric cases consisted of only 13 of the total 272 claims, the average value of these cases was £815 000. Four were valued at more than £1 million. Claims were based on either an alleged failure to identify and manage a problem or a lack of appropriate equipment for the treatment of a preterm baby. The largest claim was for £3 375 000 and related to an alleged lack of equipment to care for a baby born at 26 weeks (Dobbie and Cooke, 2008).

Although the numbers of women and babies dying as a result of obstetric emergencies in the UK are small, some of these deaths might be prevented if effective training in the prompt recognition and management of these cases is undertaken by pre‐hospital providers (Woollard et al., 2008). Although it could be argued that antenatal provision of preventative obstetric care is more effective than treating problems after they arise, the Confidential Enquiry into Maternal and Child Health (CEMACH) report of 2007 suggested that many of the pregnant women who died ‘had chaotic lifestyles and found it hard to engage with maternity services’ (CEMACH, 2007a). One of its ‘top ten’ recommendations stated:

All clinical staff must undertake regular, written, documented and audited training for the

• Identification, initial management and referral for serious medical and mental health conditions which, although unrelated to pregnancy, may affect pregnant women or recently delivered mothers
  
• Early recognition and management of severely ill pregnant women and impending maternal collapse
  
• Improvement of basic, immediate and advanced life support skills. A number of courses provide additional training for staff caring for pregnant women and newborn babies

There is also a need for staff to recognise their limitations and to know when, how and whom to call for assistance (CEMACH, 2007a).

All registered healthcare professionals are ultimately responsible for identifying and achieving their own training needs and maintaining their own competence. This extends into post‐registration training and particularly through continuing professional development activity. A strong motivation for doing so, other than the obvious one of being able to meet patients’ needs, is individual accountability for practice. A failure to provide acceptable standards of care not only risks the patient’s welfare but also challenges the practitioner’s fitness to practice and their right to maintain professional registration. Although obstetric emergencies are rare, the consequences of mishandling them can be particularly severe for mother and baby, as well as for the pre‐hospital practitioner.

2.2 Consent and capacity

Healthcare professionals should understand the legal framework within their field of practice, including:

• The legal rights of the mother
  
• The legal rights of the fetus
  
• The legal rights of the child
  
• Consent prior to providing treatment: in particular informed consent and the capacity of the patient to give this. Check the legal framework in your organisation for details of express, implied or presumed consent and ensure that you fulfil the requirements with regard to obtaining this and documenting it

There are often specific caveats in the legal framework where patients are unable to consent and their situation is life threatening. It is important that you understand how this works in your domain.

Capacity and competence of mothers who are minors is a further area that should be well understood by practitioners.