Unusual birth complication not identified

What happened

During Mrs A's labour, there were seven minutes between the baby's head being delivered and the rest of his body. This was caused by shoulder dystocia, a rare complication that happens when a baby's shoulder becomes stuck in the birth canal during labour.

Mr and Mrs A asked questions and raised concerns about what had happened and, because they were unhappy with the Trust's answers, they obtained a private review before meeting the Trust to discuss what had happened.

What we found

There was a possible two-minute delay when midwives did not identify shoulder dystocia and the appropriate process was then not followed.

The Trust apologised for this fault and the poor handling of Mr and Mrs A's initial concerns over what had happened. This had caused the family to lose confidence in what the Trust said and led them to pay for a private review.

Putting it right

The Trust apologised and acknowledged that the initial handling of Mr and Mrs A's concerns was inadequate and did not reassure them.

The Trust paid £250 for the cost of the private review, and £750 in recognition of the distress caused by the faults we identified.

It also completed an action plan to address all of the faults found.