In short
Harm at birth is read with the records of the mother and of the newborn; a single discharge summary may not be enough.
It is read with the records of the mother and of the newborn. A single discharge summary may not be enough.
The request for the patient file is in a separate writing.
The CTG and the birth note are a chain.
Related articles: medical malpractice.
The current need of care of the mother and of the baby comes first
The thought that harm occurred at birth is heavy and shaking for the family. While the baby is in intensive care, or the mother is being treated, pressure can be felt to decide quickly about the legal process. All the same, the first priority is that the health of the mother and of the baby is secured, and that the necessary referrals and treatments are not delayed. If an opinion will be taken from another centre, the existing images, the results of the follow-up, and the list of treatment should be shared. Concern about evidence should not come in front of the health care.
Legal preparation can begin, while the care continues, by keeping a regular record. The pregnancy follow-up, the application to hospital, the start of labour, the critical findings, the time of birth, the resuscitation, and the later diagnoses can be written on a separate timeline. Because the records of the mother and of the baby can be in different files, the two chronologies should later be joined in a common table. The conversations the family remembers are supportive; the time of the clinical decisions must be confirmed from the medical records, however.
This text is general information. It does not contain medical advice, or an opinion of fault about the concrete file. In an urgent need of health, the suitable health service should be taken directly.
Harm at birth and medical fault are not the same
Birth and pregnancy can carry a risk even under careful follow-up. Pictures such as preterm birth, an unexpected separation of the placenta, a condition present from birth, an infection, or sudden bleeding can lead to serious results. For that reason, harm being seen in the mother or in the baby does not automatically show that the health worker was at fault. The examination assesses the foreseeability of the risk, the standard of monitoring, the timing of the decisions, and the intervention after the problem developed.
In a claim of medical fault, these periods are usually taken up separately:
- The assessment of risk before the pregnancy and during the pregnancy
- Routine follow-up, or follow-up of a risky pregnancy
- Admission for the birth, and the first examination
- The monitoring of the mother and of the baby during labour
- The decision of a vaginal birth, of an assisted method, or of a caesarean
- The intervention at the moment of birth, and the resuscitation
- The follow-up of the mother and of the baby after the birth
A shortcoming in one period does not remove the fact that the other periods were carried on correctly. In the same way, the existence of a risky condition before the birth does not automatically justify every decision in the management of the birth. The content of What is medical malpractice? explains the general frame of a departure from the standard, of the harm, and of the causal link.
The pregnancy follow-up is the start of the birth file
The event at the moment of birth often cannot be assessed independently of the information acquired throughout the pregnancy. Factors such as the mother's age, the history of earlier pregnancies, high blood pressure or diabetes, infections, the baby's development, the condition of the placenta, and a multiple pregnancy can affect the plan of the birth. Whether a risky finding was noticed in time, and whether the necessary tests and consultations were made, is examined from the records.
If a risk was determined in the follow-up, its meaning, the frequency of checks, and the signs for an urgent application should be explained to the patient. Not every risk can be prevented from occurring, however. The important question is whether a reasonable monitoring and plan was built according to the information that existed. It cannot be said, by carrying a result that appeared later back into the past, that a condition unknown at that date necessarily had to be foreseen.
If the pregnancy was followed in different institutions, all the records should be taken. The records of the family doctor, of a private examination, of the hospital, and of the emergency department can complete one another. Not only the report of the examinations and the images in the last weeks, but, if possible, the original data too, should be presented to the expert examination.
The monitoring during the birth, and the timing of the decision
During labour, the condition of the mother and of the baby can change in a dynamic way. The contractions of the uterus, the progress of the birth, the mother's vital signs, and the records relating to the baby's heart rate are the basis of the decisions. These data are examined not only by whether they exist, but by whether they were interpreted correctly and answered in time. The intervals of the record, and the completeness of the device printouts, are important for that reason.
It is not right to give a single limit of minutes, to be applied to every file, for a decision of caesarean or of another intervention. The nature of the emergency, the time the team became aware, the preparation of the operating theatre, and the mother's safety are assessed together. If there is a claim of an unnecessary delay in the face of clear findings of deterioration, the times of the event are compared in detail.
The passage to practice after the decision was given is also part of the file. The period between the time of the doctor's decision and the start of the operation, the reason of the delay, and the monitoring done in this interval should be understood from the records. Rather than a bare claim that "the caesarean was done late", which finding appeared when, and which step was expected, should be turned into the expert's question.
The method of birth, and the technique of intervention
The choice of a vaginal birth, of a caesarean, or of an assisted method rests on the concrete condition of the mother and of the baby. One method later giving a bad result does not show that the other method would necessarily have been right. The benefit and the risks that existed at the moment the decision was given are compared. The patient's preference matters; the limits of an urgent medical necessity, and of safety, are also taken into account, however.
Pictures that develop quickly during the birth, such as the shoulder becoming stuck, bleeding, or foetal distress, can require certain manoeuvres and coordination of the team. The complication itself is not always fault. Whether a preparation fitting the risk was there, the record of the manoeuvres, and the monitoring afterwards are assessed, however. For the distinction between a complication and a shortcoming of management, the writing is it a complication or a medical error? is complementary.
The management of anaesthesia, of medicines, and of blood products can also be separate headings of the birth file. In the mother's harm, not only the obstetric practice, but the processes of anaesthesia and of intensive care too, should be examined by different specialities if they are relevant.
The baby's resuscitation, and newborn care
The assessment immediately after the birth determines the baby's need of support for breathing and for circulation. The steps of resuscitation, the members of the team, the use of medicines and of devices, and data such as the blood gas can matter in the analysis of the cause. A single score, or a single test result, may not show with certainty that the harm arose from the management of the birth, however. The whole clinical course should be assessed together.
In the newborn intensive-care file there can be infection, seizures, support of breathing, imaging, and neurological assessments. The diagnoses in the early period can change over time; understanding a lasting effect can require developmental follow-up. The family should continue the rehabilitation and the medical checks that were recommended, without waiting for the legal result.
The relation of the baby's condition to a condition present from birth, to the course inside the pregnancy, to the event at the moment of birth, or to the care after the birth can require more than one field of speciality. A genetic examination being made does not automatically exclude the effect of the management of the birth; the reverse is also valid. The scientific connection must be built with reasons.
Harms relating to the mother are assessed separately
Birth files often focus only on the baby; bleeding, injury to an organ, infection, a clot, a problem of anaesthesia, or a long-lasting loss of function can develop in the mother, however. Whether these results are a known risk, a preventable event, or a shortcoming of management should be examined separately. The mother's vital signs, the laboratory results, and the records of the operation and of intensive care are important.
Whether complaints after the birth are accepted as "normal" is also related to the standard of follow-up. The response given to warning findings, such as continuing excessive bleeding, fever, or severe pain, is assessed from the records. At hospital discharge, it is necessary that it is explained in which signs a return application should be made.
Alongside the mother's physical harm, the effects on work, on care, and the psychological effects can also be assessed inside the concrete event. The medical assessment of emotional difficulties after birth should be made by the competent health workers, however, and obtaining help for the legal file should not be avoided.
Information, and the plan of the birth
The plan of the birth is not a guarantee of a definite scenario. Because birth is dynamic, the planned method can change in emergency conditions. All the same, the reasonable options, the important risks, the possibilities of intervention, and the means of the institution should be explained to the mother beforehand, as far as possible. When the plan changes, it is important that an explanation is made to the extent the urgency allows.
A general hospital admission form may not stand in for specific information relating to every intervention in the birth. Procedures such as a caesarean, anaesthesia, an assisted method of birth, or a blood product are assessed in their own context. In a real emergency, consent not being able to be taken can be subject to a different legal frame. The writing What is informed consent? explains these distinctions.
Consent having been given does not make a careless practice lawful. On the other hand, a risk that was explained occurring does not, on its own, show a breach of information either. The technical practice, and the right to decide, should be examined as separate questions.
How are the files of the mother and of the baby collected?
All the records, from the follow-up before the birth to the newborn care, should be asked for in writing. The printouts of foetal monitoring, the ultrasound images, the medicine charts, and the device data should not stay limited to a summary report. Because there can be separate patient numbers for the mother and for the baby, both files should be asked for openly. The content of requesting the patient file helps to plan the scope of the application.
A practical arrangement of the documents can be built in this form:
- The folder of the pregnancy follow-up
- The folder of admission to hospital and of labour
- The records of the operation and anaesthesia, or of the birth procedure
- The records of the mother's care after the birth
- The baby's records of birth and of resuscitation
- Newborn intensive care, and the later treatments
- The documents of expense, of care, and of rehabilitation
If a lack of documents is seen, a complementary request can be made over the list of what was delivered. A claim that the records were altered should not rest only on an impression; a mismatch of date, of signature, or of data should be shown concretely.
The expert examination can be multi-disciplinary
A claim of harm at birth can require obstetrics and gynaecology, neonatology, paediatric neurology, radiology, genetics, anaesthesia, or other related fields. It is important that the board is formed of experts fitting the technical questions of the file. An opinion of only a general branch may not be enough to answer the baby's long-term effect, or the mother's separate harm.
The questions should be separated into periods: could the risk have been noticed in the pregnancy, was the monitoring of the birth suitable, was the decision to intervene in time, was the resuscitation in line with the standard, and did the delay that is claimed contribute to the harm? This structure prevents the report from consisting only of a sentence of result.
The reports should rest on the medical records, on the images, and on reasons. If there are contradictory reports, the speciality, the data used, and the scientific explanation are compared. The court assesses the technical opinion in law together with the other evidence.
The distinction of the application in a public and in a private hospital
If the birth took place in a public hospital, administrative liability, an application to the administration, and the route of a full-remedy action can come onto the agenda. For the general procedure, the route of compensation in a public hospital can be looked at. In a private hospital, the contractual relationship, the institution's duty of organisation, and the health worker's practice are assessed within the frame of private law.
The routes of a complaint, of a professional examination, of criminal law, and of compensation have different aims. The process of a complaint about a doctor takes up this distinction. It may not always be suitable for the family to start all the routes at the same time and with the same text; an analysis of the aim, of the jurisdiction, and of the period should be made.
In the hospitals in Ankara too, the medical standard rests on the frame across the country. The density of the local institution can affect the speed of the process; it does not change the statutory periods, or the measure of proof. A calendar of periods particular to the file should be built by recording the dates of the birth, of learning of the harm, of the request for documents, and of the institution's answer.
A realistic roadmap for the family
The workable route in a claim of harm at birth is to continue the care of the mother and of the baby, to take the two files complete, to build the chronology of the event, to document the harms separately, to determine the questions of the suitable speciality, and to choose the application according to the nature of the institution. Rather than making a definite accusation on social media, the health data and the family's privacy should be protected.
The baby's need of long-term care can become clear over time. Because of the legal periods, it may not be safe to wait for the whole development to be completed; making a future harm certain with an assumption that has no basis is not right either. A staged plan should be built with the current reports and the expert assessments.
The upper frame of health disputes is on the page of the health law practice area. Every file is assessed separately according to the history of the pregnancy, the birth records, the expert opinion, the type of institution, and the current legislation; a guarantee of a result, or of compensation, cannot be given.
Where the birth record is read from
The mother's file, the newborn's record, and the birth note are read side by side. An amount of compensation that is not written in the file is not added. Fault is not built with a statistic. The Çankaya office does not choose the competent authority for the birth file.
Conclusion
This writing is for general information. The document, the period, and the procedure of the concrete event must be read separately; there is no promise of a result from memory.
A lawyer in Ankara does not write, in harm at birth, an amount that does not stand in the file.