Protecting human rights in childbirth

Birthrights names Nadine Montgomery as charity’s first Patron

Birthrights is delighted to announce Nadine Montgomery as our first ever Patron. As a public ambassador for Birthrights, Nadine will continue her work to champion women’s autonomy and consent in childbirth, supporting our communications and campaigns, training for healthcare professional and high-level events. See our press release for more information.

In 2015, the Montgomery v Lanarkshire Health Board case powerfully affirmed women’s right to autonomy in childbirth. Read Nadine’s story in her own words here…

I am absolutely delighted to become part of the fantastic team at Birthrights and to become their first ever Patron! Such an honour!

My journey, in wishing to bring about improvements in informed consent for patients, began 20 years ago when my son Sam was born with Cerebral Palsy and left Erbs Palsy following a very traumatic delivery. 

This wasn’t about “blame,” it was about me wanting to understand what happened to me, why it happened to me and to make sure with every fibre of my being that this never happened to another woman ever again. There are times in life where you have to stand up for what you believe in, even if you are standing alone.

As a type 1 diabetic, I attended a joint diabetic/obstetric clinic to help manage my high risk pregnancy. Fortnightly ultrasounds were conducted to monitor my baby’s growth, as well as all the other regular checks you would expect. My last scan was at 36 weeks, with Sam measuring on the 95th centile. I asked questions more than once throughout my pregnancy about delivering a large baby, and I was always met with reassurances. I was told not to worry and that they were monitoring the pregnancy carefully. At no point were options of delivery, or the risks of delivering a larger than average baby vaginally, discussed with me.

I was brought in for induction of labour at 38 weeks, and it was once again noted that I was having a large baby. Oxytocin was administered the next day to augment contractions. After many hours I started to become unwell with a high temperature and a decision to take me to theatre for a trial of forceps was made at around 5pm the following evening. A different doctor brought me a consent form saying ‘trial of forceps’ and before I signed that I asked this doctor what that meant. I was told that they would be able to assess me properly in theatre where they could see better. If there was room to use forceps then they would attempt that, if not they would resort to a caesarean section. I had no real understanding about the procedure being proposed or the potential complications that could arise.

After some time in theatre I was told that they were going to put me to sleep. I knew then that something was very wrong. I woke up in immense pain and to the tearful faces of my family and I was told that I had a baby boy. The wonderful nurses brought me polaroid pictures of him, and the neonatal team kept me updated regularly until I was well enough to see him myself.

I later found out that Sam’s head was delivered using forceps, however his shoulders became stuck for 12 minutes. Last resort measures to deliver him were unsuccessful including attempts to break his clavicles, attempts to push his head back inside in order to then perform a caesarean section, and finally several attempts to break my pelvic cartilage/bone. He was eventually delivered stillborn requiring CPR and adrenaline to restore his heartbeat.

Sam had lacerations over his face, neck and head with subdural haematomas and suffered from seizures due to hypoxic encephalopathy. He spent many weeks in SCBU.

After the events I wanted to understand why this happened and my sister and I researched GMC, NICE and obstetric college guidelines, as well as many scientific papers, and discovered that as a type 1 diabetic I had a 9-10% chance of the baby’s shoulders becoming impacted, an obstetric emergency called shoulder dystocia. I was shocked! Why was this information kept from me? Especially as I repeatedly asked questions about this. I was devastated. Given that 9-10% risk combined with my small stature (I’m only 5ft), which is another risk factor, I feel adamant that I should have been told about the possibility of shoulder dystocia. If I had known I would have opted for an elective caesarean section and Sam would have been born unharmed.

A complaint letter was sent to the NHS Trust hospital and it was met with a standard reply that they were sorry for the sad outcome etc, washing their hands of any responsibility. This infuriated me. It appeared as though no one recognised that there was a deficiency in my care, and my concern was that if people didn’t recognise that, then no positive changes would be made.  And if no changes are going to be made then it surely follows that this will happen again.  So, it quickly became my goal to make sure that this never happened to any other woman, and indeed any other patient, ever again.

I wanted to ensure than others didn’t go through what I did, and that the right discussions should be taking place regarding options/risks between doctors and patients, making decisions together as stated in the GMC guidelines.

15 years later, a full bench of 7 Supreme Court judges all found in my favour and the ethical guidance with respect to informed consent  that was already essential for doctors was passed into law. The Supreme Court stated that with the advent of the Human Rights Act, patients should now be viewed as persons holding rights, rather than passive recipients of the care of the medical profession.

But the words that brought me to tears were the poignant words of Lady Hale. She stated that whatever the doctor had in mind, that it didn’t look like a purely medical judgment. It looked like a judgment that vaginal delivery is in some way morally preferable to a caesarean section, so much so that it justifies depriving the pregnant woman of the information needed to make a free choice. This is exactly what I felt.

From my point of view, I don’t care if you want to give birth in a hospital, at home or on farmland surrounded by baby lambs and chickens. ALL that should matter is that you know all your options, you understand the risks of all these options and that you make your decision and are supported by your doctor.

This is why I am delighted to be part of Birthrights, who fight to ensure women are afforded respect and dignity in childbirth. And at the very core of their beliefs is the right to autonomy and self-determination, something that I have fought for, for 15 years.

I have found my tribe.

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