Midwives provide care throughout pregnancy, labour, delivery and the postpartum period.
Like other regulated healthcare professionals, midwives must meet professional standards when providing care. When complications arise during pregnancy or labour, this can include recognizing when consultation or transfer of care is required.
When a baby suffers a serious birth injury, questions may arise about whether warning signs were recognized and appropriately addressed. These issues can form part of a medical malpractice investigation.
For families in Ottawa, Kingston and across Eastern Ontario, understanding when midwifery care may amount to medical negligence can be an important first step in exploring their legal options.
How Are Midwives Regulated in Ontario?
Midwives in Ontario are regulated under the Midwifery Act, 1991 and by the College of Midwives of Ontario Professional Standards.
The Midwifery Act defines the scope of midwifery as assessing and monitoring patients during pregnancy, labour and the postpartum period. It also includes providing care to newborn babies.
The College establishes professional standards that registered midwives must follow. These standards address matters such as clinical care, informed consent, documentation, collaboration and transfer of care.
When Should a Midwife Consult a Doctor or Transfer Care?
Midwives can provide care independently within their professional scope. However, complications can arise that require consultation with another healthcare provider or transfer of care.
The College’s Professional Standards require midwives to consult with or transfer care when the care required exceeds their scope or competence. When consultation or transfer occurs, they must also provide complete and accurate information to the healthcare provider assuming or assisting with care.
In a birth injury claim, the timing of these decisions can become important. An investigation may consider whether developing complications were recognized and whether consultation or transfer occurred when required.
Fetal Monitoring, Fetal Distress and Midwife Negligence During Labour
Monitoring the condition of the mother and baby is an important part of labour and delivery.
Ontario regulatory decisions involving midwives have considered concerns about fetal-heart-rate monitoring, recognition of fetal distress and obtaining medical assistance.
In H.G. v. Murray, the Health Professions Appeal and Review Board considered a complaint involving a home birth followed by transfer to hospital. The issues included fetal assessment, fetal-heart-rate interpretation, recognition of distress, communication and transfer of care.
The Board upheld remedial recommendations concerning documentation and clear transfer of care. It did not, however, make a civil finding that the midwife was negligent or caused the baby’s death.
Another regulatory decision, Chiodo v. Carter, involved concerns about fetal monitoring and distinguishing the maternal heart rate from the fetal heart rate. The concerns also included recognition of fetal distress and obtaining medical assistance.
Again, the decision did not determine civil negligence or causation. However, these decisions demonstrate the types of clinical issues that can arise when reviewing midwifery care during labour.
Can You Sue A Midwife for a Birth Injury in Ontario?
A serious birth injury does not automatically mean that a midwife or another healthcare provider was negligent.
A medical malpractice claim requires evidence that the care fell below the applicable standard of care and that this caused or contributed to the injury.
Depending on the circumstances, an investigation into midwifery care may consider:
- monitoring during pregnancy and labour;
- recognition of changes in the condition of the mother or baby;
- consultation or transfer of care when complications arise; and
- communication and documentation.
Medical expert evidence is generally required to assess the standard of care and causation.
Ontario Birth Injury Lawsuits Involving Midwives
Ontario courts have considered medical malpractice actions involving midwives and children who suffered serious birth injuries.
In Bunch v. Midwife Amy Jackson, a child was born with severe neurological injuries, including spastic quadriplegic cerebral palsy. The plaintiffs’ medical evidence attributed her neurological injuries to hypoxia-ischemia during labour. The defendants included midwives, a midwifery organization, physicians, nurses and hospital defendants.
Similarly, in Blackburn v. Ardalani, the plaintiffs alleged that breaches of the standard of care by two midwives during delivery caused grave birth injuries.
Both cases were resolved by settlement. Neither resulted in a judicial finding that the midwives were negligent or that their care caused the injuries alleged.
These cases demonstrate the serious injuries that can be involved in birth injury litigation and the importance of distinguishing allegations of negligence from findings of liability.
Proving That Midwife Negligence Caused a Birth Injury
Even where concerns exist about the care provided, a medical malpractice claim must establish that the breach caused the injury.
This can be particularly complex where a baby is diagnosed with cerebral palsy, hypoxic ischemic encephalopathy (HIE) or another neurological condition.
Medical records may help establish when a change in condition occurred, what information was available and what steps were taken in response. Expert evidence can then assist in determining whether the care met the applicable standard and whether any failure caused or contributed to the injury.
What Medical Records and Evidence Matter in a Midwife Negligence Claim?
Birth injury investigations often require a detailed review of the records created throughout pregnancy, labour and delivery.
These may include midwifery records, hospital records, fetal monitoring information, test results and documentation of consultations or transfers of care.
The timing recorded in these documents can be particularly important. The records may help establish when a change in condition occurred, what information was available and what steps were taken in response.
Expert evidence can then assist in determining whether the care met the applicable standard and whether any failure caused or contributed to the injury.
Questions About Midwifery Care or a Birth Injury in Eastern Ontario?
If your child or another family member has suffered a serious birth injury in Ottawa, Kingston or elsewhere in Ontario, Bergeron Clifford Injury Lawyers can help you understand your legal options.
