The Belgian, French and Dutch midwife on trial: A critical case study.

OBJECTIVE

to develop juridical recommendations in order to avoid midwifery medical liability when providing intrapartum care.

DESIGN

case law of the past 40 years concerning midwifery medical negligence when assisting labour/delivery in a hospital was analysed. Databases used were Jura and Judit (Belgium), Legifrance, Juricaf and Dalloz (France) and Recht, Rechtspraak (The Netherlands). A minority of cases were retrieved through contacts with insurance companies (only Belgium), lawyers and courts.

SETTING

law suits in Belgium, France and The Netherlands.

FINDINGS: the 100 analysed cases could be categorised into four types. The judicial assessment was focused on three domains of expertise of the midwife. Most cases involved interpreting fetal monitoring (47%), followed by recognising a specific pathology (32%) and responding to a complication (12%). A fourth type of case concerned exceeding the boundaries of the legal competencies of the midwife (9%).

KEY

CONCLUSIONS

not identifying fetal distress through fetal monitoring was the most common cause of midwifery liability (15/47), followed by not recognising the symptoms of a pathology (10/32), particularly placental abruption and uterine rupture. Also an inaccurate response to complications (3/12) and evidently exceeding the professional competencies involved midwifery liability.

IMPLICATIONS FOR PRACTICE: achieving cardiotocograph interpretation skills is the first and most important recommendation. In pathologic cases, the midwife should immediately refer to an obstetrician, without any hesitation. The third recommendation is working in a team with the obstetrician. If the midwife has reasonable (evidence-based) doubts about the practice of the obstetrician, she should insist on re-assessment with respect to the boundaries of her competencies. The fourth recommendation concerns practising with knowledge of the client׳s/patient׳s medical record and updating the record with performances and observations. Consciously choosing the type of medical intervention in urgent cases of pathology is the final recommendation.