Complete perineal tear after a forceps delivery, not medical negligence; delay in referral for post-delivery complication is negligence [Madras High Court]

By - Yadav M

The instant Writ Petition has been filed by a mother seeking compensation from the respondents for the physical pain and mental agony she underwent for nearly nine months after delivering a child in the 3rd respondent hospital due to the alleged negligence on the part of the respondents. On going through the medical literature, it is seen that a perineal tear is not uncommon after an episiotomy procedure. There is a possibility of 4 degrees of perineal tear. Madras High Court observed that in the present case, the 4th respondent had to perform episiotomy, which is a regular procedure adopted in normal vaginal deliveries. In this procedure, an incision is made on the vagina of the patient to make space at the outlet bigger for the baby to come out comfortably and to make the birth easier and avert possible brain damage for the baby. High Court further added that on carefully going through the medical literature, it is seen that "it is common for the perineum to tear to some extent during childbirth. Tears can also occur inside the vagina or other parts of the vulva, including the labia. Up to nine in every ten first-time mothers who have a vaginal birth will experience some tear, graze or episiotomy. It is slightly less common for mothers who have had a vaginal birth before. For most women, these tears are minor and heal quickly." High Court made it clear that from the above, the 4th respondent was forced to adopt this procedure since the baby's head was at the outlet and was not able to come out, and the petitioner was not able to strain any further. That apart, the fetal heart rate was decreasing, and to save the baby, the 4th respondent applied outlet forceps after giving episiotomy, whereby the perineum was cut down to create space for the delivery of the baby. This procedure adopted by the 4th respondent cannot be held negligent, and she had decided in the interest of the petitioner and her baby. In the considered view of the Madras High Court, the 3rd respondent hospital was expected to make effective decisions since the situation faced by the petitioner could not be effectively handled in the 3rd respondent hospital. This became apparent even on 13.11.2005 when the petitioner was diagnosed with a complete perineal tear. At that point, immediate steps must have been taken by the 3rd respondent to shift the petitioner to the Coimbatore Medical College Hospital. This decision does not require the consent of the petitioner or her husband. The interest of the patient gained significance, and to waste time for three more days till 16.11.2005 virtually gave an impression in the mind of the husband of the petitioner that effective steps were not being taken to treat the petitioner, and he was a witness to the pain and agony undergone by his wife. [Para 22] The High Court concluded that this Writ Petition is allowed in the result, and there shall be a direction to the 1st respondent to pay a compensation of Rs.5 Lakhs to the petitioner against the claim of Rs.10 Lakhs.


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