Reading CTG traces: the tragic consequences of getting it wrong

A CTG trace showing a baby's heart rate.
A CTG trace showing a baby’s heart rate.

Earlier this month a court made the highest ever award for clinical negligence.

James Robshaw, 12, is to receive £14.6m for injuries he received as a result of mistakes made during his birth in December 2002. Because James was deprived of oxygen during his birth, he now suffers from cerebral palsy. He can’t speak or control the use of his limbs, and he communicates using a machine that he controls with his eyes.

Although £14.6m seems like a lot of money, it is the amount needed to provide care for James 24 hours a day, seven days a week for the rest of his life.

The NHS spends about £1bn a year settling medical negligence claims. About a third of this is spent on compensation for mistakes in maternity care, equivalent to £700 per baby born. The reason it is so costly is not because obstetricians and midwives are especially negligent, but because the consequences of birth injury are long-term and catastrophic: as in James’s case, the NHS has to pay for a lifetime of care.

Earlier today, I heard James Robshaw’s mother Suzanne interviewed on the Radio 4 programme You and Yours. She talked about her long labour and the decision by doctors to allow her carry on labouring rather than perform an emergency caesarean section. Her account included a detail that is all too common in birth injury stories: the failure of her midwife to read the cardiotocography (CTG) trace correctly.

The CTG trace shows the baby’s heart rate. If it is too high, or too low, it means there’s a problem and the baby could be at risk. According to Suzanne, her husband repeatedly pointed out to the midwife that the CTG trace was showing a low heart rate, but the midwife insisted that all was fine. She was wrong.

Reading a CTG trace accurately isn’t necessarily an easy thing to do – and doctors and midwives need training in how to do it well. This article from 2011 says that 200 babies die every year because of a failure to act on an abnormal CTG reading. Others, like James Robshaw, are left brain damaged through oxygen starvation.

Part of the problem is that midwives and obstetricians are overworked and often stressed: the shortage of health professionals means that those who remain are expected to do too much. It’s not surprising under those circumstances that mistakes get made.

But it’s also true that better training – and checks to make sure that the training has been understood and is being followed correctly – can help. When I was writing my book on birth trauma, I was startled to discover, in an interview with a litigation lawyer, that her firm was so horrified by the number of medical negligence claims arising from a failure to read the CTG correctly that it offered CTG training to midwives. (This is a firm that benefits from medical negligence errors, so this is no small thing.)

Most babies are born safely: the number of medical negligence claims as a proportion of the number of births is tiny. But the financial cost to the NHS – and, more importantly, the emotional cost to the victims and their families – is enormous. A simple thing like better and more effective training in reading CTG traces could do a lot to put that right.

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