Claims for compensation after alleged birth injury in Norway. A study of obstetric claims to the Norwegian System of Compensation to Patients from 1994-2008

Abstract

Birth injuries to mother or child are infrequent in Norway, but very serious to all patients and their families. The consequences of an asphyxiated child might be severe, and the payouts from the Norwegian System of Compensation to Patients (NPE) are huge. These payouts may compensate some of the economical expenses, but neither the physical sequela nor the social consequences. Despite this fact, the information concerning these cases has not previously been described. Evaluating the 278 obstetric claims receiving compensation between January 1st 1994 and November 13th 2008, we found that sphincter injury, injury of intestines or urinary tract, hemorrhage and infection were the most common injuries of the mother. Asphyxia and sequela after shoulder dystocia were the most common injuries of the child. The most frequent reasons for inadequate care in all cases receiving compensation were failures in obstetrical and surgical skills (27%). Among the 314 patients claiming compensation due to alleged asphyxia to the child, we found inadequate fetal monitoring to be the most important factor leading to compensation (50%), including omission of monitoring despite indication or neglecting signs of fetal distress. According to the medical experts, the health personnel involved in the substandard treatment were an obstetrician in 49% and a midwife in 46% of the cases. Human error seems to be an important factor of inadequate obstetric care. When we assessed the consistency of medical experts’ evaluations of negligence in care, we found only moderate agreement. In the question concerning causality between the given care and the injury we found fair agreement, but there was an astonishingly low concordance between the experts in the evaluation of asphyxia and sphincter tear. Describing cases of inadequate care is important when trying to decrease the frequency of obstetric injuries caused by inadequate care. Studying the experts’ evaluations may increase the consistency in the judgment of these claims.