South Tyneside and Sunderland NHS Foundation Trust

3. Ms E complains the Trust failed to care for her appropriately when she was an inpatient on the maternity ward in April 2019, and later in June to November 2019. In particular, she complains:

• the Trust did not carry out a caesarean section (C-section) when she arrived, although her baby was in a transverse position (positioned horizontally across the uterus, rather than vertically) • the Trust did not recognise Ms E had retained products from the placenta following the delivery of her baby • the Trust did not carry out sufficient tests before she was discharged • when Ms E became pregnant again, she did not have any additional observations or check-ups, given her medical history.

4. Ms E says her experiences at the Trust were extremely traumatic and she had a terrible birthing experience. Ms E says as a result of the Trust’s actions she developed an infection caused by retained placenta products. She says this led to surgery to remove a fallopian tube. The resulting time spent away from her newborn baby meant she could not breastfeed.

5. Ms E says she suffers from a lot of pain and has suffered psychologically due to her experiences. Ms E says the lack of care she received meant she suffered a miscarriage at 20 weeks. This has caused her and her family extreme distress.

6. Ms E would like:

• the Trust to accept and apologise for its failings in relation to the April 2019 birth • the Trust to accept and apologise for its failings in relation to the care she received between June and November 2019 • financial compensation for both incidents; Ms E did not advise on a figure.

7. On 5 April 2019, Ms E was 39 weeks pregnant. She decided to wait for a spontaneous labour up to 41 weeks, and if this did not happen, she would have a C-section.

8. On 7 April 2019 at 6am, Ms E attended the Trust Delivery Suite, and medical staff admitted her with onset contractions. Medical staff carried out a vaginal assessment, and the on-call obstetrician and gynaecologist saw Ms E. They noted possible complications with a vaginal birth and proposed a C-section, but they did not action this as they considered a forceps birth to be more appropriate. Later that night, doctors delivered Ms E’s baby girl using forceps. They discharged Ms E the following morning.

9. On 11 April 2019, the midwife saw Ms E. She noted Ms E had not been feeling well and she had backache. Ms E informed the midwife she felt cold and shaky.

10. On 30 April 2019, Ms E was admitted to the Trust’s Integrated Critical Care Unit with suspected sepsis (widespread infection).

11. On 1 May 2019, doctors told Ms E she had an infected abdomen. They took her to surgery as the Trust found signs of infection. Surgeons removed one of Ms E’s fallopian tubes to clear the infection and prevent further risk.

12. On 1 August 2019, Ms E complained to the Trust and the Trust responded on 10 December 2019. Between February and August 2020 Ms E was in communication with us. She advised us that since she had begun the process, she had had a miscarriage and had begun a complaint about this as well. She agreed with her caseworker that, given the second complaint, she would go back to the Trust for resolution on both matters before returning to us and proceeding with both issues as one complaint. Local resolution ended in February 2021, when Ms E returned to us with her complaint.

No C-section in April 2019

16. Before we decide if we should investigate a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this, and we have not found any evidence something has gone wrong.

17. Our clinical adviser has informed us that, according to the medical records, the Trust staff acted in line with the RCOG Green-top standards for the use of forceps and C-sections in the delivery of babies, and the GMC standards on patient consent. They advised the records do not show there was a need for a C-section, only that it was scheduled. As the birth happened earlier than expected, there was not time for the scheduled C-section, and doctors decided a forceps delivery was appropriate.

18. We have seen no evidence from the records or from our clinical adviser’s advice that there was any negative impact from the use of forceps instead of a C-section, and so we have decided to not investigate further. We understand this may be upsetting for Ms E, given the sensitivity of the case and the length of time the decision has taken.

Retention of placenta products post-birth and Trust staff not testing Ms E before discharging her

19. As these two issues are linked, we offer our decision and commentary together.

20. In complaints such as these, we must find evidence something went wrong in order to investigate. In this case, we asked our clinical adviser to consider the events following the birth of Ms E’s baby in April 2019. We asked them to advise if the Trust staff acted properly in relation to Ms E’s care.

21. From Ms E’s medical records, we found Ms E had developed a bacterial (Streptococcus A) infection. Our clinical adviser told us this infection occurs regularly with vaginal births, and they were not surprised this had happened.

22. Our clinical adviser also informed us the products found in Ms E after the birth are classified as endometrium (the layer of tissue lining the uterus), and are common remains found after birth. They also advised that, based on RCOG guidance, it is unlikely for these products to have caused Streptococcus A or other infections.

23. As endometrium is not usually a cause of infection, RCOG guidelines do not tell medical staff to clear these products away after birth. Equally, according to the guidelines, there is no test Trust staff could have done to diagnose a likely post-birth complication, as endometrium would not have shown up on a test.

24. Our decision is we find no evidence of fault in this case. The Trust staff appear to have acted correctly in their treatment of Ms E after the birth in April 2019. Equally, the medical records do not suggest the retained products caused the infection Ms E suffered. We have decided not to investigate further. We fully appreciate this may not be the outcome Ms E wants from this complaint. Our answer does not undermine her concerns about the outcome of her care and treatment by the Trust, but only finds this outcome could not have been prevented by any appropriate action by the Trust.

Trust care and treatment for Ms E’s pregnancy between June and November 2019

25. Our clinical adviser has told us for the first four to five months of a normal pregnancy, a trust will provide nursing care and advice regarding diet, exercise and medication based on NICE NG25 guidelines, paragraph 1.2.1. A trust will only arrange screenings for a pregnant woman in extraordinary circumstances. By extraordinary circumstances, our clinical adviser has informed us the guidelines mean a high-risk pregnancy, such as a history of challenging deliveries or a family history of birth defects, or similar. While Ms E’s prior pregnancy was difficult, it was not unusual, and so this current pregnancy would not have been considered to have extraordinary circumstances.

26. Our clinical adviser told us the care Ms E received would have been appropriate in normal circumstances.

27. We asked our clinical adviser if Ms E’s difficulties in April and May 2019 should have been considered extraordinary circumstances under the NICE guidelines. Our clinical adviser has told us they should not, and Ms E was not eligible for early screening, as detailed above.

28. Given this advice, we cannot find any sign something went seriously wrong based on the relevant standards and guidelines. We have decided to not investigate this matter further.

29. We understand Ms E has been through an upsetting time in this matter, and has had a long wait for our services and our decision. Given the sensitive nature of this subject, we hope Ms E and her family understand we wanted to make sure we had the right answer for her, and this can take some time.

1. The Parliamentary and Health Service Ombudsman has carefully considered Ms E’s complaint about South Tyneside and Sunderland NHS Foundation Trust (the Trust). We have seen no signs anything went seriously wrong based on the established standards and guidance NHS professionals must follow.

2. We understand this has been an upsetting time for Ms E and her family, and our decision may be disappointing for her. We hope this statement explains our reasoning.