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England and Wales Court of Appeal (Civil Division) Decisions
You are here: BAILII >> Databases >> England and Wales Court of Appeal (Civil Division) Decisions >> Miah v Birmingham and the Black Country Strategic Health Authority  EWCA Civ 290 (03 April 2007)
Cite as:  EWCA Civ 290
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COURT OF APPEAL (CIVIL DIVISION)
ON APPEAL FROM QBD, Birmingham District Registry
His Honour Judge MacDuff QC (sitting as a High Court Judge)
Strand, London, WC2A 2LL
B e f o r e :
Vice-President of the Court of Appeal, Civil Division
LORD JUSTICE TUCKEY
LORD JUSTICE JACOB
| Monzur Miah
|- and -
|Birmingham and the Black Country Strategic Health Authority
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A Merrill Communications Company
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Ben Browne QC (instructed by Bevan Brittan LLP) for the Respondent
Hearing date : 15th March 2007
Crown Copyright ©
Lord Justice Waller :
"Called to see at 1.40 pm. Sister felt something unusual in vagina. On arrival no fetal heart beat . . . cervix fully (dilated) except anterior crescent. Posteriorly felt like a vaginal septum below the head . . . hooked down what seemed like a vaginal septum below the head but was a cord. 15cm of cord hanging out of vagina. No pulse in cord. No fetal heart."
"First he relied upon the agreed fact that the greatest risk of cord prolapse is at rupture of membranes . . .Thus (if there were no other evidence about it, direct or circumstantial) one would be entitled to assume, on the balance of probabilities, that the prolapse had occurred at that time. Secondly, it was his opinion that, once the head was engaged (as it was from the outset), there was no room for the cord to descend past the head. Thus it was that the cord must have been presenting itself, there to be detected, from at least the time when the head became engaged. It could not have escaped past the engaged head to the position where it was eventually found by Dr Nall after 13.20. That, in a nutshell, was the thrust of Mr Johnson's evidence."
"Professor Stirrat did not agree. Broadly speaking, there were three reasons. First, he thought it highly unlikely that a qualified midwife (albeit one who was relatively inexperienced at that time) could have failed to detect the prolapsed cord, if it had been there. Secondly (although accepting that, all things being equal, the cord was at greatest risk of prolapse at the time the membranes ruptured) he was aware that the research document upon which this statement was based provided statistics that 57% of cords which prolapsed did so within 5 minutes of ruptured membranes (43% did not). Thirdly, he would have expected the cord to occlude or go into spasm earlier rather than later. If the prolapse had occurred at 13.20, he would have expected the damaging hypoxia to have commenced earlier than 13.35, (noting of course that the fetal heart rate, although compromised, was still registering at 75 bpm at or around that time)."
Lord Justice Tuckey : I agree.
Lord Justice Jacob: I also agree