Birth Injury Claims: Dr Lorna Phelan Shares Her Medico-Legal Expertise
Ardent Expert Chambers Member Dr Lorna Phelan joined INNEG for a specialist webinar examining obstetric decision-making in birth injury cases and the clinical factors that can become central when the timing and management of delivery are later scrutinised.
The session attracted 582 registrations and 351 live attendees, representing Ardent’s highest webinar registration figures to date and demonstrating strong professional interest in Dr Phelan’s specialist expertise.
Drawing on her extensive clinical and medico-legal experience, including the preparation of more than 800 expert reports, Dr Phelan explored how intrapartum decisions are made in practice and how an expert approaches questions surrounding CTG interpretation, escalation, caesarean section and causation.
Understanding Intrapartum Decision-Making
A central theme of Dr Phelan’s webinar was the importance of understanding obstetric decisions within the clinical circumstances that existed at the time.
Labour is dynamic. Fetal heart rate patterns can evolve, maternal and fetal risk factors may change, and clinicians are often required to interpret several pieces of information simultaneously.
When reviewing a case retrospectively, an expert therefore needs to consider more than the eventual outcome.
Dr Phelan highlighted the importance of examining the complete clinical picture, including the progression of labour, maternal observations, fetal monitoring, recognised risk factors and the information available to the clinical team when individual decisions were made.
This helps ensure that expert opinion reflects the realities of obstetric practice rather than relying on hindsight.
Interpreting CTG Evidence
Cardiotocography (CTG) frequently becomes an important part of the evidence in birth injury cases.
Dr Phelan explored the complexities involved in interpreting fetal heart rate monitoring and why CTG evidence must be considered in context.
An isolated feature on a trace may not provide the complete answer. Baseline rate, variability, accelerations, decelerations, the progression of the trace and the wider clinical situation may all influence how fetal wellbeing is assessed.
For an expert witness, this requires careful review of both the CTG itself and the surrounding records.
The question is not simply whether an abnormal feature can be identified retrospectively, but how the trace should reasonably have been interpreted at the relevant point in labour and what clinical response would have been appropriate.
Escalation and the Timing of Delivery
The timing of escalation formed another important part of Dr Phelan’s discussion.
Where concerns arise during labour, clinicians may need to decide whether continued observation is appropriate or whether intervention should occur.
This can include decisions around senior review, operative vaginal delivery or emergency caesarean section.
Dr Phelan examined how those decisions develop over time and the factors that may influence the urgency of delivery.
When providing an independent medico-legal opinion, the sequence of events can be critical. An expert may need to identify when the clinical picture changed, whether that change required a different response and what an appropriate alternative pathway would realistically have looked like.
The Timing of Caesarean Section
Questions surrounding caesarean delivery can be particularly complex.
Identifying the point at which a caesarean section should have been considered is only one part of the analysis.
An expert may also need to consider when the decision would have been made, the practical interval between decision and delivery and whether an earlier intervention would have occurred sufficiently soon to alter the baby's condition.
Dr Phelan’s discussion demonstrated why these cases require a detailed understanding of how obstetric units function in practice, rather than treating the decision to perform a caesarean section as an isolated moment.
Separating Breach From Causation
Dr Phelan also explored the important distinction between identifying a potential departure from expected obstetric practice and determining whether that departure caused the neurological injury being considered.
Even where an earlier intervention is thought to have been appropriate, an expert must consider whether the available evidence supports the conclusion that earlier delivery would probably have changed the outcome.
That may involve analysis of fetal monitoring, cord gases, neonatal condition, the timing and nature of any hypoxic insult and the subsequent clinical course.
This separation between standard of care and causation is fundamental to robust medico-legal opinion.
It also demonstrates the importance of experts remaining within their area of expertise and identifying where additional specialist evidence may be required.
Considering Systemic Factors in Maternity Care
Not every adverse outcome can be understood solely by examining the actions of one clinician.
Dr Phelan also discussed how wider factors within maternity care can influence clinical decision-making, including communication, escalation pathways and the involvement of multidisciplinary teams.
A comprehensive expert review may therefore require consideration of how information moved between professionals, whether concerns were communicated effectively and whether appropriate senior input was obtained.
This broader perspective can be particularly important in complex cases where several decisions across the intrapartum pathway may have contributed to the clinical course.
Extensive Experience in Obstetric Medico-Legal Work
Dr Phelan brings substantial medico-legal experience to her expert witness practice, having prepared more than 800 expert reports.
Her work requires detailed analysis of obstetric records, fetal monitoring and the sequence of clinical decision-making surrounding labour and delivery.
The INNEG webinar provided an opportunity to demonstrate how that experience is applied to difficult questions around CTG interpretation, escalation, caesarean section, breach of duty and causation.
Rather than assessing individual decisions in isolation, Dr Phelan’s approach considers the complete obstetric pathway and the clinical context in which those decisions were made.
Dr Lorna Phelan is a member of Ardent Expert Chambers. View her full member profile to learn more about her specialist expertise and medico-legal practice.
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