£525,000 settlement for mother after forceps delivery, severe perineal tear and bowel incontinence

During her second pregnancy, our client had been clear that she did not want another forceps birth. Her first delivery had involved forceps and an episiotomy, after which the wound broke down and took around seven weeks of antibiotics to heal. Her evidence was that, if intervention became necessary this time, she wanted a caesarean section.

When difficulties arose during labour, an attempt to deliver her baby using a Kiwi vacuum cup failed and forceps were then used.

Her daughter was born in good condition. For our client, however, the consequences were profound. She suffered a complex 3B tear and serious damage to her external anal sphincter. In the months that followed she needed a temporary colostomy and further surgery. At one stage, her bowel symptoms were so severe that she could not leave the house.

Our client’s concerns did not begin in the delivery room.

After the problems following her first forceps birth, she was worried that her perineum might be more vulnerable to further tearing and infection. During discussions about her birth plan, her evidence was that she made clear she did not want forceps again and, if complications arose, wanted a caesarean section.

At a consultant appointment later in the pregnancy, she again raised concerns about another forceps delivery. She was reassured that intervention in a second birth was unlikely and was given advice about measures that might reduce the risk of tearing. An elective caesarean section was not discussed.

That became an important issue in the claim. Our client’s case was that she should have been able to consider the risks and benefits of vaginal birth and caesarean section and make an informed choice.

Our article on informed consent in childbirth explains why discussion of reasonable treatment options and their risks can be so important in maternity care.

Our client’s waters broke at just over 38 weeks, and she later returned to hospital and was admitted. By shortly after 6am she was fully dilated. Active pushing began later that morning.

The records show that, around this time, a doctor acknowledged that our client did not want a forceps delivery.

After she had been pushing for more than an hour, a decision was made to attempt an instrumental delivery. The baby’s position was recorded as possibly brow or direct occipito-posterior (OP). Our client was not offered an emergency caesarean section and was not transferred to obstetric theatre.

A Kiwi vacuum cup was applied but came off with the first contraction. According to the Particulars of Claim, the alternatives were not then discussed with our client. Forceps were applied and her daughter was born in good condition.

What was initially thought to be a 3A tear was found in theatre to be a complex 3B tear, with significant distortion of the anatomy and scarring from her previous birth.

Our client’s difficulties continued after she went home.

She developed infection and later a vulval abscess. She experienced urinary and bowel symptoms, including faecal urgency and incontinence. By the time she was seen by a colorectal surgeon, the bowel problems were so troublesome that she had been unable to leave the house.

An endoanal ultrasound showed a significant defect in the external anal sphincter. She underwent surgery to repair the sphincter and, at the same operation, a temporary loop sigmoid colostomy was formed.

Recovery brought further problems, including severe constipation requiring a manual evacuation under anaesthetic and repeated stoma prolapses. The colostomy was reversed several months later, and she subsequently needed surgery to repair an incisional hernia at the colostomy site together with further perineal surgery.

The effects did not disappear after those operations. She continued to experience faecal urgency, leakage serious enough to require pads and difficulty controlling wind. Her symptoms interfered with everyday life and affected her relationship with her husband.

She also developed PTSD, with nightmares, flashbacks, disturbed sleep and anxiety around hospitals, as well as a depressive episode, and her psychological symptoms affected her ability to work.

Our guide to serious perineal tears following childbirth explains the different grades of tear and some of the longer-term problems they can cause.

A serious tear following childbirth does not, by itself, mean that anyone was negligent.

In this case, the central issues were what options should have been discussed with our client and what she would have chosen if properly advised.

The claim alleged that an elective caesarean section should have been discussed and offered during pregnancy. It was also alleged that, once difficulties arose during labour, she should have been offered an emergency caesarean section and properly advised about the reasonable alternatives to assisted vaginal delivery.

It was further alleged that she should have been transferred to theatre before a trial of assisted delivery and that, after the Kiwi attempt failed, the available options should have been discussed before forceps were used.

Our client’s case was that, if she had been properly advised, she would have chosen a caesarean section and avoided the perineal tear, anal sphincter injury and their consequences.

The NHS Trust initially denied the allegations of breach of duty and causation. Its position included a denial that there was evidence our client had requested a caesarean section or raised concerns about forceps.

This was disputed on our client’s behalf. Witness evidence was obtained from her husband and mother, including evidence about her intention to avoid forceps and have a caesarean section if necessary.

After High Court proceedings were issued, the Trust made a limited admission. It accepted that, at a consultant appointment during the pregnancy, our client had not been fully advised about the risks and benefits of caesarean section and vaginal delivery.

However, it continued to maintain that she would not have chosen a caesarean section, whether elective or emergency. The wider issues of liability and causation therefore remained disputed.

Our guide to breach of duty and causation in clinical negligence claims explains why both parts of the legal test matter.

We obtained expert evidence from an obstetrician, colorectal surgeon, psychiatrist and urogynaecologist. The evidence addressed the care our client had received, whether different advice and management would have avoided her injuries, her ongoing condition and her future needs.

The financial claim included loss of earnings and pension, care and assistance, treatment, aids and equipment and other expenses.

Proceedings were issued in the High Court in April 2025. The Trust later made a Part 36 offer of £400,000. Further offers and negotiations followed while significant aspects of the claim remained contested.

The case eventually settled for £525,000 in November 2025. Our client accepted the Trust’s formal Part 36 offer for that amount, settling the claim without the need for a trial.

Forceps and other forms of assisted vaginal delivery are commonly used safely. A difficult birth, a forceps delivery or even a serious perineal tear does not automatically mean there has been medical negligence.

There may, however, be grounds to investigate where there are concerns about the advice a mother received, whether reasonable alternatives such as caesarean section were discussed, the way an assisted delivery was carried out, or the diagnosis and treatment of an injury afterwards.

In this case, our client’s concerns about forceps pre-dated the labour itself. According to her evidence, they had been expressed during her pregnancy. The claim therefore involved not only what happened in the delivery room, but whether she had been given the information and choices she needed beforehand.