Shouldering the burden of risk

By Dominic Wilkinson @NeonatalEthics


The UK supreme court last week awarded a woman £5 million in compensation after her obstetrician failed to warn her of a risk that she would have difficulty delivering her baby. Over on the JME Blog Kirsty Keywood discusses some interesting and important legal elements of this judgment for the practice of informed consent and how this will be evaluated in negligence claims.

However, the case raises one important ethical issue. Several expert witnesses in the Montgomery case testified that informing women of even very low risks of complications of vaginal birth would likely lead to a significant increase in the number of women choosing elective caesarean section.

If that is true, would it be justified for doctors to deliberately not discuss such risks?


In this specific case, Nadine Montgomery was thought to be at higher risk than normal of ‘shoulder dystocia’ – a serious and terrifying condition where the baby’s shoulders become stuck midway through delivery. This condition occurs in about 1 in 200 vaginal deliveries, but some women (for example who are small in stature and/or are expecting a larger baby) are at higher risk. (Ms Montgomery was thought to have a 1 in 10 chance of this condition.) When shoulder dystocia occurs obstetricians are usually able to deliver the baby safely using specialized techniques. However, there is approximately a 1 in 10 chance of major bleeding for the mother, and a 1 in 20 chance of a major perineal tear. For the baby there is about a 1 in 500 chance of nerve damage and a 1 in 1000 chance of either brain damage or death.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.