Pressure Sores During Labour

During labour, a woman faces an increased risk of developing a pressure sore

. However, each NHS Trust has clear guidelines which should, if followed correctly, prevent pressure sores from occurring. If these guidelines are not met and a pressure sore does develop during labour, there could be ground for a compensation claim.

Preventing pressure sores during labour

Clinical guidelines state that an 'initial risk assessment for pressure damage must be made within two hours of admission for patients with impaired mobility or an altered level of consciousness or sensory impairment. For all other patients, risk assessment must be incorporated within the admission procedure - within six hours.' The majority of women in labour will fall into the latter category, and so must therefore be assessed within six hours of being admitted to hospital.

During labour, the medical team must remain vigilant to the possibility of pressure sores developing. Advice should be given to the woman about the need to change position regularly, and help should be given if she is not able to reposition her own. Pressure sore risk must also be re-evaluated if:-

- There is a change in the patient's condition - eg. an epidural or a prolonged second stage of labour;

- Patient is transferred to another ward - eg. to the postnatal ward;

- After major investigation or medical/surgical procedures - eg. an episiotomy or forceps delivery;

- Weekly if patient is stable;

- On discharge.

If there is evidence that a pressure sore has occurred, the severity of damage should be graded and advice given as to how to care for the injury. This may involve limiting sitting time to two hours per session and using a pressure-relieving cushion. Patients with a grade 1-2 pressure ulcer should be given a high specification foam mattress as minimum provision. The injury should then be assessed by the Community Midwife and further treatment provided if necessary.

Failure to prevent pressure sores during labour

Should medical professionals fail to follow the clinical guidelines as described above, the standard of care will have fallen to a substandard level. Common examples of this include the failure to:-

- Assess pressure sore risk upon admission;

- Re-evaluate pressure sore risk during labour;

- Identify risk factors such as a prolonged labour or an epidural;

- Take steps to prevent pressure sore forming during labour;

- Offer appropriate advice regarding pressure sore treatment;

- Provide appropriate review and assessment after discharge from hospital.

If a woman does suffer a pressure sore as a direct result of this breach, she will be the victim of medical negligence. This means she will be entitled to pursue a claim for compensation which, if successful, will ensure she receives financial redress for the pain and suffering she had been caused.

by: Julie Glynn

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