Canadian birth trauma case: Ediger v Johnston

Ediger v Johnston is a decision of the Supreme Court of Canada which addresses causation of bradycardia by an attempted mid level forceps delivery.

The doctor did not take precautions to ensure that, in the event of bradycardia, the child could have been delivered by Caesarean section without injury.  He took no steps before beginning the mid‑level forceps procedure to have surgical back‑up immediately available even though there was no urgency that precluded him from doing so.  He did not even inquire into the availability of an anaesthetist.  That fell below the standard of care.

The Supreme Court held, contrary to the Court of Appeal’s conclusion, that the trial judge did not err by failing to account for the delay between the end of the forceps attempt and the onset of bradycardia.  The trial judge accepted expert testimony that the doctor’s attempt to position the forceps may have displaced the baby’s head such that her umbilical cord would become compressed upon a subsequent maternal contraction, leading to bradycardia.  It was open to the trial judge to do so.  This theory explained the delay between the failed forceps attempt and the onset of bradycardia. The trial judge did not err when she concluded that the doctor’s failure to have surgical back‑up immediately available was a “but for” cause of the child’s injury.

As summarised by the Supreme Court at [39]:

…it was incumbent upon Holmes J. to weigh the evidence before her and determine whether Cassidy had proven causation on a balance of the probabilities.  Holmes J. ultimately concluded that Cassidy did satisfy this burden for three reasons.  First, as already described, Drs. Shone’s and Farquharson’s testimony regarding the physical effects and distortions of labour contractions, as well as the timing of the steps leading up to a cord compression, were consistent with what occurred here.  Second, multiple experts testified that mid-level forceps procedures are potentially dangerous and carry the risk of acute cord compression.  Third, the close proximity in time of the forceps attempt and the bradycardia supported the conclusion that the forceps attempt was connected to the cord compression.  As a result, Holmes J. concluded that, although she could not be certain of the precise mechanics leading to cord compression, “[t]he only reasonable inference from all the evidence is that the mid-forceps attempt likely caused the cord compression that in turn caused the bradycardia”



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