A maternity nurse told a woman experiencing labour pains to go home and return “only if she sees something coming out of her vagina”. When the woman, who was two days past her due date, initially refused to go she was called “one of those people who knew everything”.
Matthew Hattingh, for MedicalBrief, reports that the woman, who has successfully sued the Eastern Cape Department of Health for negligence, testified that she left after the rebuke, only to return by taxi about 4pm with severe pains.
She said the nurses, at East London’s Frere Hospital, told her to stay in the waiting room but with the pain continuing, she went to look for them.
She was later instructed to walk around in the corridor.
At 7pm she again approached the nurses, this time the night shift, but was told to wait as they were busy with an emergency.
Some time later, while on the toilet, her waters broke. Seeing it was green with blood spots she screamed. Another patient summoned help. She was given a bed and told to push. The baby was soon born. He did not cry and was taken away.
The mother saw her baby the following morning at the nursery, where he was in an incubator, with tubes in his nose and mouth. She learnt that the patches on his body were for an electrocardiogram.
She was told her child could not feed, and milk had to be expressed. She was given a breast pump to help feed him when he was discharged seven days later.
The nurses told the mother her baby had seizures, explaining that “oxygen did not arrive well in the brain”.
Three months later the seizures resumed, and she took him to the hospital for treatment.
Handing down judgment in September 2025, Eastern Cape High Court (Bhisho) Judge M Makaula found the negligence of provincial Department of Health staff was the “direct cause of the brain injury and the subsequent cerebral palsy” suffered by the baby.
The mother was not cross-examined by lawyers for the Health MEC about the events around the 7 April 2006 birth.
Makaula, who described the documentary record as “sketchy”, based his judgment on the mother’s uncontested evidence and the expert testimony of Dr Berthold Alheit, a retired diagnostic radiologist, Dr Yatish Kara, a pediatrician specialising in neonatal and intensive care pediatrics; and Dr Linda Murray, a specialist obstetrician and gynaecologist.
Alheit said an MRI brain scan revealed a hypoxic ischemic brain injury involving the central parts of the brain, namely the paracentral lobule, perirolandic, basal ganglia and thalamus structure, where the motor and sensory functions of the brain are established.
“These areas, because they need energy just before birth, much more than the rest of the brain, … are more vulnerable to a lack of oxygen and the lack of blood pressure. And if this occurs, if for some reason there is a lack of oxygen, then these regions start suffering and eventually when there is lack of blood pressure that is when the actual injury happens.”
He testified this may have been the consequence of a sentinel event, like a rupture of the placenta or if the mother suffered heart arrest, or profuse bleeding of the baby. Alternatively, the same brain injury occurs after hypoxia over a prolonged period in which the foetus is compromised but not injured, and then finally cardiac compromise (ischemia) occurs, resulting in brain injury.
Kara assessed the patient’s disability and the causal connection between his delivery and subsequent brain damage.
Examination revealed spastic quadriplegia cerebral palsy, meaning that he is stiff and weak in all four limbs. Now aged 19, he is unable to use his hands, unable to speak and has limited expressive and receptive ability. However, he can hear and see. He has epilepsy and microcephaly, meaning he has a small head or shrunken brain. Because of this he relies on a caregiver.
Kara testified he could not find an alternative cause for the encephalopathy other than hypoxic ischemic injury – which is what the MRI scan showed. He had looked for and ruled out “features of infection, features of chromosomal abnormalities, features of metabolic diseases at cetera”.
“(It) appears probable despite missing information that there was acute intrapartum hypoxic injury of sufficient severity to cause cerebral palsy.”
Murray testified on the maternity guidelines and standard obstetric practice.
She felt that when the woman first arrived at the hospital, she must have been in early stages of labour because the pain continued until “she gave birth 12 to 24 hours later”, therefore it was not false labour and she should not have been sent home by the nursing staff.
She testified that sending the woman without having assessed her and the foetal condition indicated substandard care. The woman’s labour was unmonitored, unattended and neglected to an extent it was fair to say she received no medical care at all.
Murray had access to limited pediatric records, but observed that the notes revealed that the baby had an Apgar score of 3 and 5, which was very low, indicating very little sign of life. Even after birth, it remained at 5, meaning he was in a poor condition.
Like the other experts, Murray ruled out that the injury could have occurred during pregnancy, because of the lack of complications, and no congenital abnormalities on the MRI.
“The evidence given by the experts is chronologically sound and backed up by facts from the first plaintiff, their expertise and literature by scholars in their respective fields of expertise. I therefore found that the defendant’s employees were negligent in treating the first plaintiff and (baby),” said Judge Makaula.
The Department of Health was found 100% liable for the proven or agreed damages.
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