Expert Witness Journal Issue 65 February 2026 - Flipbook - Page 40
probably ended at or just before 07.50 am, because
midwife Rogers went to see M then, took her vital
signs and BSL was seen dribbling, so M may well
have moved her body during that time. There might
have been some preceding CPHI, but on balance
I prefer the expert evidence stating that there was
a unitary cause: APHI. A lot of brain injury was
caused during the APHI insult and I consider it likely
that C’s arterial cord gas pH probably reduced to 6.66.8 as Doctor Thomas postulated. After the APHI
there would then have been a period of re-oxygenation
and resuscitation for C in utero until birth, lasting
perhaps 2-3 hours. Then, C was born with improved
but still acidotic cord pH readings. Roughly 4-6 hours
after the end of the APHI insult (perhaps very roughly
between 11.50 am and 13.50 pm) the usual secondary
period of cellular damage probably arose.
pH 7.01 venous. He took his 昀椀rst spontaneous breath
at 6 minutes of age.
The total period of acute near total asphyxial insult
was about 13 minutes and the period of damaging
asphyxia was of approximately two to three minutes
in duration. The notes of the anaesthetist recorded
that it had been a di昀케cult procedure but that the baby
had recovered less than one minute after delivery.
It is said that the claimant would not have su昀昀ered
any brain damage or neurological injury had he been
delivered by 20:31 or 20:32.”
Ultimately in the OAJ case the Judge found the
insult must have occurred a few hours earlier and
although the mother was in hospital at the time the
Claimant could not establish that this injury could
or should have been avoided. The breaches of duty
that could be established all post dated the timing
of the injury.
None of the experts, other than Doctor Agrawal,
whose evidence on timing I have rejected, advised
that there was any or any continuing hypoxia after
08.30 am if the main injury had occurred earlier.
Instead, they advised the C was being resuscitated
in utero. I 昀椀nd that there was no continuing hypoxia
after 08.30 am.”
This article was originally published on 1 Crown
O昀케ce Row’s Quarterly Medical Law Review.
And
“
I 昀椀nd that C’s severe brain injury was caused
silently and tragically in the night, between 05.15
and 07.50 am, probably ending at or close to 07.50
am. It was caused by APHI. It was caused by a
reversible mechanism. This was probably due to cord
compression. This was not anyone’s fault. It was not
the midwives’ fault and it was not M’s fault. No one
was to blame. By the start of the daytime CTG, at
08.30 am, the damage was either done or the course
was set for the full damage to emerge over time in
the usual 3 phase manner. Therefore, the breaches
at 08.48 am and thereafter and those after 09.40
am made no di昀昀erence to the outcome and made no
contribution to it. The primary damage had been
caused, although the normal further sequelae of
APHI arose thereafter and further consequential
damage would arise hours later.”
Mr Haitham Hamoda
Consultant Gynaecologist, Subspecialist in
Reproductive Medicine and Surgery,
Clinical Lead Menopause Service King's
College Hospital
BA(Oxon) MBBS PhD
Mr Haitham Hamoda is a Consultant Gynaecologist and Subspecialist in
Reproductive Medicine and Surgery and the Lead for the Menopause Service at King’s
College Hospital. He is Trustee and past Chair of the British Menopause Society.
Areas of specialist interest are:
•
•
•
•
•
•
This was an unusual and di昀케cult case involving
birth damage over 14 years ago. The main problem
for the Claimant was to reconcile the Apgar scores
and relatively mild acidosis at birth and lack of
bradycardia just before delivery with a very severe
acute profound hypoxic ischaemic injury. By contrast
in the case of LMN v Swansea Bay University Health
Board [2025] EWHC 3402, where it was accepted the
acute event occurred during a 17 minute delivery of
an impacted baby the position was:
“
Mr Hamoda has published widely in his specialised field and is actively involved in
ongoing research projects both locally and nationally. He is first author of The British
Menopause Society & Women’s Health Concern 2020 recommendations on
hormone replacement therapy in menopausal women and author of the British
Menopause Society guideline on the management of women with premature ovarian
insufficiency 2017.
Mr Hamoda is a Fellow of the Royal College of Obstetricians and Gynaecologists and
was awarded a degree of Doctor of Medicine (MD) from the University of Aberdeen.
He obtained his accreditation as a subspecialist in reproductive medicine at Guy’s and
St Thomas’ Hospital.
Contact: Mr Haitham Hamoda
Telephone: 0203 146 6255
Email: haithamhamoda@gmail.com
Area of work: London and surrounding areas
The claimant was delivered by Mr Mukherjee at
20.34. The claimant was noted to be 昀氀oppy, his
Apgar scores (a measure of the need for resuscitation)
were 4 (at 1 minute of age), 4 (at 5 minutes) and 5 (at
10 minutes). He was ventilated and then intubated.
His cord gases were recorded as pH 6.86 arterial and
EXPERT WITNESS JOURNAL
Menopause
Premature ovarian insufficiency (POI)
Infertility and IVF
Gynaecological endocrine including PCOS.
Gynaecology including fibroids /endometriosis & gynaecological ultrasound
scanning
PMS / PMDD
38
FEBRUARY 2026
