How my brave little boy and I took on the world... and won
A traumatised mother, an uncaring medical establishment – and the 16-year fight for justice that gave fresh hope to every mum-to-be
IT WAS the middle of the night when Nadine Montgomery was finally wheeled into the special care unit to meet her new-born son. Bedbound after a l ong labour and an extremely traumatic birth, the 24-year- old was in agony. But the pain was nothing compared to what she felt when she saw her baby.
‘He was ventilated and had this big tube down his throat and all these wires around him,’ she says.
‘He had lacerations to his face and his neck. Seeing your baby for the first time like that, it was so sad. There was a little flap in the incubator where you could put your hand in and touch your baby. I just lay there looking at him thinking, “Is he going to live?”
‘They told me he was very, very weak and they didn’t think he would make it. Nobody thought he would survive.’
And yet against all the odds, Sam Montgomery did survive. Now a third-year university student, he recently celebrated his 21st birthday with balloons and a family meal at a Glasgow restaurant.
And five years ago, after a 16-year legal battle, Nadine was awarded £5.25million in damages by NHS Lanarkshire after doctors failed to give her important advice that would likely have resulted in her choosing to have a caesarean section.
It was a landmark ruling made by the Supreme Court and upheld by seven judges that has changed doctor-patient relationships across the UK, and has been called the most significant medical negligence judgment in the past 30 years.
But the events of that night in October 1999 cast a long shadow over Nadine and her son. Born with severe disabilities, Sam suffered damage to the nerves which control shoulder, arm and hand movement. At just a few months old he was diagnosed with cerebral palsy and will need care for the rest of his life.
All of it, says Nadine, was completely unnecessary, if only doctors had given her the right advice and allowed her to make an n informed choice about how she gave e birth to her baby.
Nadine was 24, married and living in Cumbernauld when she got pregnant nt with Sam. After studying for a degree in molecular biology, she was working for ra a pharmaceutical company.
‘I just thought I was off to have a baby by and I’d be back to work,’ she says. ‘I had ad no idea my whole life would change.’
A type 1 diabetic, from the start of her pregnancy, Nadine received extra scans ans and was under the care of both a diabetic etic and an obstetrics consultant.
But towards the end of her pregnancy, ncy, ultrasounds flagged up an issue. Sam was abnormally large, measuring on the 95th centile, a particular worry given that Nadine is only 5ft tall. ‘He was huge,’ ’ she says. ‘The doctors knew he was really y big and so they decided at that stage to bring me in for induction at 38 weeks.’
Nadine says that at this stage she repeatpeatedly asked doctors what might go wrong with such a large baby.
‘I was always met with reassurances,’ s ’ she says. ‘They always said “don’t you worry about that. Let us worry about that. You’re going to be ok.” They would monitor me all the way through the induction and if there was any problem, they would resort to a caesarean section so not to worry.’
On September 30, 1999, she was taken into Bellshill Maternity Hospital and induced. But after many hours in labour, despite an epidural and a dose of oxytocin to help contractions, she became unwell with a temperature, and was told a decision had been made to take her to theatre for a trial of forceps. When a junior doctor asked her to sign a consent form saying trial of forceps, she did so.
‘I was like any exhausted mother,’ she says. ‘I was in a lot of pain. I think at that point if someone said, “We’re going to chop your head off because it’s the only way to keep the baby,” I would have said “that’s fine”.’
In theatre they topped up her epidural. Nadine says she was aware that while the room was full of people, it was incredibly quiet. And then, the anaesthetist calmly told her he was going to put her to sleep.
‘At that point I knew something was seriously wrong,’ she says. ‘But I didn’t know what. I remember closing my eyes and thinking that was it. I wasn’t going to wake up. There was something wrong with me and I would never see my baby.’
WHEN she did wake up, hours later, she was in so much pain she felt like she’d been in a road traffic accident. Then she realised that the people around her were weeping. ‘I could hear my Mum screaming and shouting. And my Dad, a man who never cries, had been crying. My sister came over and told me that I’d had a baby boy but that he was very, very sick and he was in the special care baby unit.’
The following days were a nightmare. Until she was well enough to visit Sam, nurses brought her Polaroids of him to look at. Her parents, both doctors themselves, were extremely distressed by the situation, as was her husband. It was touch and go whether Sam would live or die.
Confused about what had happened, and having received little in the way of an explanation from doctors, Nadine decided to read her own case notes. What she discovered horrified her.
Sam’s head was delivered by forceps but his shoulders had become stuck for 12 minutes, an obstetric emergency known as shoulder dystocia. Attempts were made first to break his clavicles, then to push his head back inside to perform a caesarean section, and finally to break Nadine’s pelvic cartilage. All were unsuccessful.
When he was eventually delivered he had been deprived of oxygen for 12 minutes. He was stillborn and needed adrenaline and CPR to restore his heartbeat.
Then, the final kicker: as a type 1 diabetic Nadine had a 9-10 per cent chance of the baby’s shoulders becoming stuck. Her small size meant the risk factor was even greater. And yet no one had told her, and at no point had anyone given her a choice. She was adamant then, and is adamant today, that had she been properly informed of the risks, she would have opted for a caesarean.
‘I was so angry,’ says Nadine. ‘Why hadn’t I been told? Particularly when I had repeatedly asked what the risks were in having a large baby.’ She feels that there is often a judgment on women who have caesareans, sometimes unfairly characterised as ‘too posh to push’.
‘That ideology is still around,’ she says. ‘You’re not giving birth properly if you have a caesarean.’ Indeed, her own obstetrician l ater told the Supreme Court that in her view ‘it was not in the maternal interests for women to have caesarean sections’.
Having learnt the truth about her son’s birth Nadine was devastated. She was still extremely ill and barely able to walk. But she knew she had to find a way to motivate herself.
‘I soon realised I had to get myself moving for my baby. I had to get up. I had to. I think if one of us had died, the other one wouldn’t have made it. I really do. But I had a focus now. I had to keep going for him and get better.’
And slowly, she did. After six weeks in hospital, she was able to bring Sam home, but things were not easy. He had lost his sucking reflex and could barely feed, and often smacked his lips. His behaviour was abnormal for a baby. Again, no one had told Nadine that due to the traumatic nature of the birth, there was a possibility of cerebral palsy or brain damage.
It was only after a trip to the Royal Hospital for Sick Children in Yorkhill, Glasgow, when Sam was several months old that she received the diagnosis. ‘They told me they believed he had cerebral palsy,’ she says.
‘They gave him quite a bleak outlook. I remember thinking, “No, no, this happens to someone who knows how to look after a disabled child.” I literally didn’t have a clue.’
Overnight, Nadine’s life changed. Her mother, a GP, retired early to help look after Sam. Although two years on
Nadine and her husband had another child, a daughter, they later divorced. Nadine and her mother would look after Sam in shifts.
‘It was really difficult, those first few years,’ she says. ‘I honestly can hardly remember it, so much of it was a blur. I do remember thinking if I could just get four hours sleep a night I could function during the day, but Sam just never slept. He had seizures. There were feeding difficulties.’
Yet somehow, in between feeds and occasional naps, she started gathering evidence for a legal case. She spoke to her sister, at the time a trainee junior doctor in anaesthetics, about the consent form she had signed before being taken to theatre.
‘She told me doctors have a duty to fully inform their patients and they have to discuss the risks and options. She said, “Did that happen?” I said no but I signed a bit of paper. She explained it’s not about a bit of paper. So we started researching, spent a lot of time looking through GMC guidelines, and it became apparent that my care with regards to informed consent was completely substandard.’
Letters of complaint were written. An investigation by the local NHS health trust concluded it was satisfied that adequate care had been given. In 2009 she took her case to the Court of Session. She lost. Two years later she appealed, and lost again.
HER lawyer then suggested they take the case to the Supreme Court, as the Scottish courts were following legal principles set out in a House of Lords decision, which could not be overturned by lower courts.
‘My lawyer said to me that if we went to the Supreme Court we might be able to change the law. I thought “What? Really?” But off we went.’
In March 2015 the Montgomery case was agreed on unanimously by seven Supreme Court judges. It overturned a previous decision by the House of Lords, establishing that, rather than being a matter for clinical judgment to be assessed by professional medical opinion, a patient should be told whatever they want to know, not what the doctor thinks they should be told. Not only had Nadine achieved justice for her and her son, she had made history, changed the l aw and i mproved conditions for thousands of future patients.
She was driving the day she got the call. Her lawyer made her pull over before he told her the news.
‘I started crying,’ she says. ‘It was this flood of emotions. And then hurt, too, because this just didn’t need to happen. It’s so frustrating. There was a perfectly good option. It should never have happened in the first place. But it’s done now and the good thing is how many people will benefit from this decision.’ She smiles. ‘That just warms my little heart.’ She has since become a patron for the charity Birthrights, which supports women during pregnancy and helps them understand their rights while giving birth, something which has arguably never been more important than during the pandemic, when many women give birth alone. Life continues to improve for Sam. After spells at mainstream and special needs schools, Nadine became aware that despite his disabilities, he was highly intelligent. Aged 14 and still at a special needs school he expressed an i nterest in studying s o f t war e engineering. ‘I spoke to the school and said he would need physics and maths, and they said they didn’t teach those. They didn’t think he could do it. I was furious, so I took him to a private school, Glasgow Academy, to do their academic assessment.’ Sam duly passed with distinction, his paper so i mpressive that the rector of the school offered him a bursary. Three years later Sam achieved his goal, and was accepted at university to study software engineering. At his induction day, a conversation with the university’s disability services made Nadine realise not only was his life about to change, hers was too. ‘I was talking about bringing him in in the mornings and the guy said “No, no, Mum doesn’t come to university.” I said, “But he can’t get transport, he doesn’t know how to do that”, and they explained they would arrange all that. He would even have an assistant to go from class to class to help him. It was fantastic. ‘But I came away thinking, well, what do I do now? I’m redundant. My whole life had been caring for Sam so I didn’t really know what to do with myself.’ Slowly, an idea formed. ‘I thought, I could go and do something. I could go study.’ And so at 42, a single mum with two teenagers, Nadine decided to study law, the very thing she had immersed herself in to get justice for her and her child. Having completed a degree in microbiology she applied to do an accelerated twoyear course, and was accepted. She graduated last year, and is now doing a Masters in medical law, her research focusing, perhaps unsurprisingly, on informed consent. ‘When all this first came out, a lot of people emailed saying “This happened to me, too” and all I could say is “I’m so sorry, here’s my solicitor’s number”. Now I can help.’ Meanwhile, Sam is at university, doing a work placement, and recently received his first pay cheque. ‘He was so excited,’ she says. ‘It wasn’t much but it was enough for him to buy some DVDs. He’s absolutely loving it.’ I ask if she feels pride in what she’s achieved, for herself, for her son, and the thousands of patients whose lives have been changed. She shakes her head vociferously. ‘I think if it’s your child, you just would. People tell me I’m so determined, or they can see where Sam gets his determination from. But no, it’s the other way round. Sam has taught me so much about achieving your goals and never giving up. I get all my determination from him.’