Montgomery (Appellant) v Lanarkshire Health Board (Respondent) (Scotland)

of the evidence was plainly wrong, or on the basis that, instead of applying a
conventional test of “but for” causation, he should instead have applied the
approach adopted in the case of Chester v Afshar [2004] UKHL 41; [2005] 1
AC 134.
5. Before considering those issues, we shall explain in greater detail the relevant
facts and the approach adopted by the courts below.
The facts
6. Mrs Montgomery studied molecular biology at Glasgow University and
graduated with a BSc. She then worked for a pharmaceutical company as a
hospital specialist. She was described by the Lord Ordinary as “a clearly
highly intelligent person”. Her mother and sister are both general medical
practitioners.
7. In 1999 Mrs Montgomery was expecting her first baby. She is of small
stature, being just over five feet in height. She suffers from insulin dependent
diabetes mellitus. Women suffering from diabetes are likely to have babies
that are larger than normal, and there can be a particular concentration of
weight on the babies’ shoulders. Because of her diabetes, Mrs Montgomery’s
was regarded as a high risk pregnancy requiring intensive monitoring. She
therefore attended the combined obstetric and diabetic clinic at Bellshill
Maternity Hospital, under the care of Dr McLellan, throughout her
pregnancy.
8. The widest part of a baby’s body is usually the head. If the head successfully
descends through the birth canal, in a normal birth the rest of the body will
descend uneventfully. Since the widest part of the body of a baby whose
mother is diabetic may be the shoulders the head may descend but the
shoulders can be too wide to pass through the mother’s pelvis without
medical intervention. This phenomenon, known as shoulder dystocia, is the
prime concern in diabetic pregnancies which proceed to labour. It was
described by Dr Philip Owen, an expert witness who gave evidence on behalf
of the Board, as “a major obstetric emergency associated with a short and
long term neonatal and maternal morbidity [and] an associated neonatal
mortality”.
9. That evidence is consistent with guidance issued by the Royal College of
Obstetricians and Gynaecologists, which states that there can be a high
perinatal mortality and morbidity associated with the condition, even when it
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