In our recent Ask the Experts session, we were joined by PAO UK trustee and medical negligence lawyer Jamie Green from Fieldfisher. The aim of the evening was to help mums affected by Pregnancy Associated Osteoporosis feel informed, reassured and clearer about their rights. This blog brings together the key points from that discussion.

You have the right to be heard

One of the most important messages from the session was this: you do not have to accept poor treatment or dismissive responses.

If something does not feel right, you have the right to:

• Ask questions about your care

• Seek a second opinion

• Request referral to a different hospital

• Ask for further investigations

• Make a formal complaint.

Many women with PAO describe repeated GP visits with severe back pain, loss of height or difficulty caring for their baby, only to be told it is “normal after pregnancy”. Jamie acknowledged how hard it can be to challenge medical professionals, especially at such a vulnerable time. But legally and practically, you are entitled to answers.

Self advocacy can also extend beyond medical care. It includes applying for benefits, asking for additional support at home and seeking counselling if needed.

Jess’s Rule: Three visits should trigger a rethink

A hopeful development here is Jess’s Rule, sometimes described as “three strikes and we rethink”. It is an NHS England and DHSC initiative for GP teams. If a patient comes back three times with the same or escalating symptoms, and the problem remains unexplained or not improving, the GP team is encouraged to reflect, review and rethink. That might mean arranging a face to face appointment if previous consultations were remote, carrying out a physical examination, seeking a second opinion, ordering tests, or referring on to specialist care. For PAO mums who have had repeated appointments for severe pain, reduced function or other red flags, Jess’s Rule is a useful phrase to know and to mention, because it supports the principle that persistent symptoms deserve a fresh look and proper investigation.

What is medical negligence?

Medical negligence is not simply about a bad experience. The legal test is strict.

To bring a successful claim, you must show:

1. That no reasonably competent doctor would have acted in the same way

2. That this failure caused additional harm or loss.

With PAO, most potential claims do not argue that a doctor should have known about the condition itself. PAO is rare and still poorly understood in many medical settings.

Instead, claims usually focus on delayed referral.

For example:

• A woman presents multiple times with severe, unresolved back pain

• Physiotherapy does not help

• Pain continues or worsens

• There may be loss of height or visible spinal changes

• Yet no imaging is arranged.

In those cases, the argument is not “You should have known it was PAO”. It is “You should have investigated further because something was clearly wrong.”

If earlier scans would have led to earlier diagnosis and treatment, and that would likely have prevented further fractures or long-term complications, there may be grounds for a claim.

Is there a time limit to bring a claim?

Yes. In most cases, you have three years.

This runs from either:

• The date of the negligence, or

• The date you became aware that your treatment may have been negligent.

In delayed diagnosis cases, the second point is often more relevant. If you were only diagnosed within the last three years, you may still be within time, even if symptoms started earlier.

If you are close to the three year mark, it is important to seek advice promptly.

Can there be a collective claim for PAO?

At present, this is unlikely. Each woman’s case is different. Causes, medication history, number of fractures and long-term impact vary significantly.

Until national guidelines require doctors to warn about bone health risks in certain situations, it’s difficult to argue that failure to warn amounts to negligence on a group basis.

However, as research develops, particularly around medications such as low molecular weight heparin, this landscape may evolve. Building evidence is a key part of the charity’s wider mission.

The complaints process

You do not have to bring a legal claim to raise concerns.

If you wish to complain:

• Put your complaint in writing

• Focus on clear, factual questions

• Avoid letting the response become sidetracked into general apologies about communication

• Follow-up to ensure it’s being processed.

For example:

“I presented six times over three months with severe back pain that was not resolving. Why was I not referred for imaging?”

You can request a meeting after receiving a written response. If you do, take someone with you whose sole role is to take notes. These meetings can feel intimidating, and having a written record is helpful.

Importantly, you do not have to make a complaint before starting a legal claim. The two processes are separate.

Does the rarity of PAO make claims impossible?

Not impossible. But harder.

Because PAO is rare and often not widely known, it’s currently difficult to argue that doctors should automatically suspect it or warn about it.

This is why the charity’s work around awareness, research and national guidelines is so important. The more evidence that exists about risk factors and early signs, the stronger future arguments become.

What about informed consent and medication risks?

Some questions focused on medications such as heparin and whether women should be warned about risks to bone health when used for a prolonged period.

The law around consent has become more patient focused in recent years. Doctors must warn about material risks that a reasonable patient would want to know.

However, very rare risks are not always required to be discussed, particularly if the alternative carries a higher and more immediate danger, such as blood clots after surgery.

As research grows and clearer links are established, this may change. Advocacy at policy and guideline level is essential.

What compensation covers

Compensation is not about punishment. It aims to reflect loss.

There are three broad categories:

1. General damages for pain, suffering and loss of amenity

2. Past financial losses, such as lost earnings or care provided by family

3. Future losses, including reduced earning capacity or long-term care needs

Every case is highly individual. The difference between what actually happened and what would probably have happened with earlier diagnosis or alternative medication is central.

When there is no legal claim

Several women described situations where diagnosis only occurred because they strongly advocated for themselves.

In those cases, if no additional harm resulted from delay, there may be no viable negligence claim. The law requires proof of loss.

However, that does not mean concerns are invalid. Complaints can still be powerful tools for education and change.

Moving forward

The discussion ended on a shared understanding.

The law is one route to accountability. But awareness, research, guideline development and collective advocacy are equally important.

PAO UK continues to work towards:

• Greater professional awareness

• Clearer information about risk factors

• Better early referral pathways

• Stronger national guidance

• Support for women navigating complaints and legal questions.

Most importantly, no woman should feel dismissed or alone.

If you have questions about your rights, consider speaking to a specialist solicitor with experience in medical negligence. And if you would like support or shared experiences, PAO UK is here. Jamie, who led this webinar and is one of our trustees, would be happy to answer any questions you have.

Together, through informed conversation and continued advocacy, we can work towards earlier recognition, better treatment and fairer care for all women affected by Pregnancy Associated Osteoporosis.

Download a PDF with more information on your rights here.

Read our blog: Comments from PAO UK on The UK Government’s 10-Year Health Plan for England: ‘Fit for the Future’