5 Mar 2018

Couple "shocked" midwife left before stillbirth

4:53 pm on 5 March 2018

A mother who was left to give birth to her stillborn baby without her midwife present has had her complaint upheld.

A file photo shows a midwife with a pregnant woman.

Photo: 123RF

In a report today, the Health and Disability Commissioner, Anthony Hill, said the unnamed, self-employed, community-based midwife, who was the woman's lead maternity carer in 2014, breached four separate patient rights.

The woman was pregnant with her third child, but problems began at 22 weeks with vaginal bleeding and contraction-type pains. A hospital midwife was unable to detect a fetal heartbeat, after which the midwife, RM B, tried to contact an on-call obstetrician.

However, she failed because she dialled an incorrect number.

An ultrasound scan later that day confirmed the intrauterine fetal death - a stillborn baby.

After the scan, RM B delivered the woman and her husband home and told them to contact her as needed. She also left leaflets with them about miscarriage and stillbirth but "did not find or make a time to review these materials" with the couple or address any subsequent issues.

Mr Hill said the couple were "shocked" when the midwife left. Labour continued and the mother delivered what she thought was the placenta.

"I was frightened as I did not know what to expect, and in a lot of pain, my husband was terrified as he did not know what to do."

They phoned the midwife who returned and set about locating the placenta. She realised there was more when she went out to the porch of their house, according to Mr Hill, and "found the baby and most of the placenta complete in its sac in a container".

The mother, Mrs A, was admitted to a hospital birthing suite where, she told Mr Hill, "staff couldn't have been more caring and professional. They gave us all the info we needed and [made] sure I was in no medical danger".

At the time of the events RM B had been a practising midwife in New Zealand since 2008 and had been working as a self-employed lead maternity carer for two years.

She told Mr Hill: "It remains a regret of mine that I did not definitively identify, one way or another, that [Mrs A] had birthed her baby."

She accepted that she could have been more forceful with her early recommendation that Mrs A could have consulted an obstetrician or hospital clinical charge midwife following the scan. As well, she accepted that better documentation of events at the time they occurred was needed, but rejected as unacceptable any suggestion that she had abandoned Mrs A at home following the stillbirth diagnosis.

But Mr Hill said the community midwife failed in several respects. She did not provide Mrs A with adequate information to enable her to make an informed decision about her care, including information detailing her condition and the risks of delivering the fetus at home, and her option to deliver the fetus in hospital".

She also "did not consult with an obstetrician when she was outside her scope of knowledge and experience in relation to stillbirth". And she "failed to identify the need to request emergency services for Mrs A when she believed that a piece of the placenta had been delivered prior to the fetus."

He said the midwife had retired from midwifery practice and did not intend renewing her practising certificate. Should she return to practice, the Midwifery Council should review her competence. Meantime, he intended to refer her to the independent Director of Proceedings to decide if follow-up legal action was needed.