29 Jan 2020

Poor heart monitoring during birth reignites calls for mandatory training

5:05 pm on 29 January 2020

Doctors are backing calls by the Health and Disability Commissioner for mandatory training on foetal heart monitoring after two botched births at Hutt Hospital, which left one baby dead and another with brain damage.

Newborn baby feet with identification bracelet tag name.

Photo: 123RF

Perinatal and Maternal Mortality Committee former chair Dr Sue Belgrave said it made the same recommendation several years ago - but only some district health boards had taken it up so far.

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists provided a training programme but it was up to DHBs to give staff time to do the courses, she said.

"It's a big ask to make it absolutely mandatory but we believe that it's really important.

"It's important that people are talking the same language - that when you describe something, you are describing the same thing that will be understood by the person listening to it."

The problems with poor monitoring during labour have long been known, she said.

The Perinatal and Maternal Mortality, an independent committee that reviews the deaths of babies and mothers, set up a working group to look at foetal monitoring several years ago that made various recommendations.

ACC, which pays out many millions of dollars each year to the families of children with brain injuries, then took up the work.

It set up the Neonatal Encephalopathy Taskforce, which met with midwives and obstetricians and developed more recommendations, which are currently under consideration.

Dr Belgrave was confident that a national foetal surveillance education programme would soon become a reality.

"And I strongly believe that will improve some of the issues that have been highlighted in these reports."

Midwife shortages and pressure on resources like operating theatres were "a constant source of anxiety" for specialists working in hospitals, she said.

However, the tragic Hutt Valley cases showed it was not just about knowledge but also communication and teamwork.

"Everyone wants a healthy baby, but labour is a somewhat unpredictable time.

"When we've looked at these cases, the majority of them are basically people not recognising deterioration when it occurs and perhaps not escalating as fast as they might be and a delay in the delivery of the baby. And those are the issues we would like to address."

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