Thursday, September 20, 2007

Midwives' skills criticized after baby dies

Do you notice a tragically recurring theme here?

From today's Belfast Telegraph:
A coroner has criticised the skills of midwives who he said could have saved the life of a newborn baby boy if they had acted earlier...

Paul was born in Antrim Area Hospital "in poor condition" with the umbilical cord wrapped three times around his neck. Attempts to resuscitate him were unsuccessful.

He was transferred to the Neonatal Unit, but died four days later from Ischaemic brain injury...

The inquest revealed that during labour the midwives failed to spot a drop in the baby's heart rate through the cardiotocograph (CTG)...

Mr Leckey said: "If fetal heart traces had been interpreted correctly and medical assistance sought promptly, opportunities existed for the earlier delivery of the baby... Earlier intervention would have improved the chances of survival."
Within the past month there have been newspaper reports of 4 preventable perinatal deaths. The deaths differ in location, attendant, and in precipitating cause, but they are united by the same themes: all four involved failure to recognize or manage complications in a timely fashion; all four could have been averted with a C-section; in all 4 cases, had a C-section been done early and resulted in a healthy baby, the C-section would have appeared in retrospect to have been "unnecessary". In other words, had the attendants practiced "defensive medicine", those babies would have had a much higher chance of survival.

The consequences to the parents are devastating, but the consequences to the attendants are quite serious as well. In all four cases the attendants have been the focus of public investigations, public censure, and potential loss of license. I can assure you that none of them can use the high C-section rate as a defense in administrative hearings, disciplinary hearings or a court of law. I can assure you that none of the parents are comforted to know that they won't have to worry about VBAC (one woman actually had a C-section AND lost her baby). Newspaper accounts have indicated that none of the parents have taken the position that "sometimes babies die".

So I ask critics of the high C-section rate:

Which are the unnecessary C-sections?

If you can't even tell me which ones are unnecessary after the fact, how on earth are we supposed to know which ones are unnecessary before the fact?

How "trustworthy" was birth in these circumstances?

Where is the tolerance for the type II errors that are inevitable when you don't practice defensive medicine?

Which message is the public sending: "A few perinatal deaths are acceptable as the consequence of lowering the C-section rate." OR "Any perinatal death that might have been prevented with a C-section is totally unacceptable and will result in public investigation and public censure."?

Which parents accepted the death of their child with fatalism?

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