Thursday, November 29, 2007

Homebirth death of a breech baby

Yet another homebirth death has occured. From Midwife Is Suspended After Death of Baby During Difficult Home Birth:
A baby died during a breach birth after a midwife over-estimated her ability to deal with the difficult home labour, an inquiry has heard.Nurse Julie Duthie tried to deliver the child on her own at the mother's home two miles from the Royal Devon & Exeter Hospital.

She was forced to call for help but two back-up midwives and an ambulance crew took 20 minutes to arrive, it was claimed at the Nursing and Midwifery Council hearing in London yesterday...

Duthie also failed to follow a supervision plan drawn up by her superiors, and failed to tell them the baby was more than 4kg after scans in August, it is claimed. A breach birth carries more risk if the baby is large.

Mr Hafejee said: "There was insufficient preparation for delivery and resuscitation. Crucial information about the baby's weight was withheld and not communicated to a supervisor who was in a position to offer assistance."

Duthie told the NMC panel she had tried to arrange a vaginal birth at the hospital but it had refused because it was not the safe option...

On the day the mother went into labour, Duthie was called at about 10.30pm and arrived to find the baby was in breach as expected. But as it emerged feet first, the arms became stuck near the head.

Duthie told the hearing: "There was no sign of the arms coming down, no sign of elbows appearing, the arms were extended upwards. I tried to turn it but I couldn't."

She said she tried several movement techniques to get the arms down but the baby became stuck...
It sounds like the complication was nuchal arms, where the arms become locked behind the baby's head. This is probably the most dreaded complication of vaginal breech delivery.

The hospital had refused vaginal delivery of this patient because doctors believed it was not a safe option. The midwife and the patient decided to go ahead anyway, further increasing the danger. It is important to understand that this same complication could have occured in the hospital and had equally tragic results. That's why the doctors recommended C-section, in order to avoid precisely this outcome.

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