Tuesday, October 09, 2007

Another baby dies a preventable death at homebirth

In what is becoming a horrifyingly repetitive event, another baby died of preventable causes at a homebirth, this time in New Zealand. The midwives have been censured by the New Zealand Health and Disability Commisioner who responded to the parents' request for an investigation. The midwives failed to call for back up when they could not hear the fetal heart, and the baby was born with a pulse of 60 bpm 30 minutes later. Resucitation efforts, which, of course, did not include intubation, were unsuccessful. Only then did the midwives call for an ambulance.

According to the Health and Disability Commisioner report, the midwife stated:
[The mother] continued changing positions frequently until the head remained visible from 5.12am ...

I noted that the head was staying visible at this time. At this point [Ms E] attempted to find the heartbeat but was unsuccessful.

After the next 2 contractions, [Ms G] and I tried separately to locate the heart beat, but could not.

We were reassured that the [baby’s] heart had likely passed behind the pubic bone and we could visualise that the head was a healthy purple colour.

[Ms E] verbalised to the family that the heart rate was difficult to locate as is common at this stage of labour because the baby’s heart passes behind the pubic bone. From this point [the mother] was strongly encouraged to increase her pushing efforts.

The baby’s head was born at 5.37am, but the FHR could not be located. His birth was complicated by a shoulder dystocia. In response to my provisional opinion, [Ms E] stated that she "applied manoeuvre and traction". At 5.45am, [the baby] was delivered weighing 3.93kg.
The midwife continued:
At birth it was noted that [the baby] had no tone, no refle[x], made no effort to breathe, was blue and had a heart rate of 60bpm...

[Ms G] was unable to detect a pulse in the cord and so listened with the stethoscope. [The baby] was immediately stimulated and I attempted to inflate his lungs with oxygen bag and mask, but was unable.

[Ms E] then suctioned a significant amount of mucous from [the baby's] mouth and nose and successfully started artificial respiration. At this time the heart [rate] was low and I began chest compressions. [Ms E] and I continued CPR.

I reassessed [the baby's] heart rate and stopped chest compressions because it was 120–140. [Ms E] continued bagging because he had made no effort to breathe on his own.
The report continues:
At 6am, the ambulance arrived while Ms E and Ms D continued their attempts to resuscitate [the baby]. At 6.10am, the cord was clamped and cut, and there was no pulse in the cord. [The baby's] HR fluctuated between 80–140bpm, and he was toneless. At 6.15am, it was noted that [the baby] was becoming cold, and attempts were made to warm him with hot towels, hot water bottles, and skin-to-skin contact with [the father]. No HR was detected at 6.20am. At 6.23am, the ambulance departed from [the mother] and [the father's]home... Shortly afterwards, at 6.28am,the ambulance arrived at hospital.

On admission to the hospital's Emergency Room, [the baby] was intubated and manually ventilated, and Ms A delivered the placenta with the ward nurses' assistance. He was then transferred to the neonatal unit for review. The paediatric team advised [the mother] and [the father] in the presence of Ms D, Ms E and Ms G that [the baby's]prognosis was poor, and a decision was made to withdraw active treatment. The ventilator was disconnected and, after several intermittent gasps, [the baby] died in [his mother's] arms at 10.40am.
So once again a baby has died because homebirth midwives failed to properly monitor the baby, failed to react to fetal distress, failed to call for back up in a timely fashion, and could not perform an expert resuscitation.


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