Antenatal and intrapartum care provided by midwife

The Health and Disability Commissioner released his findings into a complaint about the care provided in 2011 by a midwife to a 24 year old woman in the third trimester of her first pregnancy. The midwife took over the woman’s care at 38 weeks’ gestation, as the woman’s Lead Maternity Carer had gone on leave.

A week before her due date, the woman sent the midwife a text message expressing concerns about a lack of fetal movement. The midwife responded via text message, advising the woman to drink ice-cold water and sit quietly on the couch to feel the baby move. The midwife did not follow up her advice or the woman’s concerns that day.

A day or two later, the woman met the midwife and a student midwife for the first time for an assessment. It was noted that the fetal movements were not as hard as they had been previously. Both midwives had difficulty detecting the fetal heart rate (FHR), but the midwife said that she eventually heard it “in the background”.

At around 3am the next day, the woman began having contractions. At 2.20pm the midwife and student midwife assessed the woman at her home. Again, the midwives had difficulty finding the FHR. Although the woman was in established labour, the midwives left her, advising her to call them when she felt bowel pressure.

At 7.35pm, after being advised that the woman was feeling bowel pressure, the midwives returned to the woman’s home. They could not find the FHR and, when meconium was discovered, decided to transfer the woman to hospital. The woman’s membranes had ruptured and she was in advanced labour. Her mother drove her to hospital, while the midwives drove separately. The woman was on all fours in the back seat, having contractions close together. The woman’s mother started panicking and got lost on the way to hospital. At one point, they crashed through a barrier and the woman fell off the back seat. The woman gave birth to her baby minutes after arriving at the delivery suite. Sadly, the baby was born with no heartbeat or respiratory effort, and resuscitation was unsuccessful.

The Commissioner found that the midwife breached the Code of Health and Disability Services Consumers’ Rights in several respects. She should not have responded to the woman’s concerns via text message without also calling her to clarify and follow up her concerns. She failed to check the maternal pulse and arrange a CTG when the woman reported reduced fetal movement. She left the woman in established labour when the FHR was still difficult to find, instead of staying with her to monitor the maternal and fetal well-being. Furthermore, the midwife left the woman unsupported in travelling to the hospital when she was about to give birth.

The midwife was referred to the Midwifery Council for a review of her competence. She was also referred to the Director of Proceedings, for the purpose of deciding whether any proceedings should be brought against her. No decision has been reached yet by the Director of Proceedings.

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