Mother "butchered" during home birth

Interested in home birth, hospital birth or private midwifery care? Questions or comments? Email Melissa Maimann or call 0400 418 448. Link

A mother was left needing reconstructive surgery after ... trying to deliver her baby ...

Victoria Anderson needed extensive plastic surgery after [her] ... midwife 'randomly hacked' at her and her 12lb baby with a pair of scissors.

Little [baby] Daisy was cut and pulled so forcefully during her birth that the nerves in her neck and arm were completely severed. She is disabled as a result.

The Nursing and Midwifery Council yesterday heard that Mrs Anderson, 39, employed [the midwife] to deliver her third daughter at her home ...

Mrs Anderson ... wanted the deal with the same midwife throughout her pregnancy.

However, she had developed diabetes while pregnant and as a result baby Daisy had grown to an enormous 12lb inside her womb.

... 'I got in the birthing pool but I was struggling to get the head out.

'I've got a history of having big babies so I asked [my midwife] to cut me to get the baby out.

'She did cut me and I could see the head so I thought I was home and dry - but then nothing happened.

'I thought I would deliver the shoulders and Daisy would be out but suddenly [my midwife] started to get stressed.

... When Daisy eventually arrived she had lost colour through a lack of oxygen and so was put in an ambulance and rushed to hospital.

... 'It seemed to me that [our midwife] was wrestling with the head ...

'I remember lots of cuts and ... blood. The last thing I remember before the baby was born was [our midwife] putting both hands inside Ms A and just pulling her out.'

Mrs Anderson, who has three other daughters, told the panel that her bowel had been permanently damaged during the procedure and she has since had to have extensive reconstructive surgery.

Her daughter Daisy suffers from Erb's palsy, a condition which causes paralysis ...

After the birth the Andersons tried to sue Mrs Rose, but they were told they could not pursue the claim as the midwife did not have indemnity insurance ...

It is not available for independent mdiwives in the UK, the same as it is not available for Australian independent midwives.

... [The midwife] is charged with inducing the birth when there was no medical reason to do so; not recognising sooner the labour could be an obstetric emergency; failing to call for immediate assistance; failing to ensure a second midwife was present and failing to follow protocol.

If found guilty of misconduct, she could be banned from working as a midwife ...

Readers of this blog will know by now that I put up articles on the good, the bad and the ugly. Let's take this apart and understand what has happened here.

A woman engages the services of a midwife for a planned home birth. No problem there. However, she developed gestational diabetes. Automatically, this places the woman and her baby at an increased risk and by hospital standards, this birth ought to have occurred in hospital. For some reason it didn't: either the woman was advised of the risks and decided to remain home (let's not forget that in the UK, women have the right to a midwife-attended home birth) or the midwife had assessed that in this case, a home birth was a reasonable and safe option.

Certainly, diabetes that is well controlled may guide the midwife to believe that home birth is a safe option. Provided that the baby is not too big, the fluid volume is normal, the glucose levels are normal and the blood pressure is normal ... home birth could be a reasonable option.

However, in this woman's case her baby was very large. Maybe the midwife thought the baby was a normal size; maybe she thought it was big, told the mother and the mother wanted to continue with her home birth plans. The article does not make this clear.

So now we fast forward to the birth. The head is not born easily and the woman and midwife are concerned. The woman asks the midwife to perform an episiotomy and the midwife does this. There is difficulty with birthing the head even after the episiotomy and the shoulders are well-and-truly stuck. The midwife cuts another episiotomy and moves the woman to an all-fours position which is useful for freeing stuck shoulders. Eventually, with much manoeuvering, the baby is born, needing resuscitation (as we would expect) and with nerve damage (also expected as a consequence of shoulder dystocia).

What else could the mdiwife have done once in that situation? Nothing really! The baby has to be born and it was not coming with maternal effort; assistance was needed and it sounds like the midwife provided the appropriate assistance. Of course this was and is terribly stressful for the parents and the midwife.

The midwife is uninsured and the parents cannot sue her. They now have a child who needs medical care, and a mother who needs surgery and they have no funds to access to cover their costs. The midwife will most likely lose her registration.

What could have been done differently? This pregnancy could have been considered to be high risk: a woman with gestational diabetes and a large baby. Had the birth occurred in hospital, perhaps the same outcome would have occurred. It would have been prevented by caesarean section which might have been offered in hospital, but would the woman have accepted a caesarean after having 2 or 3 other vaginal births? We'll never know the woman's wishes for her birth. Perhaps hospital birth was offered or advised and the woman declined. The midwife remained with the woman and acted appropriately given the emergency situation that she was faced with. What more could she have done?

Follow-up from this piece: I have since learned that the midwife was de-registered. She did not attend the hearing.

Melissa Maimann, Essential Birth Consulting 0400 418 448