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Assessment of woman in preterm labour (13HDC01460)

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(13HDC01460, 12 June 2015)

Lead maternity carer ~ Community-based midwife ~ Assessment ~ Preterm labour ~ Rights 4(1), 4(2)

A woman who was pregnant with her fourth child, began feeling what she thought felt like labour pains at 26 weeks' gestation. The woman contacted her back-up LMC midwife who met the woman at hospital and carried out an assessment.

The midwife felt that the woman had a urinary tract infection (UTI).  The woman did not produce a urine sample at that time, so the midwife asked her to bring back a sample for testing. The midwife did not perform a speculum examination, or discuss this option with the woman. The woman went home and, later that afternoon, her partner took her urine sample to the hospital to be tested.

Later that evening the woman went to the hospital complaining of lower abdominal pain. The woman was seen by a doctor, who noted the woman's history, including that she had been seen by her midwife that morning and that the midwife did not consider that the woman was showing any signs of pre-labour. He noted that the urinalysis indicated infection, and wrote a prescription for antibiotics. The woman then returned home.

Just after midnight, the woman called an ambulance because her pain was getting worse and she was transported back to the hospital for assessment. At the hospital the woman was noted to rate her pain at a score of 12 out of 10. Nursing staff contacted the midwife to come in to assess the woman.

The midwife arrived and carried out an assessment. The midwife then contacted the on-call obstetrician at the closest tertiary hospital, and the decision was made to transfer the woman to the tertiary hospital. Because of availability, there was a delay of one hour in the ambulance arriving. The midwife did not carry out a speculum assessment at that time.

The woman arrived at the tertiary hospital later that morning and her baby was born soon after by vaginal delivery. However, sadly, the baby died owing to problems associated with his extreme prematurity.

It was held that the midwife failed to assess the woman's symptoms critically, and she gave insufficient consideration to the possibility that the woman was in labour. Accordingly, it was held that the midwife did not provide services to the woman with reasonable care and skill and breached Right 4(1).

By failing to comply with professional standards with regard to the documentation of her assessments and care of the woman, the midwife also breached Right 4(2).

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