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Care provided during labour to patient with large baby (09HDC01592)
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(09HDC01592, 31 January
Obstetric registrar ~ Midwife ~ District health board ~
Maternity Care ~ Monitoring ~ Care and skill ~ Professional
standards ~ Rights 4(1), 4(2)
At 37 weeks gestation, a growth scan revealed that a woman's
unborn baby was large for gestational dates. The lead maternity
carer (LMC) consulted a specialist and delivery at hospital was
recommended. The woman went into spontaneous labour and was
assessed by the locum midwife because her LMC was on leave.
Following assessment, the midwife recommended transfer to
A CTG was commenced when the woman arrived at the hospital. The
midwife noted concerning features on the CTG and called the
obstetric registrar for review at 2.40am, 4.10am, 4.20am, and 6am.
Following the 4.20am review the obstetric registrar noted a
"suspicious but not pathological pattern" on the CTG which he
considered to be due to maternal dehydration. The obstetric
registrar identified no other concerns and was satisfied that
everything was progressing normally.
The hospital midwife was aware that meconium had been present
after the woman's membranes were ruptured. She remained concerned
about the CTG readings. Despite not being reassured by the
registrar's assessment and feeling "fearful of the outcome of the
delivery", the midwife did not contact the on-call consultant.
At 7.05am, the baby's head was delivered but the delivery was
obstructed by shoulder dystocia. An emergency call was made and
after approximately five minutes the baby was born. Resuscitation
was commenced but the baby's response was not favourable. The baby
was transferred to a specialist neonatal unit but died a short time
It was held that the hospital midwife acted appropriately in
consulting with the duty obstetric registrar when she was concerned
about the CTG trace. However, the hospital midwife failed to
escalate matters further when she remained concerned. In not
doing so, the midwife failed to provide the expected standard of
services to the mother and her unborn child, and was held to have
breached Right 4(1).
The obstetric registrar was also held to have breached Right
4(1) because he misread the CTG trace and failed to take
appropriate clinical action. In addition, he breached Right
4(2) by failing to follow the relevant policies on CTG
Adverse comment was made about a breakdown in the DHB's booking
system and the existence of a hierarchy at the DHB which may have
got in the way of good team work and the best interests of the
mother and baby.
The antenatal care provided by the LMC and locum midwife was
held to be appropriate.