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Management of an undiagnosed breech delivery (08HDC10923)
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(08HDC10923, 11 September 2009)
Midwife ~ Senior midwife ~ New graduate midwife ~ Labour and
delivery ~ Breech presentation ~ Water birth ~ Standard of care ~
A woman was admitted in labour to a primary maternity unit where
she was met by her lead maternity carer (LMC) midwife, a new
graduate. The LMC performed a vaginal examination to assess the
progress of the woman's labour, and felt small bumps to one side of
the cervix. The LMC was not sure what they were and contacted her
senior midwife mentor to discuss her findings. She asked the senior
midwife to come to the unit to support and assist her, and when she
arrived about an hour later, the woman was in a birthing pool.
Shortly afterwards, the LMC attempted to perform a vaginal
examination, but because of the woman's position in the pool she
had difficulty adequately feeling the cervix. However, she was
still able to feel the bumps. The LMC obtained the woman's
permission for the senior midwife to examine her, but when asked to
do the examination the senior midwife refused to do so, telling the
LMC that she was "doing fine". A few minutes later, when the LMC
again examined the woman vaginally, she found that the woman's
cervix was fully dilated and the "bumps" were still evident.
Fifteen minutes later, the woman pushed with a contraction and it
was apparent that the baby was in the breech position. The senior
midwife notified the duty midwife that there was an imminent
delivery of an undiagnosed breech, and asked for oxygen.
The baby was born 22 minutes later, flat and unresponsive. The
emergency bell was rung and medical assistance arrived within seven
minutes, but the baby could not be resuscitated.
It was held that the senior midwife failed to act with
reasonable care and skill when she declined to examine the woman at
the LMC's request, and breached Right 4(1). It was noted that even
if she had examined the woman at this time, it would not have
altered the care they provided from that point, or the outcome.
It was also held that the LMC took reasonable steps to follow up
her unusual findings by seeking the senior midwife's assistance.
Although she was falsely reassured, her actions were appropriate in
the circumstances and she did not breach the Code. She provided
adequate information and appropriate antenatal care. She did very
well, with the senior midwife's assistance, to manage the actual
The case highlights the importance of effective mentoring,
support and oversight for new midwives and the duty of care owed by
the mentoring midwife to the consumer. The mentoring midwife acts
as a safety net and is not simply a bystander.