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Response to woman’s presentation during labour (11HDC00123)

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(11HDC00123, 9 June 2014)

Lead maternity carer ~ Staff midwife ~ Birthing centre ~ Labour ~ Assessment ~ Monitoring ~ Referral to hospital ~ Transfer ~ Right 4(1)

A woman, pregnant with her first child, contacted her Lead Maternity Carer (LMC) at 2am one morning when she was 38 weeks pregnant and was experiencing three contractions every 10 to 20 minutes. She planned to deliver at the public hospital, but the LMC was at a birthing centre with another client and suggested that the woman meet her there for assessment.

The woman's friend drove her to the birthing centre at 4am. As her LMC was still occupied with the other client, the woman was initially assessed and monitored intermittently by two staff midwives on duty at the birthing centre. The woman advised that she had constant and severe pain throughout her time at the birthing centre. However, the midwives advised that the woman was not presenting unusually in terms of her pain.

The woman's pulse rate and the monitoring of the fetal heart rate were not reassuring. Both midwives recorded that they advised the LMC several times of their concerns about the woman's clinical presentation.

At 5.20am, the LMC's back-up midwife was paged and arrived at the birthing centre at 6am. She stated that the woman was distressed and was not in normal labour. At 6.25am, the LMC conducted a vaginal examination and referred the woman to hospital. The LMC instructed the woman's friend to drive the woman to hospital, without any midwifery support.

When the woman arrived at hospital, the hospital midwife and nurse recorded that the woman had constant and severe abdominal pain. The woman suffered a placental abruption and required emergency care. Sadly, her baby was stillborn.

It was held that the two staff midwives' assessment and monitoring of the woman was fragmented and incomplete. They failed to respond appropriately to the woman's presentation and breached Right 4(1).

It was held that the LMC failed to take appropriate action to assess the woman at the birth centre, in response to the concerns that were relayed to her about the woman's presentation. In addition, the LMC's decision to transport the woman by private car without any midwifery support was inappropriate in the circumstances. For these failures the LMC breached Right 4(1).

It was also held that the absence of clear policies contributed to the delay in the actions of the staff midwives, particularly in light of their ongoing concerns about the woman's presentation. The birthing centre breached Right 4(1). 

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