Human Rights Review Tribunal, [2017] NZHRRT 11, (3 April 2017)
The Director of Proceedings filed proceedings by consent against a midwife, Priscilla Punita, in the Human Rights Review Tribunal. Ms Punita accepted that her actions amounted to breaches of the Code of Health and Disability Services Consumers’ Rights (the Code) and the matter proceeded by way of an agreed summary of facts. The Tribunal was satisfied that Ms Punita failed to provide services to the aggrieved person with reasonable care and skill, and that complied with legal, professional, ethical, or other relevant standards. The Tribunal issued a declaration that Ms Punita breached Rights 4(1) and 4(2) of the Code.
Ms Punita was an independent midwife and the Lead Maternity Carer (LMC) for Ms S’s second pregnancy. Ms S had previously had an emergency Caesarean section due to failure to progress and fetal distress. Ms S discussed with Ms Punita her wish to try for a vaginal birth after Caesarean (VBAC). At a subsequent visit with the hospital obstetrician, Ms S was advised of the need for continuous electronic monitoring of the fetal heart rate (FHR) during her labour using a cardiotocograph (CTG) due to the risks associated with VBAC, in particular uterine scar rupture and fetal distress. On admission to hospital at the onset of labour, Ms S advised the hospital midwife of the obstetrician’s advice for continuous CTG monitoring. Not long after instituting CTG monitoring the trace recorded decelerations in the FHR below normal levels before slowly recovering to a normal rate. Ms Punita arrived and after about 30 minutes she discontinued the CTG knowing that this was contrary to accepted professional guidelines regarding decelerations of the FHR, contrary to the hospital’s policy for VBAC deliveries, and contrary to the obstetrician’s advice that Ms S be electronically monitored continuously. Before discontinuing the CTG Ms Punita failed to identify the trace as suspicious. Ms Punita also failed to communicate effectively and appropriately with Ms S, and failed to provide her with any information to enable Ms S to make an informed decision about discontinuing the CTG. Ms Punita then left the room and had no contact with Ms S for over an hour. Eight hours after discontinuing the CTG, Ms S’s baby was delivered by ventouse suction cup. He was pale, floppy, not breathing, and covered in fresh meconium (fetal stool). Sadly, after full intensive management, Ms S’s baby died.
According to expert midwifery advice, Ms Punita failed to monitor the fetus adequately throughout labour. It is standard practice to continuously monitor the FHR electronically with known risk factors like Ms S's. The suspicious nature of the admission CTG should have acted as a warning to Ms Punita, indicating the need for increased surveillance. Expert advice was that if continuous CTG monitoring had taken place, then it is very likely that changes in the FHR would have alerted health professionals to the need for earlier intervention, with the probability that death could have been avoided.
The Tribunal’s full decision can be found at:
http://www.nzlii.org/cgi-bin/sinodisp/nz/cases/NZHRRT/2017/11.html?
Last reviewed February 2019