Use of saline as placebo pain relief during labour

Health and Disability Commissioner Anthony Hill today released a report finding a midwife in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for giving a woman intravenous saline as a placebo instead of the requested pethidine.

The midwife was the lead maternity carer (LMC) for a pregnant woman and recorded in the woman’s birth plan that the woman would use pethidine for pain relief in labour if needed. When the woman was in labour and requested pethidine, the midwife gave her an intravenous bolus of saline but told her it was pethidine.

Anthony Hill described the midwife’s conduct as "disgraceful" and said that by not providing the woman with the medication she had requested and agreed to receive, the midwife ignored the fundamental importance of consent.

"It was the woman’s right to make an informed choice about the pain relief she was to receive, and not to be given IV normal saline when she had not consented to this," Anthony Hill said.

"The midwife’s conduct in misleading her client during labour by administering saline and telling her that it was pethidine was not only dishonest, but also showed a concerning degree of paternalism.

"Such behaviour by a midwife is an abrogation of the essential partnership between the midwife and her client, which lies at the heart of the midwifery model in New Zealand.

"The principle of informed consent is at the heart of the Code. Services may be provided to a consumer only if that consumer makes an informed choice and gives informed consent. It is the consumer’s right to decide and, in the absence of an emergency or certain other legal requirements, clinical judgement regarding best interests does not apply."

Mr Hill recommended that the midwife undergo further training with regard to the Code of Rights, informed consent, and communication with clients, and that the Midwifery Council of New Zealand consider whether she should undertake a competency review. He also recommended that she provide a written apology to the woman.

The midwife has been referred to the Director of Proceedings.

The full report for case 18HDC01578 is on the HDC website.

ENDS

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