Care and information provided to a pregnant woman
Deputy Health and Disability Commissioner Rose Wall today released a report finding a midwife in breach of the Code of Health and Disability Services Consumers’ Rights (the Code) for the care provided to a pregnant woman. Ms Wall’s investigation focused on the woman’s decisions around the birth of her baby, and the information she received and understood, when making those decisions.
"It is essential that women receive full and balanced information about risks and care options," Ms Wall said.
At 32 weeks’ gestation, the woman transferred care to the midwife as her lead maternity carer to have a home birth, with a "Plan B" for a hospital birth or a Caesarean section if necessary.
At 41+1 weeks’ gestation the midwife noted the baby’s growth had slowed, which indicated the need for obstetric consultation and an ultrasound scan. While a scan was offered, Ms Wall found that the midwife failed to communicate effectively that this offer was made because the baby’s growth had slowed. Further, Ms Wall found that the midwife failed to follow the actions set out in the Ministry of Health Referral Guidelines when her recommendation for a scan was declined.
Ms Wall also found that the midwife failed to provide the woman with adequate antenatal notes during her pregnancy.
When labour at home did not progress, the midwife offered a transfer to hospital but also referred to the on-call obstetrician at the hospital as "Mr Slice and Dice". Ms Wall found that the midwife failed to communicate effectively that the transfer was recommended due to concerns about slow progress in labour and that by referring to the obstetrician as "Mr Slice and Dice", she created doubts in the woman’s mind and tainted the interactions she went on to have with him.
The woman was eventually taken to hospital however it was unclear when the woman’s care was handed over from the midwife to the hospital, and Ms Wall was concerned about both the midwife and the hospital’s role in this lack of clarity.
At the hospital, the obstetrician found that the baby was likely in deep transverse arrest and recommended a Caesarean section. Ms Wall found that at this point, the midwife did not communicate clearly that she supported a Caesarean section and explain the reasons for this. Later, the midwife documented that the CTG was "really reassuring", and told the woman that the baby was "ok" when the CTG actually showed that the baby was in distress. Furthermore, the midwife provided this information to the woman without interpreting the CTG herself.
A Caesarean section was eventually consented to. The baby was born in poor condition and required significant resuscitation.
Ms Wall recommended that the midwife apologise to the family. She also recommended that the Midwifery Council consider whether any further review of the midwife’s competence was warranted; and advise HDC when the midwife’s supervision concluded and how she had addressed their concerns about her competence. Ms Wall recommended that the District Health Board review its maternity protocol for the Transfer of Clinical Responsibility from Primary to Secondary Care and advise whether any further improvements could be made.
The full report for case 16HDC01065 is available on the HDC website.