Charges possible after oversights lead to brain-damaged baby
Cerise Lawn says pregnant women must speak up when things don't look right, after signs of distress were overlooked and her baby was left struggling with disabilities from a damaged brain.
Her daughter Ariana was the victim of a botched labour and birth in January 2012.
Health and Disability Commissioner Anthony Hill has criticised an obstetrician, a midwife and the Taranaki District Health Board. A decision is pending on whether charges will be laid against the two practitioners in the Health Practitioners Disciplinary Tribunal.
After the obstetrician arrived at Taranaki Base Hospital at 2.50am on January 24, 2012, he decided against an emergency caesarean because the other staff were at home asleep and a vaginal delivery would be quicker than calling them in, Mr Hill said. He ruled out forceps on the basis of his unsubstantiated impression that Mrs Lawn did not want obstetric "interference".
This belief was reinforced when the Lawns did not welcome him to the birthing unit, although he acknowledged Mrs Lawn would be very tired because of her labour.
When asked what welcome he normally expected, he told the commissioner's staff, "Patients would recognise the fact that I am there, or say, 'Thank God you have arrived' or whatever ... On this occasion, nothing was said by the patient."
Asked if this might have influenced his care, he said, "Well, I guess I had in my own mind that she preferred to do it all herself if she could, and I guess at that time I went along with it."
He gave Mrs Lawn the drug Syntocinon to bring on the delivery. An expert cited by Mr Hill said this might have increased the fetal stress and should have been accompanied by continuous electronic monitoring of the fetal heart rate and labour contractions.
Mrs Lawn, 23, believes Ariana's troubles could have been avoided if antibiotics had been given during labour and proper monitoring had been done.
She told the Herald parents should watch for "red flags" such as lack of monitoring during labour or the presence of meconium - fetal poo - and make sure that staff do something about it.
Meconium in the amniotic fluid, visible after a woman's waters have broken, can indicate fetal distress.
Ariana has moderately severe cerebral palsy. She suffers developmental delay and seizures, is fed mostly via a tube through her abdomen and can say only about 10 words. Mrs Lawn is unsure if she will ever walk unaided.
The obstetrician, who has since ceased practising, was Mrs Lawn's lead maternity carer (LMC) and shared her care with an Opunake doctor. He saw Mrs Lawn only three times before the birth and did not document a plan of care. He breached his legal obligations as LMC, Mr Hill said. His failings were a "severe" departure from expected standards.
Ariana had to be resuscitated when she was delivered at 3.50am because she was pale, floppy and "flat with no respiratory effort", Mr Hill said.
The neonatal team should have been called immediately, but this was delayed several minutes while the obstetrician tried to resuscitate the baby himself, with a method that could have aggravated Ariana's problems from having meconium in her airways. Hospital staff had noticed meconium-stained liquid four times after Mrs Lawn's waters broke.
Mrs Lawn said she, her husband Tim and a support person repeatedly expressed concerns about the meconium but the staff kept reassuring them by telling her: "You're coping beautifully."
The DHB said it had accepted Mr Hill's findings and implemented his recommendations.
• Ariana Lawn was born in January 2012 after a botched birth at Taranaki Base Hospital.
• Signs of distress during the labour were overlooked and Ariana now suffers from moderately severe cerebral palsy.
• The Health and Disability Commissioner has criticised an obstetrician, a midwife and the Taranaki District Health Board over the botched labour.
• A decision is pending on whether charges will be laid against the two practitioners in the Health Practitioners Disciplinary Tribunal.