GP let off after 'horror' birth

A doctor who failed to notice that things had gone horribly wrong during a forceps delivery of a baby has been let off after apologising to the woman.

Health and Disability Commissioner Ron Paterson has ruled that the doctor failed to act with "reasonable care and skill" during the delivery, which created an inadvertent finger-sized hole between the woman's vagina and her rectum.

But he said the failings were partly the result of the doctor's heavy workload because of the dwindling number of general practitioners providing maternity care. Fewer than 15 of the country's 3000 GPs now deliver babies.

The doctor's name and location were suppressed and Mr Paterson ruled that there was no public interest in further proceedings against him.

The doctor delivered two other babies on the day of the incident, April 4, 2002. He also had other patients waiting at his surgery, and left the hospital at 2pm when the woman's cervix was fully dilated but the baby was not yet in the right position to be born. He was called back by the midwife at 5.10pm, but got caught in traffic and did not get there until 6pm, and then argued with the anaesthetist about whether the case should be moved into the caesarean theatre.

He delivered the baby with forceps at 7.41pm. It was the woman's first baby and the doctor had to cut her to get it out. He sewed up the cut afterwards and checked on the woman in hospital the next morning.

The next day, a Saturday, nurses in the maternity unit rang the doctor and told him the woman was suffering "terrible" diarrhoea.

On the Sunday, she found that a surgical swab had been left in her vagina. On the Monday, nurses rang the doctor again to tell him about the swab and that the woman was discharging "offensive" material from her vagina.

The doctor gave instructions to administer antibiotics, but did not see the woman from the morning after the birth until April 13, eight days later.

When he visited her then at her home, he described her pelvic area as "tender but healing" and did not pick up anything unusual.

She went to his surgery on April 24 and told Mr Paterson later that she informed the doctor then that there were faeces coming from her vagina. But the doctor denied that she told him this.

He finally realised something was wrong when she visited again for a six-week check on May 22.

This time he referred her to a gynaecologist, who found the hole between the woman's vagina and her rectum "of a size that admitted the top of her index finger".

The hole was closed by surgery on June 6.

An experienced GP obstetrician, Dr William Ferguson, said in a written report to Mr Paterson that the hole was probably caused by the forceps delivery, but was extremely rare.

He had seen it only once before.

Dr Ferguson did not blame the doctor for not picking up the injury at the time, but expressed "mild disapproval" that in the days after the birth the doctor was "conducting his postnatal care by remote control".

But he said this was partly because of the maternity funding system, which provided only $45 for doctors who were lead maternity carers to provide care from birth until the required six-week check.

Dr Ferguson said yesterday the funding system had driven almost all GPs out of maternity work - down from 60 per cent when the system started in 1996 to only 10 to 15 GPs today.

Dr Ferguson himself will stop maternity work in January.

But Midwifery Council chairwoman Sally Pairman said the GPs' move out of maternity care was not a problem because midwives, unlike GPs, could concentrate on the work and bring in specialists if required.

She declined to comment on Mr Paterson's decision to take no further action in the case.