Reprimand for midwife over teen's birth care

A midwife who told a teenage mother to keep her legs together and be "ladylike" after a tear that meant she could barely walk for weeks has been reprimanded.

The Human Rights Review Tribunal said the former Blenheim midwife, now practising in Northland, had breached the Health and Disability Commission Code of Consumers' Rights by failing to provide services of an appropriate standard to a 16-year-old mother.

The tribunal decision said Natasha Thomson was working as a community-based registered midwife in 2011 when she started providing care to the patient.

Thomson had been working as a midwife for about nine months at the time.

The decision said Thomson told her client that she might be "looked down on" because of her age at antenatal classes and instead offered to teach her everything an antenatal class would teach her.

But the tribunal found Thomson did not give her young patient enough information to make sure she understood the labour process and how to care for a newborn.

Thomson arrived at her patient's house six minutes after the birth of the baby despite receiving several calls from her client and the baby's father leading up to the birth on January 15, 2012.

The patient said she was in "excruciating pain" in one call an hour before Thomson arrived, while the baby's father said he would take the patient to hospital if Thomson did not arrive shortly.

The baby's grandmother told Thomson she needed to come immediately after she arrived to help with the birth.

But Thomson told the baby's grandmother that young mothers sometimes panicked when labour first started.

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The baby was born three minutes after the phone conversation on the bathroom floor of the patient's house at 6.36am.

Thomson did not have scissors with her to cut the baby's umbilical cord when she arrived shortly after the birth and the cord was cut with kitchen scissors found by the baby's father.

She advised her patient to change her pads frequently, keep her legs together and be "ladylike" after assessing a tear to the patient's perineum.

Thomson left her patient's house at about 9am, telling her she would be back later in the day. She did not talk to the patient or the baby's father about the risk of infection or how to deal with the tear.

When the patient told Thomson that she was finding breastfeeding very uncomfortable following the birth, Thomson told the patient that pain was normal and advised her to watch a breastfeeding DVD that she had earlier provided.

Three days after the birth the patient phoned Thomson crying because she could not get her baby to latch on.

Thomson did not offer to come over and help, even though her patient asked her to. In the weeks following the birth the patient was in so much pain from the tear that she could barely walk.

Thomson told the patient to sit on the couch and only walk when walking to bed. She gave her antibiotics, pain relief and told her that she should apply witchhazel in distilled water to reduce the inflammation.

She did not take any action to have the patient assessed by a medical practitioner. More than three weeks after the birth the patient was admitted to Wairau Hospital, in Blenheim, after a GP inspected the tear during an appointment for a separate issue.

At Wairau Hospital she was given intravenous antibiotics and required surgery for the tear.

The Human Rights Tribunal decision found Thomson failed to provide services of an appropriate standard.

Failures to develop a birth plan, provide information about the birth process, attend the birth when the patient asked, and adequately examine the patients tear or refer the tear to a medical practitioner for treatment factored into the decision.

The tribunal also found Thomson did not adequately respond to the patient's request for help with breastfeeding.

Nelson Marlborough District Health Board chief executive Chris Fleming said Thomson was a self-employed lead maternity carer who had an agreement with the health board to access maternity facilities.

After the board became aware of the circumstances that led to the complaint, an investigation took place and Thomson was referred to the Midwifery Council.

Thomson "actively engaged" in the health board investigation, and completed all the recommendations made following the investigation to safeguard the public, Fleming said.

He said Thomson was never employed by the board and was no longer working in the region.

 - The Marlborough Express

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