Boy's birth injury 'reveals divisions in maternity care'

01:43, Jan 31 2009

A case  in which a boy was injured during a delayed birth has highlighted the differences of opinion between obstetricians and midwives.

In a report made public today, Health and Disability Commissioner Ron Paterson finds the baby's injuries may have been avoided if his mother had been moved from a private rural maternity hospital to a public hospital earlier.

But he ruled the midwife did not breach the code of patients' rights, noting a difference in professional opinion about the standard of care she gave.

ACC accepted expert obstetrician advice that the midwife's delay amounted to "poor practice", but midwifery advisers said the care was "reasonable" and "close and appropriate".

Mr Paterson describes that situation as curious. A "differing philosophy and practice" between obstetricians and midwives is evident, he says.

He has recommended the groups work together on joint protocols for transferring women in labour.


But the College of Midwives said yesterday that protocols and guidelines already existed.

"I'm not sure what it is that we would be able to produce that would be different to all the existing protocols," chief executive Karen Guilliland said.

Mr Paterson's report into the case comes as he begins investigating the death of a baby during delivery at Porirua's Kenepuru Hospital last month, which has already prompted a Government review.

He had not received a formal complaint by yesterday but had decided to start an investigation because of the level of concern.

But he said midwives gave very good care "in the vast majority of cases".

His report into the earlier case says the boy was born by a "difficult" emergency caesarean at a public hospital in January 2007, after it was found he was in an abnormal position.

His young mother had been admitted to an unnamed private rural maternity hospital in labour nearly 12 hours earlier.

After a "prolonged second stage" of labour, an ambulance was arranged to take the woman to the public hospital - a journey of about 2 1/2 hours.

The baby stopped breathing shortly after birth and had to be admitted to neonatal intensive care.

He had severe bruising on his brow and face and suffered a "crush injury" to his nose.

His mother complained to Mr Paterson about the services the midwife gave.

ACC also accepted her treatment injury claim after an independent obstetrician advised that the delayed transfer contributed to the injuries.

The obstetrician later told Mr Paterson: "By any First World standard, the care in this case is below what is generally considered acceptable."

But Mr Paterson's midwifery adviser and her colleague both said the standard of care was appropriate.

In his report, Mr Paterson says it seems obstetricians and midwives "do not agree on what is reasonable care in this type of situation".

Obstetricians take a "risk-averse, interventionist" approach and midwives a "less interventionist" one.

The Dominion Post