Midwives sanctioned for substandard care
The health and disability commissioner has sanctioned two midwives for failing to recognise the seriousness of their clients' cases.
Health and Disability Commissioner Anthony Hill today released two reports finding midwives in breach of the Code of Health and Disability Services Consumers' Rights (the Code).
In the first case, a woman, 35 weeks' pregnant with her second child, went into labour. She made two telephone calls to her Lead Maternity Carer back-up midwife, saying she was in pain.
After the second call, the midwife advised the woman to go to a maternity unit for assessment.
When the woman arrived at the unit it was apparent she was in labour. An ambulance was called to transfer her to hospital. Meanwhile, the midwife failed to assess the stage of labour or the presentation of the baby.
In transit, the woman said she needed to push, and the midwife decided to return to the maternity unit. The baby was identified as being in a footling breech position (feet first). Another midwife then ordered the ambulance to return to the hospital. A cord prolapse was then identified.
The baby was born at hospital by caesarean section, and immediately admitted to the neonatal unit. The baby remains in hospital, being followed up by the developmental team.
Hill found the midwife breached the Code by failing to identify the woman's stage of labour during the first phone call.
The midwife's instruction to go to the unit was "inappropriate", Hill said, as was her decision to return there once the woman started pushing.
The midwife was referred to the Director of Proceedings, who has not yet decided whether to take a proceeding in this matter.
In the second case, a midwife again underestimated the condition of her client.
The young woman was 41 weeks pregnant with her first child. In a text to her midwife, she complained of stomach pains at 15 minute intervals.
The midwife advised her, via text, to take four paracetamol tablets. She failed to document this conversation in her notes.
That night, the midwife decided to travel out of town to following day, without telling the woman.
She organised another midwife to stand in, but remained in text communication with the young woman, who was reporting "a lot of pain" over the course of the morning. The midwife was also in touch with the stand-in, but did not relay information about the young woman's condition.
That afternoon, the woman was taken to hospital by ambulance. Staff were unable to find a foetal heartbeat, and the baby was stillborn with a true knot in the umbilical cord.
Hill found the midwife failed to assess the young woman's condition or needs adequately by responding to her initial distress via text message. He was particularly concerned the midwife did not consider attending and providing reassurance to the young woman, especially given her age, and circumstances (being overdue and in labour).
The midwife also prescribed an inappropriate dose of paracetamol.
The midwife failed to inform the woman she was going off call and out of town, and failed to pass on the details of the stand-in, despite the woman being in regular text communication.
The handover was poorly managed, in that the midwife did not mention the young woman's concerns. The midwife's record keeping was also substandard. She was asked to apologise to her client, and review her practise.
Names and locations were suppressed in both cases.