Coroner urges backup midwives

16:00, Nov 02 2010
Joanna Marshall and Blaze
FALLING SHORT: Joanna Marshall, with daughter Blaze, 3, believes her home birth could have been handled a lot better.

Backup midwives should be present at all home births, a coroner has recommended after the death of a Motueka baby.

Coroner Ian Smith made the recommendation in his findings on the death of Breeze Marshall in October 2006.

Breeze's mother, Joanna Marshall, said yesterday she agreed with the recommendation. "I reckon it would have helped."

She said the buildup to the birth of her third child four years ago had gone smoothly, but intense labour pains told her something was wrong.

"I said to my partner that something was not right, but the midwife sort of ignored me," she said.

At the inquest this year, midwife Carmille Mathews, known as Maggie Mathews, said she could see the umbilical cord was obstructing the baby as she was being born.


Mathews started CPR and called an ambulance. A rescue helicopter flew Breeze to Nelson Hospital, but she was pronounced dead soon after.

"As far as I'm concerned, it was a complete disaster," Marshall said.

Mathews told the inquest that cord prolapses occurred in one out of 1000 births and resulted in the death of the infant in half the cases.

In Marshall's case, labour was short and there were no indicators of a prolapse, she said.

Mathews was suspended from practice in 2007 by the Midwifery Council.

At the time, chairwoman Sally Pairman said the suspension followed complaints from other medical professionals, and Matthews presented a risk of "serious harm to the public".

The coroner's findings said Mathews, who had been a registered midwife for 25 years before the baby's death and a home birth midwife since 1997, had stopped practising in 2007.

Marshall, who had had two children before Breeze's birth, has since had another child and is expecting a fifth.

She said the family got together every year to remember Breeze, who is buried on her father's family marae at Kawhia, Waikato.

The coroner's report said Marshall's partner did not believe he was fully informed about the risks of home births.

The report recommended midwives ensure partners or husbands were present when giving advice about home births.

The coroner said he was concerned there was no backup midwife to support Mathews.

"It is not good practice to go it alone," he said.

"Motueka is not an isolated area – it is within 40 minutes of Nelson City and less to Richmond."

The Press