Midwife fails teen mother: report

A midwife whose "seriously suboptimal" practice resulted in her 16-year-old client needing genital reconstruction has been found to be in breach of health standards.

In a report released today, the Health and Disability Commissioner Anthony Hill found the midwife did not provide services with reasonable care and skill, having failed to attend the labour, give breastfeeding advice, and assess and address a torn perineum.

The midwife, who had name suppression, had been practising for about nine months, and had about 15 clients.

Family Planning referred the pregnant girl to the midwife, because she would have been sympathetic dealing with a young mother, the HDC decision said.

The girl was living with her boyfriend in his parents' home. The girl said she had nowhere else to go as her family did not support the pregnancy.

The girl told the HDC that during the pregnancy, she never received a birth plan, nor developed one with the midwife.

The midwife also told the girl she would be "looked down upon" at antenatal classes, and would take it upon herself to teach her what would be in the lessons. The girl said most of what she knew about pregnancy she had learned online.

The girl said that early one morning when she was more than 37 weeks' pregnant, she woke in pain and went to the toilet, where the mucous plug fell out.

She searched what this meant on the internet, and thought she was at the "start of the beginning of labour".

She called the midwife because she did not know whether she was in labour, or if something was wrong with her baby.

The midwife told her to call back in eight hours, and to put up with the pain because it would "only get worse from here", the decision said.

She tried to sleep, but could not due to the intense pain, so returned to the bathroom.

The girl's boyfriend said she was sitting on the toilet, "bent over, screaming".

After about 20 minutes, the girl, upon feeling the baby's head being born, called the midwife to say the baby was coming. The midwife came over, but before she arrived the baby had been born on the bathroom floor.

The midwife said that from the time of the first call, she was going to check in on her client in two hours.

After the birth, the midwife noticed her client had a small tear in her perineum.

The midwife said it was "tiny", and that she would be "perfectly fine" and did not need stitches, the decision said.

She told the girl she would have had to go to hospital to get stitches if she wanted them, because she did not have the correct equipment with her.

She told the girl to be "ladylike" and keep her legs together, and change her pads often.

The girl was in extreme pain and could barely walk, and resorted to tying her thighs together with her dressing gown cord so she would not open the wound.

The midwife thought this was "excessive" and "quite funny". She said she thought that by making light of the situation, she had eased the tension in the room.

Later, the girl started getting hot and cold spells, and her boyfriend stood beside her with the hairdryer, blowing cold and hot air on her.

The girl eventually went to hospital, where a doctor found she had an infected labial cut, and her perineum had failed to heal.

All the infected tissue was removed, and the girl had reconstruction of her labia and perineum.

The midwife said she was "gutted" when she found out how bad the tear was.

In his decision Hill said the 16-year-old's vulnerability should have resulted in a higher standard of care, which the midwife failed to provide.

He recommended the midwife undertake further training and be subject to a New Zealand College of Midwives review. He also referred her to the director of proceedings for possible further action.

Hill also told the midwife to apologise to her client, to reflect on her failings, and to provide a written report to the commissioner, stating how she had changed her practice.

Fairfax Media