A former midwife with more than 40 years experience has suggested the level of care by midwives who worked on Casey Nathan and her son Kymani fell below Midwifery Council standards.
However, counsel for the midwives and other health professionals have questioned whether she is suitably qualified to offer that opinion.
Yesterday was day five of a coronial inquest into the deaths of Miss Nathan and baby Kymani, following her post and pre-natal care at the Huntly Birthcare centre in 2011.
Margaret Anne McGowan, a retired general and obstetric nurse, and midwife, was asked by the Nathans' lawyer, Kay Hoult, to give an opinion on the notes taken by the lead midwife during Miss Nathan's labour.
In her report, McGowan expressed the view that the midwives' care of Nathan "fell below a reasonable level of competence set out by the Midwifery Council".
McGowan outlined five competencies she said were set by the council that she believed were not adhered to by the midwives.
These included what she said were failures to: recognise a condition that necessitated consultation or referral; identify factors in Nathan or baby Kymani during the labour and birth which indicated the necessity for consultation with or referral; prescribe, supply and administer medicines within the midwife's scope of practice; and provide accurate and timely written progress notes and relevant documented evidence of all decisions made and midwifery care offered and provided; demonstrate an accurate and comprehensive knowledge of legislation affecting midwifery practice and obstetric nursing.
McGowan later clarified her view by saying that a midwife has a set list of drugs that she can prescribe.
She said that adrenalin, which was given to Kymani, can only be administered in consultation with a medical practitioner.
"As this was administered to a baby with a reported good heart rate, the reason for administering it is unclear," McGowan said.
She said the dosage was also of concern, in her view, as there was no supporting documentation. Mrs McGowan also expressed concerns about the lead maternity carer's note taking.
Under cross-examination McGowan was grilled about her qualifications and whether she was suitable as an expert witness.
Waikato District Health board lawyer Iris Reuvecamp asked McGowan, who is not a member of the Midwifery Council, whether she could give an opinion on the Huntly situation, given her experience was working in Christchurch, an urban area with a more affluent clientele.
She said the distance from Huntly to Waikato Hospital was 30 minutes, while the distance between the St George birthing unit - the birthing unit McGowan managed for 24 years - and Christchurch Women's Hospital is eight minutes.
McGowan told the court that she dealt with a broad clientele from all walks of life.
Reuvecamp asked McGowan if she had ever dealt with the same circumstances the midwives faced when confronted with the medical complications suffered by Nathan, to which McGowan replied, "yes with a good outcome".
The midwives' lawyer, Matthew McClelland, questioned McGowan's experience while she was a manager at St George birthing unit, saying she only took on the role of lead maternity carer for one or two birthing mothers per year while she was a manager - which would be a little more than 24 cases over 24 years.
McClelland also put to McGowan that the lead maternity carer for Nathan had more experience than she, having had more than 30 cases in her 18 months as a LMC.
McGowan, who said she had acted as an assistant in thousands of births over her 24 years as manager, replied "Yes."
The inquest will continue next week.
- © Fairfax NZ News
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