Expert midwife shocked mother 'fainted'
An inquest into the deaths of a mother and her baby boy has focussed on whether lead maternity carers (LMCs) are supervised and supported after graduation or left "flying solo".
Auckland midwife Stephanie Vague was asked by Coroner Garry Evans to provide an expert witness statement - mandated by the NZ College of Midwives - on the midwifery care of Casey Missy Turama Nathan, who died after giving birth to her son Kymani on May 21, 2012.
Coroner Evans, as part of the inquest into its sixth day in Hamilton yesterday, was also investigating the circumstances around the death of Kymani, who died two days later.
Counsel assisting the coroner, Chris Gudsell, asked Ms Vague what support and supervision, if any, a lead maternity carer had after graduating.
Ms Vague replied that the responsibility lay with each lead maternity carer.
"She is a registered midwife and accountable for her practice."
The graduate would herself identify any areas where she felt she needed guidance or advice, Ms Vague said.
Mr Gudsell questioned whether they were flying solo, to which Ms Vague replied no, because they were usually part of a practice with a group of midwives.
"They are a member of a profession and midwives generally act collegially so I would expect support from other LMCs that would be working with her at the unit and the core staff that are employed there."
Coroner Evans then double-checked his understanding of the process.
"So following completion of a mentoring exercise . . . the LMC is flying solo except you say, she works in a collegial atmosphere with others?" Coroner Evans asked Ms Vague.
"Yes," Ms Vague replied.
Coroner Evans asked then if that made her the sole judge of her own practice, and Ms Vague replied that midwives were required to complete annual exams for neonatal and adult CPR, in order to keep her practising certificate.
Coroner Evans persisted, asking if it meant the midwife continued to work unsupervised, or if she was "subject to any practical supervision following cessation of her mentorship".
"No, it's not the subject of any formal kind of supervision," Ms Vague said.
Christchurch-based midwife Jacqui Anderson, who has 30 years' experience, was requested by Coroner Garry Evans to give expert evidence in respect of Kymani's birth.
Mrs Anderson said it was unusual that three different midwives would all record a large baby, measuring in the 90th percentile, when Kymani was born at the light weight of 3.160kg, which she said was classified at the opposite end of the spectrum - under the 10th percentile - as a "very small baby".
"I can't explain that," she said.
As for growth charts, coroner Evans put it to Mrs Anderson that the guidelines of their use stipulate that if the measurements note a very large or very small baby, they should be sent for a consultation.
Mrs Anderson also commented that she was shocked about Miss Nathan's faint in the birthing pool, which the inquest has heard was about 90 minutes prior to Kymani's delivery.
"I have never seen a woman faint in the second stage of labour in my 30 years' [experience]."
The inquest continues today.