Flu shot may have saved mum
Immunisation might have prevented pregnant mother Daile Eden from contracting swine flu, says a coroner who has investigated the death of the 24 year old and her unborn baby daughter.
However, while Ms Eden was offered the influenza vaccine, she had declined it.
Ms Eden, 34 weeks pregnant, died from the effects of severe influenza A H1N1 at her Stoke home on Friday, September 20 last year despite seeking medical help.
She had been discharged from Nelson Hospital the previous Monday and had seen her GP the day before her death.
Coroner Chris Davenport did not hold a public hearing, and instead held "a hearing on the paper" and made a chambers finding at Hastings.
Ms Eden had been expecting her second child, who she and partner Andre Evans had named Mia-Rose.
The coroner's findings said that in May Ms Eden went to the Nelson Family Medicine practice in Collingwood St after several weeks of a persistent cough and a hoarse voice, and was treated for infective asthma.
In September, after a week of feeling unwell, her midwife advised her to see a doctor. She saw Dr Jennifer Cooper on September 13 who wrote a prescription for the antibiotic, amoxicillin, for her to take if she developed worsening fevers or cough. Dr Cooper urged Ms Eden to seek medical attention if her condition deteriorated.
Because there was a whooping cough problem in Nelson, Dr Cooper recommended she be vaccinated against pertussis and also asked if she had been offered the influenza vaccine. Ms Eden advised she had previously been offered it but had declined.
She again saw Dr Cooper on September 15 because the afternoon before she had vomited five times, was tired, had sore legs, chest discomfort on coughing and she felt her foetal movements had reduced.
Dr Cooper assessed Ms Eden was suffering from influenza and she was admitted to Nelson Hospital, to a room in the medical unit for isolation. She was given panadol regularly for her fever, rehydrated with intravenous fluids and given medication for nausea. Consultant obstetrician Dr Flora Gastrell reported that Ms Eden responded well and the baby was noted to be active. She handed over care to Dr Kevin Hill and Ms Eden was discharged from hospital at 1pm on September 16.
When Ms Eden went to Nelson Family Medicine on Thursday morning with Mr Evans and saw Dr Andrew Dawson she was hyperventilating. She was given a brown paper bag to breathe into, a standard first aid procedure for hyperventilation.
Dr Dawson assessed that she had a bad case of influenza, compounded by being heavily pregnant.
He commented that there had been a recent significant increase in influenza-like illness over the weeks leading up to then, and he too had just recovered from it. Dr Dawson's assessment was that Ms Eden would return home for rest, increase her fluids and continue with paracetamol and Ondansetron to reduce nausea that had been prescribed at the hospital. She was given a brown paper bag and instructions what to to do if hyperventiliation stated again. He made a note to follow up with her the next day with a phone call and the practice nurse assisted her to the car and gave instructions about getting in touch with the medical centre or emergency department if there were concerns.
During the evening she continued hyperventilating and feeling uncomfortable and slept in her mother's bed for more comfort.
She was checked on by her mother, Rewa Eden three times, the last at 4am when she was assisted to the toilet and given a glass of orange juice.
Her breathing was hard, with her fingers and lips blue. Ms Eden raised the issue of going to the Nelson Hospital emergency department to which her mother replied they would wait and see how she was in the morning. At 7am her mother found her dead in bed; her unborn baby had also died.
Dr Dawson phoned at 8am and Rewa Eden told him of her death.
The coroner inquired into whether her death could have been prevented.
He said he was satisfied that immunisation with that year's influenza vaccination might have prevented Ms Eden from contracting influenza A H1N1, but she had declined it.
The use of Oseltamivir (Tamiflu) in the initial stages of her illness might have protected her against the possible complications of the influenza virus A H1N1 but was only effective if started within two days of the onset of symptoms, he said.
On September 13, when it would have had to have been prescribed to have effect with the two-day window of opportunity, there appeared no clinical basis for considering prescribing Tamiflu.
The severe symptoms of the influenza virus A H1N1 were also not present, in Dr Gastrell's opinion, when on September 15 Ms Eden went to the hospital A&E.
Chief medical officer Dr Nick Baker said the Nelson Marlborough District Health Board's report into the death of Daile Eden would be shared with her family, and they would seek their advice about releasing recommendations from the report.
Immunisation 'won't affect baby'
Rewa Eden doesn't want the fate that befell her daughter to happen to anyone else.
Every week Mrs Eden visits the grave at Marsden Valley of her 24-year-old daughter, Daile, and granddaughter Mia-Rose.
Daile died from the effects of severe influenza A H1N1 and her unborn baby with her.
A coroner's findings notes her midwife offered her a vaccination but she declined it, which was very common.
Mrs Eden said today Daile's reluctance wasn't because she was scared of injections, but because she was concerned about how it might affect the baby - in the same way that pregnant women were warned not to eat food such as raw meat and salami.
She said it was good that there was now an influenza immunisation campaign.
"It's not going to affect the baby at all, it builds antibodies."
Mrs Eden reluctantly accepts the coroner's findings into the death.
"At the time I was absolutely livid. There are still a lot of questions not quite covered but nothing is going to happen.
"Nobody is taking the blame and they're saying it's Daile's fault that she didn't have a vaccination.
"My biggest issue is let's hope it does not happen to anybody else. We can't bring her back."
Last week Mrs Eden finally received a death certificate for Mia-Rose, which she said helped bring closure, and is arranging for a new headstone to mark the grave where the pair rest with Daile's father Neil.