Mother's family 'abusive', midwife says
A midwife who delivered the baby of a young Huntly mother - both of whom later died - says she and ambulance staff were threatened by the woman and her family.
The lead maternity carer spent yesterday afternoon giving evidence via audio-visual link during day three of the inquest into the deaths of Casey Missy Turama Nathan, 20, and her son, Kymani, in Hamilton.
The midwife, who has interim name suppression, continually defended her practices during questioning from Kay Hoult, lawyer for Hayden Tukiri, who was Nathan's partner.
Hoult asked the midwife why she did not act upon what was referred to as two, and nearly three, recordings on Miss Nathan's growth chart registering in the 90th percentile.
The midwife said she did not take the growth chart as an accurate recording as Nathan was "a serial non-attender".
As for why she did not send Nathan for a scan after learning of her 42-centimetre gestation measurement on the Friday before she died, she replied there was no capability for that to be done until Monday morning. She also said she was on leave until the Monday - when Nathan eventually gave birth and later died.
Hoult questioned the midwife as to why, she said, the midwife later changed her estimation of Miss Nathan's blood loss from 1000 millilitres to 480ml.
However, Coroner Garry Evans said it was "notoriously difficult to estimate blood loss; I don't think a lot hangs on that".
In her evidence, the midwife spoke of being abused by the family as she was wheeling Miss Nathan to the ambulance on the trolley.
The midwife told the inquest that the family said to her: "You are going to pay for this, I'll hunt you down."
The midwife said she accompanied Miss Nathan and Tukiri in the ambulance to Waikato Hospital.
On the way, the midwife said, Nathan was abusive when she tried to palpate her, give her oxygen, and maintain a functioning intravenous line.
She said Nathan and Tukiri were again abusive to two paramedics who were picked up between Ngaruawahia and Horotiu when they also attempted to maintain the intravenous line.
The midwife was questioned by Hanna Janes, lawyer for Dr Aidan O'Donnell and Dr Penelope Makepeace, about why she did not transfer Nathan for tertiary care at 7am - prior to birth - which Janes said was recommended by two specialists, who are yet to give evidence.
The midwife said consideration was given to that as Nathan's labour was progressing slower than normal, however the baby's vital signs were good.
Later at the inquest, Canterbury District Health Board clinical director of haematology Mark Smith - offering expert evidence called by the midwife's lawyer, Matthew McClelland - said it appeared that Nathan's faint in the birthing pool was the sentinel event which initiated her "catastrophic decline".
"The fact Casey appeared to slowly improve reflects this ability to compensate... although clearly she didn't return to normal... by the time she reached hospital she was critically unwell and, with respect, she was probably dying."
Smith also gave evidence that it was his opinion that an amniotic fluid embolism (AFE) was one of the reasons she died.
Smith expressed the view that by the time Nathan arrived at Waikato Hospital her condition was "irretrievable" after she had suffered kidney, renal, central nervous system and cardiovascular system failure.
Meanwhile, the 111 call script that was entered into evidence by the midwife's lawyer recorded a 111 operator stating how coverage of the job "needs a big debrief and a learning curve".
According to the transcript, St John Ambulance officer Nigel Dawson replied:, "Yes", before the operator stated: "A lot of it is the midwife at [Huntly Birth Centre]," and Dawson replied: "Yeah, she had no idea what was going on."
The inquest will continue tomorrow.