Witness says midwives missed vital warning signs
A heavily pregnant mother's weight, the fact she smoked and her large gestation should have raised the "index of suspicion" of midwives that assessed her, in the opinion of an expert giving evidence at a Hamilton inquest.
Dr Sylvia Rosevear, who told the inquest she has more than 30 years' experience in obstetrics and gynaecology, spent most of yesterday in the dock during the seventh day of the inquest into the deaths of Casey Nathan and her two-day-old son Kymani.
Miss Nathan died at Waikato Hospital on May 21, 2012, after giving birth to Kymani at Birthcare Huntly. The child died two days later.
Yesterday Chris Gudsell, counsel assisting the Coroner Garry Evans, questioned Dr Rosevear.
Earlier the inquest had heard evidence that Miss Nathan had told her midwife she weighed 75kg at her first appointment and was 170cm tall. Miss Nathan weighed 99kg and was 166cm in height post mortem.
Dr Rosevear said that: "In a 20-year-old, 99kg and the marked increase in weight of pregnancy would be a concern for me.'.
Earlier the inquest had heard evidence that Miss Nathan's gestation at 39 weeks and six days was measured by Huntly midwife Nicola Mecchia as being 42cm - in the 90th percentile.
Coroner Evans asked if the these measurements indicated that a client was at risk.
"Yes," Dr Rosevear replied.
Coroner Evans asked where on a midwife's "index of suspicion" they should put a woman who registered three gestational measurements over the 90th percentile.
Dr Rosevear said a midwife should have a "high index" of suspicion, especially given the fact Miss Nathan was a smoker and overweight and birthing in a primary birthing centre, as opposed to a hospital which provides tertiary care.
Mr Gudsell then asked her opinion on the lead maternity carer's comment in her notes at 6.46am that Miss Nathan was progressing with her labour "brilliantly".
"It worries me that she just thinks that labour is a function of time. If you wait long enough you will get there in the end," Dr Rosevear said.
She said it appeared Miss Nathan's slow progress of labour of 2cm between 1.20am and 6.59am had been "normalised as not much of a problem".
"Why?" Mr Gudsell asked.
"Because they didn't do anything about it, it was OK," Dr Rosevear said.
When questioned by Coroner Evans whether a midwife graduate should do a year's internship at a public hospital, Dr Rosevear replied: "I think she would benefit enormously".
Dr John Tait, executive clinical director of surgery for women and children at Capital Coast DHB, also took the stand yesterday. Mr Tait was asked by the coroner his view on the lead maternity carer (LMC) being found with "a very heavy load on her shoulders" with only 35 deliveries under her belt, some of them as an LMC, but others as a back-up.
"I expect it was a very difficult case. I do also think that this would have been a very difficult case in a tertiary hospital."
It is expected that the inquest, which is in its eighth day, will conclude today.