A matter of life and death
A family tragedy - the death of a mother and her baby at the Huntly Birthcare centre in 2011 - has been the subject of a lengthy and very public inquest in recent days. The revisiting of events that ended in the deaths of Casey Nathan and her son Kymani will be distressing for her former partner and whanau. It will be distressing, too, for the midwives who were involved as questions of competence are raised and opinions are expressed about the standard of care they provided.
Giving expert evidence is testing, too. The qualifications of Margaret Anne McGowan, a retired general and obstetric nurse, and midwife, were challenged after she expressed the view that the midwives' care of Miss Nathan "fell below a reasonable level of competence set out by the Midwifery Council". The Waikato District Health Board's lawyer asked if she could give an opinion on the Huntly situation, given her experience was working in Christchurch, an urban area with a more affluent clientele. The implication seemed to be that the acceptability of standards will differ depending on a birthing unit's socioeconomic location and its distance from a public hospital. Affluence is no guarantor of a safe birth, however. Dr Paul Henderson, an Auckland GP, a year ago commented in an online article on the death of a former Christchurch Crown prosecutor, Anna MacGougan, from complications of a blood clot after childbirth. This was "a poignant reminder that even today there are risks in pregnancy and birth that cannot be prevented and may still lead to devastating consequences".
There is a general belief that there is nothing more natural than being born and of giving birth. But much can go wrong, despite the advances of modern medicine in reducing the risk.
Unhelpfully, the issue of what is best for a mother-to-be can be clouded by rivalries between doctors and midwives and disagreements about whether women should have the most hi-tech medicine nearby. Some midwives will urge women to be empowered by today's care systems and recognise that having babies at home is a safe and viable option. Regardless of the option taken, however, what should be a joyous experience can become an exhaustive medical ordeal - suddenly a matter of life and death, sometimes - for reasons unforeseen by the best of medical advisers.