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Baby death shows need for collaborative care

The death of a baby during delivery demonstrates the need for collaborative arrangements between doctors and midwives.

Coroner John Hutton last month handed down his findings of an inquest into the newborn’s death following a birth intervention at Gold Coast’s John Flynn Private Hospital in 2008.

Baby Samara was born at 2.01am on November 8, 2008. She was delivered by Ventouse extraction after prolonged second stage labour. She died shortly after birth.

An autopsy concluded that baby Samara died at birth of asphyxia caused by a tight umbilical cord around her neck.

The coroners report includes 21 recommendations, several which reiterate the need for models of collaborative care, under-pinned by evidence-based guidelines which protect women and their babies from harm due to inadequate care.

Among the recommendations he made, Hutton said all women should be given balanced antenatal information and classes outlining normal and abnormal labour including when and what medical interventions might be necessary.

The issue of birth plans, he said, needs to be re-cast.

“Patients and staff need to be reinforced that a birth plan is a guide only and does not dictate the only method of delivery. Expecting mothers need to be told that birth plans are important, but are only a guide and that all concerned need to be flexible and prepared to swiftly change the birth plan and do whatever is required to deliver the baby safely,” Hutton said.

He said maternity units at all hospitals should schedule paid time for staff to understand hospital birthing policies and all maternity units should ensure there are clear guidelines and instructions for midwives as to when to refer obstetricians.

Another recommendation was that all maternity units should have a paediatrician or staff member capable of intubating a baby available to be present at all deliveries through meconium; where there is evidence of foetal distress in labour; or any instrument delivery or caesarean section.

“This tragic case of the loss of a baby, which appears from the coroner’s report to have been potentially avoidable with earlier referral to an obstetrician who could have performed lifesaving medical treatment at the appropriate time, said president of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), Dr Rupert Sherwood.

“This highlights two critical aspects of good collaborative care between midwives and doctors, namely the importance of following established protocols such as fetal heart monitoring when indicated, and timely referral to another member of the team with training and expertise to intervene in a safe and timely manner.”

Sherwood said RANZCOG has repeatedly stated that failure to work as a team in a truly collaborative manner has the potential to lead to tragedy, as in this case at the John Flynn Hospital.

“The coronial report highlights the need for accurate medical records and adherence to well researched and agreed protocols for monitoring the well-being of both mother and baby, particularly during labour. The need for fully informed consent processes and birth plans that are realistic and are focused on safe, achievable outcomes is also noted,” said Sherwood.

“We will not support collaborative care models that in any way compromise the safety of patients who place their trust in us as maternity care providers.”

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