Refusing c-section to mother of stillborn baby 'inappropriate' - inquest hears
Published 03/09/2016 | 19:19
It was "completely inappropriate" to refuse a caesarean section request from a mother whose baby was later stillborn, a coroner's court has heard.
Dr Tara Fairley said if a woman with a previous history of a c-section asks for the procedure during another pregnancy, she should be facilitated.
The experienced medic was giving evidence during the fourth day of an inquest into the death of baby Cara Rocks in 2013.
Appearing via videolink, she told Belfast Coroner's Court: "If any patient who has had a previous caesarean section said they wanted an elected c-section I would have acceded to that request and planned the elective c-section for around 39 weeks' gestation."
Baby Cara was stillborn at the Causeway Hospital in Coleraine, Co Londonderry on June 26 2013.
The Northern Health and Social Care Trust, which runs the hospital, has already apologised for her death and accepted a series of failings.
Dr Fairley, a consultant obstetrician and clinical director with NHS Grampian, was tasked to independently review the care provided to the infant's mother, Michelle Rocks.
Representing the Rocks family, barrister Fiona Doherty QC said Mrs Rocks had a very clear view about the mode of delivery.
The lawyer said: "She was quite clear that the best thing for her, in this her third pregnancy, was to have a c-section.
"She communicated that at 32 weeks and 36 weeks but was told she was more than capable of delivering the baby herself and the request was refused."
When asked for her view on the scenario, Dr Fairley answered: "I would consider that to be completely inappropriate."
Mrs Rocks was well overdue when she was admitted for induction of labour on June 25 2013. Baby Cara was stillborn the following day at 4.33pm.
According to Dr Fairley, medics failed to spot "obvious" signs of foetal distress following that induction and did not act accordingly by proceeding for an emergency c-section.
"Unless birth was imminent vaginally you would deliver the baby by c-section," she added.
The court has previously heard how heart rate traces were incorrectly recorded as suspicious and not pathological, meaning critical.
Meanwhile, Dr Fairley was also asked to provide opinion on an earlier hospital consultation when Mrs Rocks presented with her baby lying in the wrong position at 38 weeks' pregnant.
"It would not be appropriate to discharge someone at 38 weeks' gestation with a transverse lie because the chances of a chord prolapse are fairly substantial," she said.
The high profile inquest is the first in Northern Ireland to focus solely on the examination of a stillbirth.
Coroner Joe McCrisken has described the case as "historic" and said the region now had legal powers which were the envy of other jurisdictions.
On Thursday it emerged that despite being considered high risk, Mrs Rocks never saw the consultant to whom she was assigned.
Manchester-based obstetrics expert, Dr Leroy Edozien was also highly critical of the care provided.
He highlighted a number of missed opportunities and said Mrs Rocks should have been seen by a consultant at a much earlier stage.
"It was clearly a high risk situation and a transverse lie at 38 weeks is always a risk but add that to the risk of uterine scar rupture it is even more of a high risk situation," said Dr Edozien.
"The advice she was given was inappropriate and on the balance of probabilities had she been seen by a consultant the management would have been different."
When difficulties in tracing Cara's heart rate developed following the induction of labour, Mrs Rocks should have been assessed by a more senior doctor, Dr Edozien concluded.
"I think it was not right, given the risk of the situation for the assessment and decision making to be in the hands of an ST1 doctor. If there were strong reasons why a registrar could not go and assess her (Mrs Rocks), if they were busy on the labour ward, that's fair enough.
"But, the midwives recognised that (risk) and they knew the level of seniority of who to bleep," he said.
Meanwhile, the court heard that a successful normal delivery is achieved by between 67% and 75% of women who have had a previous c-section.
The coroner stressed that natural births for many women who had previously had a caesarean section were safe.
The risk of uterine rupture exists for between two and seven in every 1,000 for women who go into spontaneous labour, but, when a prostaglandin is used to induce labour that risk increases to around two in every 100 women.
Throughout the hearing, Mrs Rocks and her husband Barry were supported in court by their parents and other relatives.
The coroner is expected to delivery his findings on Monday.