Sunday 23 September 2018

'This is the first formal audit I am aware of' - Clinical director at Our Lady of Lourdes Hospital in Drogheda

One death among 21 undiagnosed breech babies at hospital

Our Lady of Lourdes Hospital in Drogheda. Picture: Collins
Our Lady of Lourdes Hospital in Drogheda. Picture: Collins

Louise Kelly and Eilish O'Regan and Maeve Sheehan

A clinical director at Our Lady of Lourdes Hospital in Drogheda has said that the current audit into undiagnosed breech births at the hospital is "the first formal audit that I am aware of".

Dr. Alan Finan said that these cases, however, were being "constantly monitored" and maintained that the number of undiagnosed breech births of babies were "better than the average".  

There's not an awful lot of literature out there but from what is out there, the figures in Drogheda are very much on a par if not lower than the average," he told RTE's Morning Ireland.

An internal audit has revealed that thirteen babies who were in breech position were not diagnosed until their mothers were in the late stages of labour at Our Lady of Lourdes Hospital in Drogheda.

The cases were among 21 undiagnosed breech babies at the hospital over two years and included one tragedy in which a baby died.

Most babies are born head first but some are in a breech position if they are lying feet first, making their birth more complicated and often needing a caesarean section.

Undiagnosed breech babies are not detected until their mother is already in labour. Breech not diagnosed in late labour is regarded as a "significant incident".

The other eight of the 21 babies were discovered while their mothers were in the early stages of labour.

The case of the deceased baby is now with the coroner.

"In eight cases [of breech birth], it could potentially have been spotted earlier," conceded Dr Finan.

"[But] babies turn around in the uterus and don't settle in many cases until later on in the pregnancy. This is not an entirely unusual event and it can't really be controlled for."

Complaints

A spokeswoman for the hospital said the internal audit which covered two years, up to June of 2014, was sparked by the baby's death in 2013 and two later complaints by parents who also had undiagnosed breech babies.

The review of these three cases by the hospital's risk management committee "triggered a retrospective 24-month audit which was undertaken in 2014 and identified 21 cases of undiagnosed breeches".

"These cases had already been identified and discussed with mother at diagnosis," she added. "There will always be a percentage of women who present with an undiagnosed breech in labour. Based on international evidence, a percentage of breech cases will be missed."

The expected rate of undiagnosed breech in labour is around 20-25pc and the rate in Drogheda was 9.5pc, she said.

The review found that 13 of the undetected breeches occurred in the Clinical-Led Unit (CLU), while eight were undetected in the Midwifery-Led Unit (MLU).

The eight cases discovered in the MLU were found to be "a disproportionally large number" for a unit where just 10pc of the total births in the hospital take place.

Sheila O'Connor of Patient Focus criticised the hospital for not doing an audit sooner and waiting until patients came forward with complaints.

"It just goes to prove, why did these events have to occur for the changes to be made, when they should have been identified by professionals working in the area?" she asked.

Training

A total of 7,667 babies were delivered during the two years and 221 were in breech position.

The spokeswoman said training has since been undertaken at the Rotunda Hospital in Dublin to improve the identification of breech babies.

The number of undiagnosed breech babies in Drogheda has since significantly reduced.

The audit recommended that doctors improve their clinical examination of a woman to increase the chances of detecting a breech baby.

They should also act more quickly to carry out a scan if there is "any suspicion" of a breech.

She said the review process involved the parents and all reports have been provided to them at the conclusion of investigations.

Dent

Eight years ago, an inquest was told that baby Shane McArdle died less than 24 hours after being delivered in a breech position at the same hospital.

The latest audit will be another dent in confidence in maternity services here, despite official assurances.

It comes just weeks after it emerged that an external investigation is to take place into two baby deaths and the births of five others who suffered lack of oxygen in Portiuncula Hospital maternity unit.

The probe is expected to be widened to include other parents who feel their questions were unanswered.

Holles Street obstetrician Peter Boylan is also conducting a review of around 30 cases which emerged in the wake of revelations about Portlaoise maternity unit where a number of babies died after suffering lack of oxygen.

A HIQA report on the Portlaoise cases is due to be published in the coming weeks.

Irish Independent

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