‘Home deliveries should be within 30 minutes of hospital’

AN obstetrician has told a court hearing into the death of an infant who died after what appeared a normal delivery at home that home births should not take place more than half an hour away from a hospital.

Dr Matthew Hewitt made the claim at the inquest into the death of Tadgh McLoughlin at Cork University Maternity Hospital (CUMH) last January, six hours after he was born at his mother’s home in west Cork.

Hazel McLoughlin had the services of community midwife Bridget Sheeran, who arrived at her home in the early stages of her labour on the night of January 2, 2009. Ms Sheeran told Cork City Coroner Dr Myra Cullinane everything seemed normal with the labour up to shortly before he was born at 8.20am the next day.

The only indication of any difficulty was the passage of a meconium, an infant’s faecal waste which can be a sign of distress, shortly before he was delivered, but it was not considered a cause for concern because it was thin.

The court heard that after Tadgh was born normally, he gave a few cries and his eyes opened, before he was handed to his 23-year-old mother. But within less than a minute, he had become pale and unresponsive, and blood was coming from his nose.

Ms Sheeran took Tadgh on her lap and made efforts to ventilate him, and at the same time noticed his mother was bleeding and the placenta did not deliver.

Between her efforts to ventilate him and aspirate the bleeding, she administered drugs to his mother resulting in the placenta delivering.

An ambulance arrived about 25 minutes after the birth, by which time a neighbour, Dr Olivier de Bluy, had intubated the child to help ventilate him. The baby was taken from the house at Lettercollum, Timoleague, to CUMH, where consultant neo-natologist Dr Eugene Dempsey continued efforts to try resuscitating him.

He told the coroner that baby Tadgh was grey in colour, giving occasional gasps, had very weak pulses, and did not respond to medical interventions.

The ventilating tubes were removed from him at around 1.50pm and he passed away in the arms of Ms McLoughlin and his father Raul Cartaya at 2.30pm.

Dr Dempsey said he believed, despite Tadgh appearing normal in the first minute of delivery, that the cause of his distress was ongoing for some time before his birth.

Ms McLoughlin’s consultant Dr Hewitt said he had advised her of the potential increased risks with home birth compared to hospital delivery. He inquired about the distance of the patient’s home from CUMH and was told it was about 48km or a 40-minute drive.

“I would find that unacceptable. Most studies which say home delivery is as safe [as a hospital birth] state the patient should be within 20 to 30 minutes of hospital,” he said.

Based on records provided to her and the expert analysis of the umbilical cord, assistant State Pathologist Dr Margaret Bolster found the cause of death was a lack of oxygenated blood to the baby’s brain, with total organ failure, associated with a blood-clotting defect and acute bleeding from the lung, following a delivery during which a retroplacental blood clot was clinically observed.

She also believed that whatever brought about the abnormalities was ongoing for some hours before delivery, rather than just after birth. She was satisfied there had been bleeding behind the placenta before delivery.

Based on the evidence, the six-member jury found Tadgh McLoughlin died of natural causes. Dr Cullinane said she hoped the case might help those tasked with oversight of home delivery services.

The dead infant’s parents have moved to Barcelona in Spain but Ms McLoughlin’s mother Karen Austin told Dr Cullinane she is trying to get on with her life after her son’s tragic death. Speaking after the inquest, Hazel’s father Con McLoughlin said that, even if she had given birth in hospital, there was no guarantee the tragic events would have been avoided.

“I was really looking forward to being a grandfather. It was very tragic the way it worked out. But I feel it is a natural thing for a woman to do to give birth at home,” he said.

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