Burden too great on midwives at home births

The burden of responsibility on midwives when assisting at home births is too great for them to be on their own, a coroner has said.

Coroner John O’Dwyer called for changes to ensure no midwives deal single-handedly with home deliveries.

“The load that midwives carry is, in my view, inordinate,” he said. “Changes should be made so that no midwives go out [to carry out a home delivery] on their own.”

Mr O’Dwyer also recommended that the ambulance service should be notified whenever a home birth is planned in case an emergency develops.

The coroner made his recommendations at the conclusion of an inquest in Castlebar, Co Mayo, into the death of baby Kai David Williams Henaghan in May 2011. The infant was stillborn at Mayo General Hospital after a planned home birth was abandoned when the foetal heartbeat began to diminish.

The midwife involved was Christina Engel from Ballinrobe, Co Mayo, who worked in New Zealand both as a tutor and midwife for many years before returning to work in Mayo.

At the conclusion of the inquest yesterday, Mr O’Dwyer returned a verdict of misadventure.

Expressing his deepest sympathy with the infant’s parents, Sarah Williams and Emmett Henaghan, the coroner said he hoped that lessons could be learned from the tragedy.

Mr O’Dwyer added that the distance of a home birth from the local maternity hospital should be factored in whenever home deliveries are planned.

Ms Williams, aged 39, and her partner Mr Henaghan were living in Kilsallagh, Westport, about 22km from Mayo General Hospital, Castlebar, when their baby Kai David was stillborn on May 24, 2011.

In court on Monday, Mr Henaghan told how the couple prepared for the home delivery by lighting candles and playing soothing acoustic sounds on their stereo as Sarah waited in a birthing pool.

However, at 2.15am, after long hours when the baby’s head was showing and retracting, Mr Henaghan became “extremely stressed and concerned about the lack of progress”. He turned off the music and when he heard the baby’s heartbeat diminish he insisted the couple go to hospital.

Mr Henaghan’s intention was to drive midwife Ms Engel’s car to the hospital, but it would not start. So they travelled in his van with Sarah “sitting against the dash in extreme discomfort with her hands on the headrest”, he said.

Mr O’Dwyer said that, based on the evidence, Mr Henaghan had made the comment first about going to hospital, and the midwife, Ms Engel, had agreed with him.

The coroner added that the theory was that if they arrived earlier at the hospital, the baby might have survived.

Mr O’Dwyer said he did not know conclusively that this would have been the case, but with better facilities within the hospital, it would have been reasonable to assume so.

He said he was excluding natural causes as the cause of death, which left him with the choice of either medical misadventure or misadventure.

Misadventure was the appropriate verdict, the coroner decided.

John Jordan, counsel for the infant’s parents, said the couple had been anxious that their voice be heard. They were happy with the way the inquest had been conducted and with the recommendations made.

“Their desire is that the recommendations be heeded in a meaningful way so that the prospect of this ever happening again be diminished or reduce,” said Mr Jordan.