Baby's death prompts better care for expectant Asians

Improved care of expectant Asian mothers will result from the death of a Japanese baby at Christchurch Women's Hospital.

Baby Hana Yanagawa suffered fatal skull fractures during an excruciating forceps delivery in March last year.

A rare and frightening complication, known as pelvic outlet contraction, caught doctors and midwives by surprise.

Now guidelines are being developed for the prenatal care of Asian women. A study planned by Otago University's new clinical decision unit, in conjunction with the Canterbury District Health Board, will establish the normal range of pelvis size for typically smaller Asian women.

It is one of the key recommendations in the formal release of the findings of the inquest into Hana's death.

The suggestion came from Christchurch obstetrician Harry Bashford, who identified the need for research while giving evidence at the coroner's hearing in August.

It was Mr Bashford who was summoned when mother Akiko Yanagawa did not progress after more than three and a half hours in advanced labour.

Taking over from lead midwife Kate McKay and obstetric registrar Michelle Bailey, he declared he would "easily get this" with forceps.

Instead, baby Hana became wedged in her mother's pelvis. Subsequent scans revealed it to be unusually small.

For 24 agonising minutes Mr Bashford struggled to bring baby Hana safely into the world. During that time:

* Two different types of forceps repeatedly slipped off the baby's head.

* Forceful pulls dragged Mrs Yanagawa down the bed on several occasions.

* A cracking sound was heard as the forceps were applied.

Hana's father, Kazuhide Yanagawa, was overcome by nausea as he watched.

Baby Hana was eventually born with skull fractures and brain damage.

She died almost 11 hours later in her mother's arms.

Coroner Trevor Savage said the key question was whether caesarean section should have emerged as the preferred option and, if so, at what point.

Mr Savage concluded that "the difficulties encountered in delivering Mrs Yanagawa's baby were caused by pelvic outlet contraction, but that Mr Bashford should have been alerted to this by the time four traction efforts had proved unsuccessful and the forceps had slipped twice".

Mr Bashford told the inquest that removing baby Hana by emergency caesarean was too risky. Moving her back up the birth canal could have caused spine or brain damage, even death.

The coroner found that the decision by Mr Bashford to persist with forceps "in the agony of the moment" could not be said to be unreasonable.

"Particularly having regard to its likely effect on the professional reputation of a highly regarded and experienced practitioner, there is not here the clear evidence that would be required to support a finding that his conduct went beyond the limits of discretion and fell below accepted standards," Mr Savage said.

Responding to the findings, Mr Bashford expressed his "sincere condolences" to the Yanagawa family for "the tragic loss of baby Hana, which has deeply affected all those involved".

Hana's parents in Japan were unable to be contacted. The Yanagawas have complained to the Health and Disability Commissioner, Ron Paterson.

Meanwhile, the College of Midwives said that the moves to develop guidelines for Asian mothers was ethically and medically wrong.

Chief executive officer Karen Guilliland said the implication that because Mrs Yanagawa was Japanese the size and shape of her body was the source of the problem was not supported by the fact that millions of Japanese women gave birth with a lower intervention rate than for New Zealand women.

She said the college would like to see further discussion on the case that "concentrates more on the issues as they pertain to the standard of care that all women should expect regardless of race within the New Zealand health system".

- NZPA