The baby was "large" and Ms Nathan's fundal height (size of the uterus, used to assess fetal growth) was in the 90th percentile. Guidelines on the customised growth chart used by Ms Mecchia indicated that a referral for a scan should have been made but this was ignored.
When asked by coroner Garry Evans why she chose not to obey the advice on the chart or to communicate to Ms Nathan what was going on, Ms Mecchia said she understood the guidelines "but I also used my own experience".
Mr Evans responded: "But you didn't communicate that or indicate that a scan was needed ... you didn't tell her that. She was entitled to know that. You don't know the variable reasons for the aberration ... it was a clinical judgment made in isolation ... without Ms Nathan, wasn't it?"
Another midwife, Sheryl Wright, who also saw Ms Nathan towards the end of her term, considered Kymani was of an "average size" and Ms Nathan's fundal height and growth were appropriate for her estimated gestation of 34.5 weeks - despite the lead maternity carer earlier observing a fundal height that was well in excess of the 90th percentile.
She said that there were "noother clinical symptoms present that could indicate concerns".
The inquest also heard that Ms Wright did not record an entry on Ms Nathan's growth chart as she was not using them in her practice saying they had "limitations".
Earlier Waikato Hospital obstetric anaesthetist Dr Aidan O'Donnell told the inquest Ms Nathan had an amniotic fluid embolism, or AFE, but she was haemorrhaging severely on arrival and staff were unable to run a blood test that could have indicated this.
AFE is a rare and unexpected complication when it is believed amniotic fluid, fetal cells, hair or other debris enter the mother's circulation and cause cardio-respiratory collapse.
Ms Nathan's lead maternity carer, who has interim name suppression, is today expected to give evidence via a video link to the country where she now lives.
nzherald.co.nz
Read previous stories on this case here: tinyurl.com/nzhKymani
