Newborn dies after delay in caesarean

A newborn baby died after an emergency caesarean operation was delayed, prompting the Health and Disability Commissioner to call for tougher maternity safety controls.

The baby died at North Shore Hospital in 2004, two days after being delivered by emergency caesarean. A private midwife and a doctor at the time employed by the hospital, a senior registrar, were involved with the birth.

Commissioner Ron Paterson, who is calling for tougher safety controls on private maternity practitioners, plans to release his report on the case early tomorrow. The Weekend Herald has been told in advance of key contents.

It is understood that although Mr Paterson's report found that the care provided by both practitioners was below the required standard, their lapses did not warrant referring them for possible disciplinary proceedings.

The Herald understands that the obstetrics and gynaecology registrar was so shaken by the case that she has given up obstetrics.

"They didn't intervene fast enough for a caesarean," Dwayne Crombie, chief executive of the Waitemata District Health Board, which runs the hospital, said yesterday. "They didn't recognise the baby was distressed quickly enough, and they didn't show enough urgency in getting the emergency caesarean done [in the handover] between the midwife and the registrar."

Dr Crombie said Mr Paterson had found that no systems controlled by Waitemata were at fault, but he had found a national problem in the so-called access agreement.

This is a three-page Government document governing the access of private maternity practitioners - midwives, obstetricians and GPs - to maternity hospitals, most of which are state-owned.

"When they come to public facilities under the access agreement, there is no requirement for them to observe the policies of the facility," Dr Crombie said.

"There's no quality requirements that they have to observe at the organisation they are coming into. My staff have to obey my protocols around clinical safety, but private midwives or obstetricians only have to practise according to what they believe is acceptable from their professional point of view.

"They don't have to take any notice of any concerns of my staff or protocols and policies of my units.

"The access agreement the Ministry [of Health] set up makes it clear I cannot impose those things. The only thing imposed on them is cultural safety."

A number of district health boards had suggested introducing safety controls into the access agreement, but the ministry had not done so.

Dr Crombie said national clinical guidelines, of some form, were needed.

They would cover things such as what constituted fetal distress and what actions should be taken in response. Everybody, public or private, would be bound by them.

The head of the New Zealand branch of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists, Dr Bill Ridley, said last night the access agreement was a serious concern to the college.

He tied it to concerns about midwives' accountability and training.

Midwives, like doctors, must be registered and have a practising certificate to work in their field. But Dr Ridley claimed midwife training was inadequate.

"They need an extra year in hospitals to pick up on things that are going wrong."

Midwifery groups have rejected this view in the past, but yesterday College of Midwives chief executive Karen Guilliland declined to reply to Dr Ridley.

Earlier, Midwifery Council chairwoman Dr Sally Pairman declined to comment on the Paterson report before its release, as did the ministry and Health Minister Pete Hodgson.

The ministry is already reviewing aspects of the Government's maternity regulations, including clinical quality, and is likely to accept the need to develop systems suggested by Mr Paterson.

Mrs Guilliland said the access agreement had helped hospitals and lead maternity care providers understand their roles.

"Any change to this system must be well thought out."

Mr Paterson's report follows criticisms last year by Wellington coroner Garry Evans of midwifery training and his call for a review of maternity services, greater involvement of GPs and an audit of baby death rates.