Mother’s care in labour ‘substandard’, inquest told

The inquest is being held at Belfast Coroners Court
The inquest is being held at Belfast Coroners Court

A doctor and a senior midwife made “very damning concessions” as to hospital care given to a mother whose newborn baby died in the Causeway Hospital in Coleraine.

While midwife Karen Armstrong conceded at the Coroners Court on Tuesday that Tracy Hook received “substandard care” in her labour leading up to the birth of her daughter Alexis, obstetrician Dr Tughral Rahman accepted that he should have spotted there was a danger to the baby more than an hour before a decision was made to perform an emergency caesarean section.

Giving evidence at the Belfast inquest, Dr Rahman accepted that in hindsight, he should have seen that the foetal heartbeat trace from baby Alexis Hook, taken at 12.06am on July 4 2012, was “pathological” and therefore, “would have set alarm bells ringing”.

He further accepted had that been the case, little Alexis could have been born within half an hour rather than at 01.42am.

Two weeks after her due date, baby Alexis was born by emergency caesarean section, and although alive initially, within minutes she had developed breathing problems and despite efforts to resuscitate her she died, leaving the lives of her parents Tracy and Allistair “ruined” as Mrs Hook put it.

The inquest being conducted by senior coroner John Leckey has heard that Alexis died as a result of asphyxia brought about when she inhaled meconium, described as “baby poo” by the pathologist who examined her body.

She explained that if babies become distressed in the womb, they sometimes open their bowels, allowing faecal matter to float in the amniotic fluid.

On Monday on-call consultant Dr Lorraine Johnston said she was at home when Dr Rahman contacted her at 12.15am on July 4 to tell her there were difficulties interpreting the trace on Alexis’ heart rate so she told the staff on the ward to wait until she examined Mrs Hook which happened at 1.05am.

At 1.23am Dr Johnston made the decision to perform the emergency C section and at 1.43am, Alexis was born weighing 3,743 grammes.

Dr Johnston conceded on Monday that a trace of Alexis’ heartbeat at 12.27am was “pathological”, but on Tuesday it was suggested to Dr Rahman that a trace taken 21 minutes earlier was pathological rather than “suspicious” as he had described it.

Mr Leckey put to the doctor that while he realised the interpretation of traces “isn’t always black and white and sometimes a pathological trace can only be identified with the benefit of hindsight,” he had two expert reports which opined there was a “failure to escalate concerns” at an earlier stage, and that the trace was pathological at 12.06am so “therefore there was an urgent requirement to deliver the baby”.

Dr Rahman conceded that the trace “should have been classified as pathological”.

He added, however, that it was “highly unusual and difficult” to assess the trace as it was difficult to identify specific contractions, and that by 12.36am, “I started getting the impression that this was a pathological trace and that we needed to take action”.

Later senior midwife Mrs Armstrong said no decision was made about what stage of labour Mrs Hook was at until around midnight and agreed with the suggestion by the family’s solicitor that an internal examination would have determined that.

There was however, as the inquest heard, no internal examination conducted for around 12 hours and the midwife agreed that was “unacceptable”, especially as Mrs Hook was in increasing levels of pain, had used different types of pain relief and was experiencing frequent contractions which were being timed by her husband Allistair.

Mrs Armstrong told the inquest that on the night of baby Alexis’ death, the unit was short staffed and extremely busy with seven high-risk deliveries along with a premature baby being born.

On Monday the inquest heard that in his statement, Mr Hook described how he repeatedly had to ask for kidney dishes as his wife was vomiting.

Mr Leckey said: “Let’s not beat about the bush, the care given to Mrs Hook was completely unacceptable and was substandard.”

Mrs Armstrong replied: “On this occasion, yes.”

However, the senior coroner told her in no uncertain terms: “Mr and Mrs Hook are here because their baby died. They’re not interested in any other occasion. As a result of this incident, their baby died.”

The inquest continues.