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Administration of Vitamin K to newborn baby (11HDC00957)
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(11HDC00957, 10 June
Midwife ~ Vitamin K ~ Jaundice ~ Guthrie test ~ Screening ~
Care planning ~ Documentation ~ Rights 4(1),
A 25-year-old woman complained about the care provided by her
midwife during her first pregnancy. On a Thursday in late 2010, the
woman had a rapid delivery, following which she required the manual
removal of a retained placenta and suturing of tears under
anaesthetic. The midwife had not discussed the administration of
Vitamin K with the woman during the antenatal period, and she asked
the father whether he agreed to the baby being given Vitamin K. The
father was unsure and asked to defer the decision until his wife
returned. The midwife did not discuss the administration of Vitamin
K again while the woman and her baby were in hospital.
The woman was discharged on Saturday. The midwife visited the
family at home on Sunday. At that visit, the woman asked about the
Vitamin K and the midwife said she would get it from the hospital.
On Sunday, the baby became mildly jaundiced.
The midwife visited the family at home again on Monday. The
woman asked again about the Vitamin K, and the midwife said she
would pick it up and bring it the next day. By Monday, the baby was
"a bit yellow", and by that night/the following morning she was not
feeding at all.
When the midwife visited on Tuesday, the baby was lethargic, not
feeding, had "bright yellow jaundice", and had had a 10% weight
loss since birth. The midwife called the public hospital and
performed a Guthrie test (a screening test to detect a number of
conditions, recommended to be carried out within 48 hours of
feeding or as soon as possible after this). The baby was admitted
to the public hospital with neonatal jaundice, anaemia and high
sodium levels. It was found that she had suffered a large right
cerebral haemorrhage and she was transferred to a paediatric
intensive care unit. The baby required an urgent craniotomy and
evacuation of a subdural haematoma.
It was held that the midwife's care planning and documentation
were not in accordance with professional standards and,
accordingly, she breached Right 4(2). Her lack of discussion with
the parents about Vitamin K administration during the antenatal
period was a failure to provide an explanation of the options
available including an assessment of the risks, side effects, and
benefits of each option. Accordingly, she breached Right
The failures to perform a Guthrie test within an appropriate
period after birth, to respond to the baby's deterioration
appropriately, and to ensure that the baby received Vitamin K were
together a serious departure from expected standards. The midwife
failed to provide services with reasonable care and skill and,
accordingly, breached Right 4(1).
The midwife was referred to the Director of Proceedings for the
purpose of deciding whether any proceedings should be taken.