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Midwife accidentally caused scald when warming baby's heel for Guthrie test (00HDC06573)

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(00HDC06573, 3 April 2002)

Midwife ~ Standard of care ~ Guthrie test ~ Record-keeping ~ Rights 4(1), 4(2)

A complaint was made by a mother about a midwife who called to examine her new baby, and obtain a Guthrie test. The midwife intended to place the baby's heel in a cup of warm water, but she heated the water in the kettle to almost boiling, subsequently picked up a cup containing the water, and placed the baby's heel in the cup. After realising that she had burnt him, the midwife peeled off the burnt skin and pressed a napkin over the burn to control the bleeding. ubsequently, as there was no running water at the home, she immersed the heel in rainwater. The midwife then attempted to obtain blood for the Guthrie test, and applied ointment and gauze. The midwife's recollection of events was somewhat different from the mother's, and there may have been a number of factors that distracted the midwife's attention. The midwife returned to the home later with a homeopathic burn remedy and surgical dressings. The mother decided to take the baby to the medical centre, and the baby subsequently received hospital treatment. Over the following two weeks the baby healed completely. As a result of the accident the midwife stopped practising midwifery.

The Commissioner reasoned that it is not unusual to use heated water to assist blood flow before undertaking a heel prick, but held that the midwife breached Rights 4(1) and 4(2) of the Code in that she failed to test the water temperature before submerging the baby's heel. The presence of the burn indicated that she did not take sufficient care.

The first aid for a burn is to immerse it in cold water for at least ten minutes. Lotions and ointments should not be applied, and medical attention should be sought if there are any concerns about the severity of the burn. There was no evidence that the midwife gave any advice on the treatment of the scald. Therefore, with regard to first aid and advice, the midwife did not provide services with reasonable care and skill. It was inappropriate for the midwife to then proceed with the blood test, as her actions had an adverse effect on the baby's well-being.

It also appeared that the midwife had amended her original record of the incident. Although it may be necessary to add to clinical records retrospectively, this should occur infrequently and it is imperative that amendments be appended with the date and time they are added.

The midwife did not advise the mother to seek follow-up assessment and treatment for the baby's burn, and she did not accompany the mother to the medical centre or inform the clinic staff about the circumstances of the incident. The midwife had a professional responsibility to fully inform the health professionals of the nature of the accident to ensure the baby received appropriate care.