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Provision of antenatal care, labour care, and post-partum support (10HDC00267)

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(10HDC00267, 21 May 2012)

Midwife ~ Lead maternity carer ~ Antenatal care ~ History taking ~ Information ~ Documentation ~ Birth care plan ~ Communication ~ Perineal tear ~ Co-operation with other providers ~ Post-partum support ~ Health of midwife ~ Rights 4(1), 4(2), 4(5), 6(1), 6(1)(b),7(1)

A woman complained about the care provided to her daughter by two midwives. Her daughter had suffered a large tear in her perineum when giving birth to her first child, and when she became pregnant again, informed her Lead Maternity Carer (LMC) several times about her previous experience giving birth and her anxiety about tearing again.

The LMC took some steps to ascertain further details about the woman's first experience giving birth, but did not obtain a copy of her previous labour and birth notes. The LMC provided the woman with reassurance and advice on using massage and hot cloths during the pregnancy to reduce the risk of tearing again, but did not offer the woman a referral to an obstetrician. She did not document a care plan for the woman's labour and birth.

The LMC could not attend to the woman during her labour and birth but arranged for another registered midwife, the back-up LMC, to do so. The back-up LMC had previously suffered from sinus tachycardia (SVT), which made her heart beat rapidly and irregularly and left her feeling light headed. The back-up LMC did not tell her colleagues or the woman about her medical condition.

Towards the end of the woman's labour, the back-up LMC began to feel light headed but she continued providing care. While giving birth, the woman suffered an extensive second degree perineal tear that required repair in an operating theatre.

Immediately after the baby was born, the back-up LMC left the room, leaving the woman and her baby without any midwifery or medical support until the obstetrician arrived.

The LMC was held to have breached Right 4(1) for failing to take an adequate obstetric history, failing to document her conversations with the woman, and failing to ensure the accuracy of the facts that were documented. The LMC was also found to have breached Right 6(1)(b) and Right 7(1) for failing to provide the woman with adequate information to allow her to make an informed choice about how her pregnancy and birth would be managed. The LMC also breached Right 4(2) for failing to document a care plan.

The back-up LMC breached Right 4(1) for failing to ensure the woman had midwifery or medical support immediately after the birth, and Right 4(2) for failing to comply with professional standards. She also breached Right 4(5) for failing to inform her colleagues and the DHB about her SVT condition, and Right 6(1) for failing to inform the woman about her SVT condition, how it might impact on the woman's delivery, and the strategies she had in place to manage this. The back-up LMC was referred to the Director of Proceedings. The Director decided to issue proceedings, which are pending.

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