Concern over drug used before birth
Inquest into baby’s death hears medication was used to speed up delivery
Shauna Keyes and her partner Joseph Cornally arriving at Portlaoise County Council buildings for the inquest. Photograph: James Flynn/APX
An inquest has opened into the death of a newborn baby boy at the Midlands Regional Hospital in Portlaoise four years ago.
Baby Joshua Keyes died an hour after being delivered by Caesarean section in the hospital on October 28th, 2009.
His mother Shauna, from Tullamore, Co Offaly, had been admitted early the day before, after her membranes ruptured.
Lawyers for Ms Keyes expressed concerns at yesterday’s inquest about the hospital’s management of the birth and about later meetings with staff in relation to Joshua’s death.
Roger Murray, of Callan Tansey solicitors, argued that the medical team continued to administer Syntocinon, a form of artificial oxytocin used to speed up delivery, when it should have been stopped because the foetal heartbeat was slowing down.
He also claimed there was a delay in carrying out the Caesarean, which was completed about 15 minutes beyond the recommended target of 30 minutes after a decision to deliver.
Ms Keyes said she was admitted to the hospital at 6.30am on October 27th, 2009.
She was transferred to the labour ward at 3pm that day and administration of Syntocinon was begun. However, this was stopped at 5.15pm after the foetal heartbeat started slowing.
Administration of the drug was recommenced shortly after when the heartbeat steadied and the dosage increased but later that evening there were further decelerations of the heartbeat.
Mr Murray said the family’s fundamental difficulty was in understanding why staff did not stop administering the drug at this point, when they had done so earlier in the day. Syntocinon can cause contractions to come too quickly and put undue physiological pressure on the baby in some situations, he said.
However, nurse Margaret Coss, who was on duty, said that the two incidents were not comparable. The decelerations noted earlier in the day were late and required a suspension of the drug but those occurring in the evening were variable and of less concern because the foetal heartbeat returned to normal more quickly.
She agreed with Mr Murray that by the 10.40-11.30pm period there were signs Joshua was in distress. She said she asked doctors several times for a section but agreed this was not recorded in the notes.
Dr Miriam Doyle, the consultant obstetrician on call on the day, said from her reading of the file she would have had concerns about the baby’s heartbeat from 10.30pm and would have stopped administration of the drug by 10.50pm.
Some babies did not tolerate Syntocinon very well, she said. As Joshua’s condition worsened, the drug was stopped at 11.46pm and a Caesarean ordered. He was born at 36 minutes after midnight but died an hour later.
Ms Keyes described as “horrific” the experience of looking over at her baby boy while the medical team worked in vain to resuscitate him. Ms Coss said she was disappointed that the delivery had not been carried out sooner but insisted there was no delay on her part.
Ms Keyes says that in subsequent meetings with hospital staff she was told Joshua’s organs were “too heavy” but were not enlarged so they appeared normal on scans. Staff told her he may have had Down syndrome and was so severely brain damaged it would have made no difference to his fate if he had been born two weeks earlier.
She said she was told that she could not hold her baby after his death because he was being kept on ice while one midwife referred to Joshua as “stillborn” and said “these things happen”.
She said she was told to lose weight and that it was not a good idea for her to have another baby immediately.
Ms Keyes said that although she had just turned 18, Joshua was and is her first-born and she desperately wished to know what happened to him, and why it happened.
Her father Donie said the manner in which his daughter had been treated was “traumatic” and he hoped the HSE had learned lessons from his grandson’s death.