Coroner recommends drawing up guidelines for use of drugs in difficult deliveries
Eugene O’Connor gives cause of death of baby Joshua Keyes as reduction of oxygen supply at birth
Shauna Keyes: Arriving at the inquest in Portlaoise into the death of her baby Joshua, who was delivered by Caesarean section. Photograph: James Flynn/APX
A coroner has recommended the drawing-up of guidelines for maternity units to govern the use of drugs used to speed up difficult deliveries.
Co Laois coroner Eugene O’Connor said he was surprised there were no national guidelines for the use of Syntocinon, a form of artificial oxytocin.
Mr O’Connor yesterday returned a narrative verdict in the inquest into the death of baby Joshua Keyes, who died after being delivered by Caesarean section at the Midlands Regional Hospital in Portlaoise four years ago.
He gave the cause of death as intrapartum anoxia, or a reduction of the oxygen supply at birth, but declined to make a causal link between the death and the hospital’s management of the birth, as urged by lawyers for Joshua’s mother, Shauna.
Ms Keyes was admitted to the hospital early on October 27th, 2009, after her membranes ruptured. That afternoon, she was administered Syntocinon to speed up her labour but the baby’s heartbeat slowed down in the evening and a Caesarean delivery was ordered. Joshua was born shortly after midnight but died an hour later.
Roger Murray, solicitor for the family, claimed the underlying cause of death was the misuse of Syntocinon, which can cause contractions to come too quickly, and a failure to expedite delivery in an appropriate fashion.
There was a direct causal link between the cause of death and the deficiencies identified at the inquest, he said.
Lawyers for the hospital rejected this argument as a “quantum leap” and pointed to the evidence of pathologist Dr Peter Kelehan, who said he was unable to identify the underlying cause of death. Dr Kelehan said Joshua was a big, well-grown baby with no major congenital abnormalities. There was nothing to indicate why he had developed anoxia. The majority of infant deaths were unexplained, he pointed out.
Mr Murray said there was clear evidence that Joshua had abnormal cardiotachygraph readings (measuring foetal heartbeat and his mother’s contractions) for two hours during Ms Keyes’s labour. This was the only possible explanation for his death.
However, Dr Kelehan said the CTG test delivered a 98 per cent false positive rate, meaning that of 100 children with an abnormal trace, 98 births would turn out perfectly normal and two would prove abnormal.
Consultant obstetrician at the hospital Dr Miriam Doyle agreed, saying the test provided an indication there might be a problem but it didn’t say what the problem was or what was causing it.
Earlier, consultant paediatrician Dr Ciara McDonnell told the inquest she arrived in the hospital 16 minutes after baby Joshua was born. He was white in colour, floppy and not responding to stimulation.
Dr McDonnell said she met the family at its request in January 2010 to discuss the result of the postmortem.
They had many questions and were offered counselling but chose to pursue this option close to home.