A consultant obstetrician delayed doing an emergency Caesarean section at Cavan General Hospital because there was no nursing staff available for theatre, an inquest heard. Dr Salah Aziz told the inquest into the death of baby Jamie Flynn, who died from a hypoxic brain injury in late 2012, that he opted to try delivery using instruments first because he knew that the on-call nursing staff were already tied up at another emergency C section.
Jamie was born shortly before midnight on November 22nd, 2012, in very poor condition. He was transferred to the Rotunda hospital in Dublin where he died in his mother’s arms two days later.
Dublin Coroner’s Court heard that Fiona Watters, Tara Court Square, Navan, Co Meath, was admitted to the hospital for induction on November 20th. She was given prostaglandin, a hormone used to induce labour, over the next two days. She was seen by Dr Aziz for the first time on the morning of November 22nd. He said they discussed the possibility of a C section but she told him she would like to try a “normal delivery”. He broke her waters and the baby’s heart rate was monitored over the course of the day.
At 10.30pm, midwife Breege Lavin contacted him to say that Ms Watters had been pushing for an hour but the head was not visible. The obstetrics registrar and senior house officer on duty were carrying out an emergency C section on another woman and were not available.
Dr Aziz arrived at the hospital at 10.45pm. She needed to be delivered, he said, but because nursing staff were already at another procedure he was “left with no choice” but to try delivery using a vacuum or forceps in the labour ward.
Cavan General Hospital has three nursing staff for the operating theatre after hours. Off-duty staff must be called in to open a second theatre. “I was fully aware from my previous experience that there could be a significant time delay before a second theatre could be opened,” Dr Aziz said.
The instrumental delivery failed and Ms Watters was transferred to theatre where she had the emergency C section. Nursing staff had become available after the other patient stabilised, the court heard.
Dr Aziz said that evidence of hypoxia was not "clear cut" on the baby's cardiotacography (CTG) – or foetal heart monitor. However, he said that there was an abnormal CTG at one point when Ms Watters was being given prostaglandin. He told the court the normal process in such cases is to stop the prostaglandin and ask the consultant to review the patient.
He said that in his opinion there may have been a prolonged period of hypoxia before birth rather than a single event. Any problems on the CTG should have been brought to the attention of the registrar by the midwife, he said.
At postmortem, pathologist Dr Deirdre Devaney found that Jamie’s brain injury had occurred prior to birth. The postmortem found no apparent cause. However Dr Devaney said she was not given the placenta to examine despite requesting it. As a result, an issue with the placenta could not be excluded as a potential cause.
Ms Lavin told the court that she specifically pointed out that the placenta should be kept. It was normally given to the midwife to take back to the labour ward to examine, she said. However, there were three C-sections that day and when she went to collect it, there were three placentas and she could not determine which one belonged to Jamie.
Coroner Dr Brian Farrell said he was adjourning the inquest to consider the evidence and whether expert opinion was required. The inquest was put in for further mention on July 29th.