A midwife has been found in breach of the code after failing to provide an appropriate standard of care to a young pregnant woman whose baby later died.
The woman, aged in her late teens, was living in a rural area when she went through her first pregnancy in 2018. Despite living outside the midwife’s practice area, she had agreed to be her lead maternity carer, Deputy Health and Disability Commissioner Rose Wall said in her report , released today.
The midwife did not measure the fundal height in centimetres at every antenatal visit, and she encouraged the woman to count the fetal movements, which was not consistent with current midwifery practice.
In the final weeks of her pregnancy, the woman developed oedema, headaches, and elevated blood pressure. However, the midwife did not request a pre-eclampsia blood test at 37 weeks’ gestation or perform a urine analysis at each visit, according to the report.
Pre-eclampsia is a potentially dangerous pregnancy complication characterised by high blood pressure, usually beginning at around 20 weeks' gestation in women whose blood pressure had previously been at normal levels.
The midwife assessed the woman's condition by telephone after she went into labour but failed to recommend an in-person assessment. The woman was then rushed to hospital, where her baby had died.
The woman had showed signs of impaired health that were not recognised by her midwife, which meant that a referral to secondary care was warranted but not done, Wall said.
"Had this occurred, the symptoms of pre-eclampsia, intrauterine growth restriction, and reduced fetal movements may well have been detected sooner," she said.
The report highlights the importance of appropriate assessment of a woman’s condition, monitoring of a baby’s growth accurately, and the need for appropriate action in response to the development of clinical concerns that have the potential to affect the health of the woman and/or her baby.
Wall was also critical that the midwife did not maintain accurate antenatal records, and that the arrangement for remote oversight was not suitable to detect and respond to the issues arising as the woman’s pregnancy progressed.
She recommended that the midwife provide a written apology to the woman and her whānau, undertake training on pre-eclampsia in pregnancy, and documentation and the Growth Assessment Protocol.
SHARE ME