Monitoring in the Birthing Pool

[rzl]

Our baby died due to a lack of oxygen around the time of his birth. We are unable to pinpoint the exact time or cause of the oxygen starvation but my wife was in the water just before the birth and the midwife found it very difficult to monitor the heartbeat. She says that she could feel the pulsation on the monitor but no-one I have spoken to (incl. an obs consultant) has ever heard of this ? can anyone help?

The second stage lasted less than half-an-hour and the fetal heart rate was monitored just twice in this time and in both cases the midwife has recorded that it was difficult to pick up. We feel that the monitoring was insufficient and perhaps there could have been a different outcome if the monitoring had been done properly and more often.

oh i am so sorry to hear about your loss.

I have no experience of this myself but I hope someone out there comes along soon to offer you some advice.

Are you investigating/complaining about this unfortunate incident?

You should have access to your wifes birth notes which may explain these questions.

Hope you and are wife are coping as well as you can do at this sad time.

x

that is so sad rzl.

I had a home water birth. Between each contraction, my midwife used a doppler underwater on my belly to monitor the heartbeat. Is this what your midwife did?

I think the midwife used a sonicaid so I would have expected to hear the heartbeat but I heard nothing. When I queried this with the matron later, she said that the mw didn't need to hear the heartbeat as she would be able to feel it pulsating between her fingers. This is what I am confused about because no one else I have spoken to (including other midwives) seem to have heard of using the sonicaid in this way.

I have read the medical notes and we have asked the relevant questions but we will never know if our baby got the hypoxic brain-injury during the labour or before.

We have told the hospital that we think that the midwife should have gone for help because she had difficulty with the fetal monitoring underwater, and that she should get more training.

Would our baby be with us today if the mw had taken a different course of action? I don't think we can ever know.

I'm so sorry for your loss

dopplers work using reflected sound waves, so TBH I can't see how the m/w could have "felt" it pulsating Maybe it was possible she saw the reading of the HB on the display, even though it couldn't be heard through the loud speaker on the doppler?

The latest NICE guidelines say that during the second stage "Intermittent auscultation of the fetal heart should occur after a contraction for at least 1 minute, at least every 5 minutes." I thought normal practice with water births was that if there was any difficulty/concern monitoring baby then the woman is asked to leave the water?

RZL I am so sorry for your loss.... my condolences to you and your wife, I can't imagine what you must be going through

NICE guidelines (Sept 2007) state that intermittent auscultation of the fetal heart should occur after a contraction for at least 1 minute, at least every 5 minutes.

But I'm sure that normal practice is for the heart rate to be monitored after EVERY contraction during 2nd stage. See point 2.7 according to the World Health Organisation's publication Care in Normal Birth

If the mw was finding it difficult to pick up the heart rate she should have called for back up, but (being Devil's advocate) perhaps she daren't leave your wife to go get it! Mw do work in appalling conditions within the NHS, with staff shortages, overwork etc... Not any consolation to you and your wife but it may be that your case can add to the argument over NHS funding by the government (in general) and be a wake up call to your local hospital's policies in particular. I bet that mw is devastated too, whether or not it is proven she was negligent.

The sad fact is that birth is a risky business and some babies do die or suffer injury. It is very rare these days, because we do have better hygeine and good nutrition, and most often an exact reason is hard to find. Which does not help you at all.... I know of someone else who recently lost a baby at birth even though she underwent a Crash CS under general anaesthetic. Brain injury is thought to have occured shortly before birth. This poor lady is also looking for answers.

Be good to your wife (and yourself!), accept all offers of support from friends and family and don't be afraid to talk about this, it will help the grieving process.

My thoughts are with you both.

Aaah, it took me so long Betsyboop already quoted the NICE guidelines....

Midwife should have got dw out of the water and she could easily have asked me to get back-up as the nurses station was right outside the room.
She looked quite young and I don't think she had the experience to take control of the situation. We have asked the matron how many births the mw has been responsible for but she evaded the question.

I don't think there was an issue with resourcing as there were plenty of staff on hand for the resus.
A friend had a waterbirth at home a couple of weeks ago; she had 2 midwives plus a student dedicated to her alone.

yes, RZL, that's the beauty of homebirth, you get a mw out to you and then when birth is imminent a second one arrives. There needs to be one for mum and one for baby in case of complications.

I am so sorry you are going through this....

It does sound like inexperience.

Maybe matron can assure you that hospital policy has been updated to take into account the latest NICE guidelines? And that mw is going through a period of review so that she learns from this...

IF not.....

Well, when I asked the matron how many times baby's heartbeat was monitored during the second stage (this I asked before we had the notes) she responded...
"We work under national guidelines and in relation to the fetal heart the NICE guidelines on fetal monitoring was the policy/guideline"

Hi rzl

am so very sorry to hear about the loss of your baby , it must be extremely distressing for you and your DW .

have you asked for your wife's notes?

have you taken legal advice?

if the heartbeat was not auscualted regularly, and there was an issue finding it, then steps should have been taken, not least to get back up , and to get your DW out of the water to try to get a better HB.

you cannot feel the pulsation of the HB on a sonicaid, you can hear it and see how fast it is, but you cannot feel it.

the matron will say that the staff work within NICE guidelines,as saying anything else is going to be an admission of not doing things properly.

when did this happen ?

so, you do have the notes? do you think they are a true reflection of what happened?

The notes say the heart-rate was only monitored twice and was difficult to pick up which is my recollection too.

We haven't gone down the legal road - I just can't see what good it would do. It definitely won't bring our baby back and I don't want to put a price on his life.
I'm sure the midwife will have been devastated too and that she will have learned from tragedy.

i understand, it is an option some parents would choose, if it is not right for you , then that is ok, only reason i ask, is that if you are considering it, the quicker you get the notes the better. have heard of notes 'disappearing'.

i think that nothing more can be done, there is no guarantee things would have been different. my sincere condolences to you both.

Hope that's not so Lulumama regarding notes disappearing, because that would immediately be a red flag to me.

quite, noname.

what is your knowledge of problems with HB in a waterbirth, would protocol be dictated by NICE or would it be by each MLU or hospital?

rzl, you and your wife must be devastated, I know that nothing can change what happened for you, but by instigating an enquiry into what happened, nothing to do with litigation or financial recompense, you may help to ensure that practise is changed, maybe by more than the one midwife, and others may be spared your trauma.

Whatever the options or mode for delivery Lulumama, the fetal heart rate must be monitored between contractions during the second stage, anything less is in my opinion negligence.

okey doke

thanks

Not wanting to hijack this thread, but interested to know Lulumama whether it has been your experience while acting as a doula to note whether the monitoring of the fetal heart during the second stage has been 'appropriate'?

This new system on mumsnet is a little wierd! Lulumama.

Prior to leaving the NHS, the hospital I worked at didn't have a birthing pool(they have now).

The protocol will be as dictated by NICE.

it's funny, i can reacall it in my own second stage, but not in any of my clients, except a home birth where the sonicaid was faulty and it was impossible to monitor the heartbeat fully for the correct amount of time, luckily there was a good outocme, and second stage was less than 10 minutes

The hospital have concluded their investigation; in response to our assertion that my wife should have been taken out of the bath to get an accurate monitoring, a consultant obstetrician said that in retrospect it would have been a wise course of action. He added that "on the other hand, whenever the heart was osculated, it was always in the normal range."

There has been a postmortem which concluded he died of severe hypoxic ischaemic encephalopathy due to deprivation of oxygen "around the time of birth" - they were unable to pinpoint the exact timing of this episode.

There will also be an Inquest to which the midwives have been asked to make a statement.

This is so sad.

In my experience i have never'felt' a heart beat pulsating through a sonicaid.

If the midwife did not feel she could leave your wife, i wonder why she did not call the call bell to get someone in to help her.

I also wonder why the midwife was not being supervised more closely if she was a junior midwife. The Nursing and Midwifery Council Code of Crofessional conduct 6.2 discusses professional competance.

I can only reiterate the NICE guidelines that have already been spoken about.

Incidently, do the hospital admit that the fetal heart was not listened to often enough?

To answer your last question TeaDrinker, the evasive answer I got was as posted above ie.

[CODE]Well, when I asked the matron how many times baby's heartbeat was monitored during the second stage (this I asked before we had the notes) she responded...
"We work under national guidelines and in relation to the fetal heart the NICE guidelines on fetal monitoring was the policy/guideline" [/CODE]

The notes show just two entries for FH monitoring in the second stage;

11:30 Difficult to listen to FH. FH 130-140 re-assuring.
11:50 FH auscillated under water, reassuring but difficult to pick up.

I'm not sure if the midwife was a "junior" she looked in her early twenties. When I asked the maternity matron how many births the mw had been responsible for she just said that she was an experienced midwife.

rzl, I hope you don't think I'm being intrusive but may I ask a few questions?

When was baby born and how long after did the hospital conclude their investigation?

Were the fetal heart recordings throughout the first stage of labour well documented with no variation from the normal range?.

Do you have a full copy of your wife's labour notes and have you have you considered asking an indepentent professional to look at them?

Have they made any recommendations following the enquiry.