Consultant obstetrician delayed emergency C-section

A consultant obstetrician delayed doing an emergency Caesarean-section at Cavan General Hospital because there was no nursing staff available to man the operating theatre, an inquest heard.

Dr Salah Aziz told the inquest of Baby Jamie Flynn, who died from a hypoxic brain injury, that he opted to try delivery using instruments first because he knew that the on-call nursing staff were already tied up in the operating theatre at another emergency C-section. 

Baby Jamie, of Tara Court Square, Navan in Co Meath, was born shortly before midnight on November 22, 2012, in very poor condition. He was transferred to the Rotunda Hospital where he died in his mother’s arms two days later.

Dublin Coroner’s Court heard that his mother Fiona Watters was admitted to the hospital for induction on November 20. 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 22. He said they discussed the possibility of a C-section but she told him that 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 Special 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 on-call nursing staff manning 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,” he said.  

The instrumental delivery failed and Ms Watters was transferred to theatre where the emergency C-section was carried out. 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 prior to 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 post-mortem, pathologist Dr Deirdre Devaney found that Baby Jamie's brain injury occurred prior to birth. The autopsy 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 cannot be excluded as a potential cause.

Midwife Lavin told the court that she specifically pointed out that the placenta should be kept. The placenta is normally given to the midwife to take back to the labour ward to examine, she said. However, there were three C-sections carried out that day and when she went to collect it, there were three placentas and she could not determine which one belonged to Baby Jamie.  

Coroner Dr Brian Farrell said he was adjourning the inquest to consider the evidence and whether expert opinion is required. The inquest was put in for further mention on July 29.