Midwives express remorse after home birth and Victorian baby's death

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20 hours ago

Two midwives have told a coronial inquest about their regrets after a baby died in hospital following a home birth in 2022.
The infant, who can only be known as Baby R, died in August 2022 of perinatal hypoxia, six days after an emergency caesarean at Bendigo Health.
The inquest, held in the Coroners Court of Victoria this week, heard two private midwives present during the home birth of Baby R conceded their care was inadequate when complications arose, and that a transfer to the hospital should have happened sooner.
The Melbourne court heard Baby R's mother, a former midwife herself, wanted a "natural" vaginal home birth after a traumatic first birth in 2019, which resulted in an emergency c-section after her baby was born macrosomic (large).
The inquest heard on Thursday that under Australian midwifery guidelines, Baby R's mother was not considered suitable for a home birth.
Earlier this week, an obstetrician at Bendigo Health said she held concerns at the time that the two private midwives were practising "outside national midwifery guidelines".
Elizabeth Murphy was Baby R's mother's primary midwife while Marie-Louise Lapeyre, the only other private midwife in the region, was also present to assist in the birth.
The women were experienced home birth midwives and had worked together frequently.
The inquest heard doctors Andrew Woods and Helen Cooke suggested both midwives should have discussed a transfer to hospital with Baby R's mother about four hours earlier than they did.
Ms Lapeyre broke down in court as she called it a "deep regret" and that "extreme tiredness" could have impaired her decision-making during the birth.
Both women had come straight from other births and had not slept.
The inquest heard Baby R's mother thought she would be on her way to hospital when she passed meconium liquor, which could indicate a baby in distress.
Instead, Ms Lapeyre told her they would monitor the baby more closely.
"I should've given Baby R's mother a choice and I didn't, and that goes against everything I stand for as a midwife," Ms Lapeyre told the court.
Ms Murphy echoed her colleague's regrets, and said the midwives should have consulted another midwife or obstetrician at that moment.
"I recognise that in this situation we made mistakes and I'm so remorseful about that," Ms Murphy said.
"I know that Baby R suffered because of what we did, but I think that women can have a good experience and mostly do at home, even when they're having a vaginal birth after a caesarean."
Later in the labour, Ms Murphy was taking a nap at 6:55pm when Ms Lapeyre first detected that Baby R's heart rate was abnormally fast.
Ms Lapeyre did not wake Ms Murphy but told the coroner's court in hindsight, she should have.
The inquest heard when the baby's heart rate was again found to be too fast 50 minutes later, Baby R's mother was taken to hospital.
"I'm just sorry for the journey of grief you are undertaking and will be ongoing — I know about that journey," Ms Laperye said to Baby R's parents watching the inquest online.
Ms Murphy told the inquest on Thursday she maintained Baby R's mother was "suitable to have the opportunity to try and have a home birth".
She told the coroner's court she felt Baby R's mother was aware of the potential risks and was "diligent" in her preparation for birth.
The inquest heard that in January 2022, eight months prior to Baby R's death, Bendigo Health head of obstetrics Nicola Yuen met with Ms Lapeyre and Ms Murphy with the aim of building a "collaborative relationship".
"There were a couple of times Bendigo Health became aware of women birthing in the community who were high-risk," Dr Yuen said.
Dr Yuen said while Ms Lapeyre was highly engaged with Bendigo Health after the meeting, the doctor did not recall the same attitude from Ms Murphy.
Dr Yuen said there was a "missed opportunity" to change the outcome for Baby R, when the baby's mother declined a routine obstetrician consultation at 36 weeks' gestation.
Ms Murphy had written to Bendigo Health saying Baby R's mother did "not need" the consultation, but hospital staff flagged risks in Baby R's mother's birth history and offered it anyway.
Baby R's mother said in her statement to the inquest she declined the hospital's offer as she thought it was a "box ticking exercise".
Ms Murphy told the court she regretted her wording in the letter and should have written that Baby R's mother did not "want" to see an obstetrician.
However, the midwife said she did not think an obstetrician would have "positively contributed" to Baby R's mother's care.
She said her previous clients had been "badgered and treated unkindly by obstetricians because of the choices they were making".
Ms Lapeyre said women who chose home birth were rarely respected for their choices and obstetricians often used coercive language.
But, she said she would tell her patients they needed to go into a home birth "with eyes wide open" and recommended they faced their fears of seeing an obstetrician.
The court has heard since Ms Murphy and Ms Lapeyre were directed not to practice private midwifery by health authorities, more women in central Victoria had chosen to "free birth" without any healthcare professional present.
The inquest continues.