Mother left to die after home birth: the importance of regulation of private practicing midwives in home settings
Date: October 5, 2016
Key Points
- Caroline Lovell passed away at Austin Hospital in January 2012 after having given birth to her second child at her home in a birthing pool.
- A coronial inquest into Ms Lovell’s death was undertaken which found (among other things) that Ms Lovell suffered a post-partum haemorrhage which was not picked up by the midwife, Gaye Demanuele. It was also found that Ms Demanuele failed to monitor Ms Lovell’s blood pressure or properly examine her and also failed to notice the changing colour of the bath, indicating major blood loss, or call an ambulance urgently even after Ms Lovell begged her to
- The coroner made a number of recommendations including that specific guidelines be developed to define mandatory clinical competency and experience standards for privately practising midwives working within home settings and for mandatory training for these midwives.
- Ms Lovell’s death highlights the need for greater regulation for midwives in private practice. Midwifery services for home births should only be undertaken by highly trained, experienced and accredited practitioners.
Background
Ms Lovell was 36 years old at the time of her death. She delivered a healthy baby daughter on 24 January 2012 in a bath at her home.
Ms Lovell had previously given birth to a daughter in 2010. Following her first pregnancy, Ms Lovell experienced post-partum bleeding and was considered at risk of this reoccurrence with subsequent pregnancies.
Ms Lovell’s home-birthing process was overseen by two midwives: Gaye Demanuele and Melody Bourne. Ms Lovell’s daughter was born early on 24 January 2012. Her daughter was noted was noted to have had blood on her head which was indicative of a possible vaginal tear during the delivery. A significant tear to the vaginal wall and perineum was found during the autopsy which would have caused the considerable bleeding.
When Ms Lovell tried to get out of the bath, she fainted. After regaining consciousness, Ms Lovell said she feared she was dying and asked for an ambulance to be called. Ms Demanuele did not call an ambulance. Ms Lovell collapsed again. Ms Demanuele started CPR and an ambulance was finally called.
By the time paramedics arrived at Ms Lovell’s home she was in cardiac arrest. Ms Lovell’s heart stopped, likely as a result of the post-partum haemorrhage, 5 minutes after the ambulance was called. Despite resuscitation and interventions to stem the bleeding at the hospital, Ms Lovell passed away on 24 January 2012.
Findings
A coronial investigation into Ms Lovell’s death was conducted in the Coroners Court of Victoria.
The Coroner accepted medical evidence that Ms Lovell had “bled out” in a birthing pool where she remained for an hour in a dark room after delivering her daughter.
It was found that Ms Demanuele’s personal feelings towards medical intervention led to a failure to conduct or direct a full examination of Ms Lovell, including a vaginal examination which was inconsistent with midwifery protocols. Instead a focus was placed on seeing the mother and baby connect uninterrupted. The coroner found that Ms Demanuele had attributed Ms Lovell’s breathlessness, agitation and fear to anxiety “in a setting in which Gaye steadfastly maintained her commitment to home birth, without outside intervention”.
It was found that Ms Demanuele’s failure to maintain appropriate blood pressure and vital sign monitoring in the hour following the birth was wholly inappropriate and caused or substantially contributed to her death.
At the time of Ms Lovell’s death, Ms Demanuele was registered, but four months later, she wrote to the Australian Health Practitioner Regulation Agency to say that she was forfeiting her registration because she did not want to work in a system that coerced women into receiving medical treatment during birth. She has since continued to offer her services.
The investigation lead to a number of recommendations being made to AHPRA and the Nursing and Midwifery Board of Australia, the Department of Health and Human Services, and the Director of Public Prosecutions. The recommendations included:
- Department of Health and Human Services, in conjunction with AHPRA, examines the adequacy of the regulatory system currently in place and develops a specific framework for privately contracted midwives, working in the setting of a home specific guidelines be developed to define mandatory clinical competency and clinical experience standards, for privately contracted midwives, working in the setting of a home.
- ongoing training for registered midwives specifically engaged with providing home birth services. For the protection of all concerned, participation in such ongoing training should be mandatory.
- a public campaign designed to provide education for women and for their partners who may be considering home birth, to seek to inform as to how safe and otherwise reasonable decisions on this matter should be reached
- a system of monitoring mandatory clinical competency and clinical experience standards be developed for privately contracted midwives working in the setting of a home
- the Director of Public Prosecutions examines the evidence collected in this investigation and takes such action against Ms Demanuele as appropriate.
Conclusion
The tragic circumstances of Ms Lovell’s death highlights the need for greater regulation for midwives in private practice. Midwifery services for home births should only be undertaken by highly trained, experienced and accredited practitioners. The coroner’s recommendation that the NMBA develop specific guidelines to define mandatory clinical competency and experience standards for privately practising midwives working within home settings and for mandatory training for these midwives will assist in this regard.
Ms Lovell’s death also stresses the importance of women and their partners being fully informed of the risks associated in home birth.
The implementation of the recommendations made by the coroner will allow for a high level of safety for babies and mothers, as well as protection for the work of midwives properly engaged in providing birthing services to women.
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