by JENNY HOPE, Daily Mail
16 August 2002
A senior coroner has urged a change in the guidelines for midwives on home births after two breech babies died.
Westminster coroner Dr Paul Knapman said research showed a caesarean section was the safest option for babies who are facing the wrong way in the womb.
He said midwives should make explicit the dangers of home births for infants in the breech position. They should note their advice in writing and even get a parent to counter-sign the record.
His warning came after inquests yesterday into the deaths of Phoebe Baker and Christopher Gurney, who were both starved of oxygen after being delivered at home.
Around 24,000 births each year - four per cent - are breech and the Royal College of Obstetricians and Gynaecologists advises that babies are 75 per cent less likely to die if they are delivered surgically.
Dr Knapman was backed by Professor Philip Steer, obstetrician at the Chelsea and Westminster Hospital. He said the risk of a breech baby suffering oxygen starvation increases tenfold if it is born naturally.
'If a woman insists on a vaginal birth, we recommend it is medically managed in hospital,' he added. 'This is because of a high likelihood of complications arising in labour.'
The inquest heard that Penny Baker gave birth to Phoebe at her home in Battersea, South London, on January 20.
She told the coroner's court that her midwife Susan Burville realised the baby was very likely to be a breech, but she did not want a caesarean section.
Mrs Baker said: 'The facts were put to us and it was our choice what to do with the facts.'
Although the birth appeared to go smoothly, Phoebe had to be resuscitated by Mrs Burville.
Mrs Baker said her daughter was feeding happily when the midwives left but by the following evening she was 'sleepy and unresponsive'.
On the morning of January 22, when Mrs Burville arrived for a routine check she found the baby was not breathing and had no heart rate.
She was taken to the Chelsea and Westminster Hospital but attempts to resuscitate her failed. The cause of death was an adrenal haemorrhage, brought on by lack of oxygen at the time of the delivery. Dr Knapman recorded a misadventure verdict.
He was also told of the case of Yvonne Gurney who gave birth to Christopher at home in Streatham, South-West London, on July 18.
He was also found to have been 'upside down' during delivery and died an hour later. The inquest into his death was adjourned.
Dr Knapman said he would write to the Nursing and Midwifery Council asking them to consider 'that in respect of home birth the guidance given should be extended to include explicit recording, in writing, in what terms the risks have been explained, including a recommendation, if any, and perhaps even to encourage the mother to counter-sign'.
Melanie Every of the Royal College of Midwives said guidance on breech births was not issued specifically for home births.
She said: 'Midwives record all discussions held with the mother but we would have reservations about counter-signing because it might put emotional pressure on her.'
Mrs Baker and her husband Hugh, both 34, who have a daughter Charlotte, two, said they felt no bitterness towards their midwife.
Mrs Baker said: 'I chose a home birth because during my first pregnancy I had an appalling experience of the NHS.'
This article was originally published in print and online in the Daily Mail, 16 August 2002. It is reproduced here in case the original becomes unavailable.
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