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From The Times

May 15, 2008

Joanne Whale died after home birth midwife had = crisis of=20 confidence

Fran Yeoman

A young mother who developed complications during a home birth died = after a=20 midwife lacked the confidence to inject her with fluids, an inquest was = told.=20

There was also a delay in giving Joanne Whale treatment that could = have saved=20 her life in hospital after another midwife failed to pass on information = to the=20 doctors there.

Dr Peter Dean, the Greater Suffolk Coroner, said that lessons must be = learnt=20 from her death and that women should be made more aware of the dangers = of home=20 births. He also demanded better communication between midwives and = doctors.

Miss Whale, 23, gave birth to a healthy boy at home in Ipswich last=20 September. But she died hours later after a severe haemorrhage. =

When Ms Whale began to lose blood she needed an injection of fluids. = Julie=20 Bates, a midwife, said that she had been trained in the process but had = never=20 had to use it. =93I=92ve got the theoretical knowledge but not the = practical=20 knowledge,=94 she said. =93I felt uncomfortable having to do that in = this=20 situation.=94 She added: =93Knowing the ambulance was only a few minutes = away I=20 thought it was better to leave it for the proper paramedics.=94

The inquest was also told that Miss Whale=92s arrival at hospital had = been=20 delayed because the paramedics had found it difficult to remove her from = an=20 upstairs bedroom. Martin Hambling, who was in the first of two = ambulances to=20 arrive after a 999 call, said: =93Extraction was extremely difficult = because of=20 the layout of the house. We had to negotiate several sharp turns.=94 =

Miss Whale was taken to Ipswich Hospital but doctors were not told = the exact=20 nature of her condition, which led to a delay in getting her to the = operating=20 theatre. Sarah Hall, another midwife, admitted that she did not pass on=20 information that Miss Whale had suffered an inverted uterus during = labour.

Marlar Raja, a specialist registrar in gynaecology at the hospital, = said that=20 the patient would have been taken straight to the theatre if she had = been made=20 aware.

Balroop Johal, a consultant gynaecologist, said: =93The staff were = expecting a=20 retained placenta. If they had been told that it was a complete = inversion of the=20 uterus she would almost certainly have gone straight to theatre and I = would have=20 been ready for her.=94

Dr John Chapman, who carried out the postmortem examination, said = that Miss=20 Whale died as a result of the inverted uterus causing a uterine = haemorrhage. Her=20 body was in so much shock that her blood failed to clot, adding to = extensive=20 bleeding.

Dr Dean recorded a narrative verdict of death from complications = after an=20 obstetric home delivery. He said he was surprised that midwives would = not be=20 confident in injecting life-saving fluids. =93It does worry me a lot = that mothers=20 are giving birth in the community and the first line of call is the = midwife, who=20 might not be able to get fluid into her in those crucial early moments. = That=20 needs to be addressed.

=93We can=92t be certain that, had these things been done, she would = have=20 survived. All we can say is the chances of survival would have been = greater.=94=20

Elizabeth and Eleanor-this was an = incompetent,=20 undertrained and overconfident midwife whose appalling management of = this poor=20 woman led directly to her death. All the damage was done in that first = hour,=20 'the golden hour' . A drip is a simple procedure and could have saved = her life,=20 whalesong won't.

Christina, Belfast,

Rachel in Bristol - Which 'clear and = unequivocal' evidence are you speaking of? As someone who had a = carefully=20 researched and planned homebirth a year ago I am aware of no such = evidence. In=20 fact all of the evidence I found pointed to the exact opposite.

Amber, Swansea,

E Bluefish is probably an = undertrained=20 midwife. There is a culture of mifwives vs doctors. Time is important in = development of DIC - once it has set in it is difficult to reverse - = even fab=20 doctors cannot replace god in the presence of overconfident, = undertrained=20 midwives.

Ashish Sukthankar, Manchester, UK

Home births don't kill: = complications kill.=20 This comes down to lack of training & communication between the = health=20 professionals.

Women & their babies are still as safe if not = safer=20 giving birth at home IF their care givers are properly trained &=20 experienced., which in most cases is how it is.

Lynn , Evesham, UK

To Elizabeth and Eleanor- have you = never heard=20 of the "golden hour"? The first hour after major trauma is the one in = which=20 lives are lost or saved: after that the "fab doctors" are working = against the=20 damage already done. The midwife was responsible for this death- that's = it.

Emile, Weybridge, UK

I expect that the vociferous home = birth=20 proselytisers will say that more deaths in labour occur in = hospital....true, but=20 only when everything that can be done, has been done. Not when people = stand by=20 and watch a mother die because they don't know how to put up a drip. =

Emile de Sousa, Weybridge, UK

I have experienced a hospital birth = and a=20 homebirth - and I am currently pregnant and planning a homebirth again. = I have=20 no doubt that is was poor training for the midwives involved and a = complete lack=20 of communication at the hospital that caused the death of Joanna Whale. =

Heather , Flitwick,

Every doctor, nurse, or midwife is = taught that=20 the key to saving a sick patient's life is ABC (airway, breathing, = circulation).=20 A midwife who cannot replace circulation by giving fluids should not be=20 operating. Early fluids could have saved her. This is why home births = kill.

Rebecca, Cheltenham,

Dear Ian, If you do another search, = a more=20 recent, up to date one, you will realise your findings are incorrect. = Home is=20 every bit as safe if not safer than hospital. As Elizabeth points out, = the woman=20 died 5 hours after being in hospital, plenty of time for the 'fab' = doctors to do=20 their stuff.

eleanor bluefish, newbury, uk

Elizabeth in Hampshire is clearly = unaware of=20 the clear and unequivocal evidence that home births are less safe than = hospital=20 births.
In this woman's case the midwife was negligent. The mother = shouldn't=20 have been in a place the paramedics couldn't get to, and she should have = had=20 fluids.

Rachel, Bristol,

This woman died 6 hours after giving = birth and=20 5 hours after arriving in hospital. Poor communication, transfer delay = and lack=20 of skills were the contributing factors and these are the issues that = should be=20 addressed. The coroner's comments about home birth safety tantamount to=20 scaremongering.

Elizabeth, Hampshire,

"Dr Peter Dean, the Greater Suffolk = Coroner,=20 said that lessons must be learnt from her death and that women should be = made=20 more aware of the dangers of home births"

Right, so the powers = that be=20 want to use this as publicity against home births... Why not instead = against=20 under-qualified midwives?!

Brijit , Paris, France

How could this happen it shows a = severe flaw=20 in training of staff and their competence. Training today is all about = ticking=20 boxes of competence while down playing the importance of experience. I = believe=20 this will become the greatest undoing of medical training in the UK. =

Samuel Nwaomu, Stoke-ontrent, United = Kingdom

I did a small survey called HOME -v- = HOSPITAL=20 when I was a student nurse in the 1990's about the needs of mothers = undergoing=20 home -v- hospital birth environments.

Chice wise I came to the=20 conclusion that it was good to have choice. Safety wise I concluded = hospital had=20 & always will have the edge.

Ian Payne, WALSALL,

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