Inquest opens in Castlebar into death of babyTuesday 10 September 2013 07.03
An inquest has opened in Castlebar into the death of a baby boy in May 2011.
Kai David Williams Heneghan was stillborn after an attempted home birth.
His mother and father gave evidence at the Coroner's Court in Castlebar.
Sarah Williams told the Court that her baby was due on 12 May 2011.
She had always contemplated a home birth and arranged for this after meeting Christina Engel, a registered home birth midwife, based in Ballinrobe, Co. Mayo.
Ms Williams said everything with her pregnancy was fine when she had a third scan at 26 weeks.
Her labour began on the morning of 23 May 2011, at which time she had a scheduled visit from Ms Engel. The midwife checked her vital signs and found all to be in order. She returned to the house at around 6pm after labour pains had intensified.
Ms Williams said that when an internal check was conducted at 8pm that night she was dilated between 5cm-7cm and her contractions were quite intense.
She alternated between a birthing pool and standing in the room where the delivery was planned to take place.
Ms Williams' waters broke after 12:30am but she said there was an irregular heartbeat reading at around 1:30am and her partner made the decision to go to hospital at that time.
She said she did not believe the midwife would have gone to the hospital but for the fact her partner had insisted.
When the midwife and the couple attempted to travel to Mayo General Hospital in Ms Engel's car it would not start and they had to make their way to Castlebar in a van belonging to Ms Williams' partner.
It subsequently transpired that there was dirty diesel in the car, which made starting the vehicle difficult. An ambulance was not called.
They arrived at the hospital shortly before 3am. The baby was stillborn.
In his evidence, Ms Williams' partner, Emmet Heneghan said he was sceptical of Ms Engel's professionalism from the first time he met her.
He said he made the call to leave the home and travel to hospital as the situation had become "farcical" by the early hours of 24 May.
Mr Heneghan said he was certain at that stage that there was an emergency situation.
He disagreed that there had been regular foetal heartbeat checks throughout the later stages of labour and that by the time they were leaving for hospital he "more or less knew" that his child would not survive.
Mr Heneghan said at this stage he was concerned about the life of the mother.
In her deposition, midwife Christina Engel outlined the events on the night in question. She said she had no concerns for the mother or baby when she arrived at the house at 6pm on 23 May.
By midnight she said Ms Williams was showing signs of second stage labour. Her membranes ruptured at 00:40am and at that stage, maternal and foetal assessments were all normal.
Ms Engel detected foetal distress at 2:10am and decided an emergency transfer to hospital was needed at that point.
She told the inquest that she called Mayo General Hospital and informed the labour ward that intervention was required.
This conflicts with evidence from Mr Heneghan who said he alone made the call to move to the hospital.
Ms Engel said it would be inconceivable to stay in a home when there were signs of foetal distress and she was adamant that she had made the decision to transfer the patient to the labour ward.
Under cross examination by John Jordan BL for Ms Williams and Mr Heneghan, Ms Engel said there had been no problem and no reason to transfer Ms Williams to hospital until then.
She said there was no maternal or foetal distress evident until 2:10am.
Ms Engel told Mr Jordan that she had looked after thousands of women in labour and that she would never ignore signs of foetal distress.
She said she had experienced problems in starting her car prior to that night but that she knew how to start the vehicle.
Ms Engel said it was not an unreliable car, rather it had "transient problem" that had occurred.
When the baby's foetal heartbeat decelerated, Ms Engel said she became extremely concerned. She considered calling an ambulance from Castlebar to attend Ms William's home in Louisburgh, outside Westport.
However, she said she made a call that it would be more efficient to transfer Ms Williams to hospital by private vehicle and she stood by that decision.
Under cross examination by Declan Buckley SC, for the HSE, Ms Engel and Mayo General Hospital, Christina Engel said she had over 30 years of midwifery experience.
She said she had practiced as a domiciliary midwife in the HSE West and North West area since she returned to Ireland from New Zealand in 2000.
Prior to this she spent 26 years in New Zealand working in hospitals and teaching in university.
Ms Engel said she maintained her private practice at all times when she resided abroad.
She said she treated between ten and 12 women who wanted home births in the western region each year
She said she was not reluctant to move women in labour into hospital from their home and that she had done so on many occasions.
Ms Engel agreed that note taking was very important and she said that she had a system in place to write up retrospective notes in a home birth setting at least every 20 minutes.
She told the Inquest that in a domiciliary setting, just one midwife is usually present so it is not as easy to have notes entered with the frequency that would be normal in a hospital. Any gap that may arise in timings does not reflect a gap in the frequency of checks.
Coroner John O'Dywer asked Ms Engel about evidence given by Mr Heneghan that he made the decision to travel to the hospital.
Ms Engel rejected this and said it would be out of the question for her to keep a woman at home when problems arose.
Mr O'Dywer put it to Ms Engel that she had been overworked and that leaving responsibility and all the work to a single practitioner was a lot to carry.
Ms Engel said has since secured the services of a second midwife for home births.
She told the coroner that the issue of having two practitioners at home delivery is being reviewed at present and is at final draft.