A woman whose newborn baby died following a homebirth has claimed that she might have been prevented from having a home delivery if a maternity hospital had passed on details to a midwife of previous difficulties she had experienced during the birth of her first child.
Paula Cashin told an inquest at Dublin District Coroner's Court that she wondered "how events would have unfolded" if such information had been available.
Her son, Rob, died in the Rotunda Hospital in Dublin just hours after he had been delivered at Ms Cashin’s home in Holywell Gardens, Swords, Co Dublin on 27 August 2020.
Ms Cashin and her husband, Colm, have two other children – seven-year-old Sarah and 18-month-old Ben.
She told an inquest into her son’s death that a community midwife, Carolyn Coughlan, had not been made aware that there was an issue during the birth of her daughter with a condition called shoulder dystocia, where there is a problem with the shoulder getting stuck after a baby’s head has been delivered.
The inquest heard medical records made available by the Rotunda to Ms Coughlan in preparation for the homebirth did not contain such information.
The witness said she only became aware herself recently of the complication with Sarah’s birth after she had applied to the Rotunda for her medical records.
"It came as a bit of a surprise," she remarked.
Ms Cashin said there was also a problem with the delivery of the shoulder in the birth of baby Rob.
The witness said she believed she would have been ineligible to have a homebirth or would have needed to be assessed by a consultant before being allowed to have a homebirth if Ms Coughlan had known about her previous incident of shoulder dystocia in birth.
The coroner, Clare Keane, adjourned the inquest after counsel for the Rotunda and a number of midwives, Conor Halpin SC, said the hospital and medical staff would need time to assess what was "new evidence".
Mr Halpin said it would have been unfair to put the issue raised to relevant witnesses without first allowing them time to review the records.
Dr Keane apologised to the Cashin family for the adjournment but stressed that it was a "very critical piece of evidence which we have to explore".
Earlier, Ms Cashin said she had always been interested in the idea of a homebirth as her own "nana" had always spoken fondly of the experience, but she herself had been too nervous to consider one for the couple’s first child.
She said it was also a good experience as her husband was able to attend all the check-ups as he was also at home because of the restrictions on movement with the Covid-19 pandemic.
The inquest heard that there had been no problems during the course of her pregnancy with Rob, apart from a concern that he was going to be a large baby.
Ms Cashin said she attended the Rotunda when she was nine days past her due date for a check-up where she was informed by a consultant that she would have been induced at seven days if she had been a patient of the hospital.
She recalled feeling that the meeting was "stressful and very confusing" as the HSE policy on homebirths allowed for 14 days after a due date before a woman was induced.
Ms Cashin said it had been "a challenging conversation".
She didn't want to say it was "fearmongering" but she said she felt "blind-sided" by being informed of risks of which she had previously been unaware.
Ms Cashin said she was surprised, angry and "a bit scared" by what the consultant had said as well as feeling that "pressure was being put on me," although she believed the HSE would not have allowed a timeframe of 14 days if there was any risk before that stage.
"It was very confusing being told these scary things," she added.
Ms Cashin told the hearing that she had subsequently been reassured by Ms Coughlan about her condition and they agreed to continue with the homebirth as planned.
Evidence was heard that Ms Cashin went into labour on the evening 26 August 2020 with her baby being delivered at home the following day.
The inquest was told that the baby’s head was delivered while she was in a birthing pool but she was moved to a couch for the remainder of the birth.
"Colm told me it was a boy and that moment was pure relief and happiness," Ms Cashin recalled.
She remembered thinking that everything was OK before she realised that an ambulance was being called.
Ms Cashin said there seemed to be some "important" issue with the midwives and the ambulance crew about not having "a smaller tube".
The inquest heard that she was feeling "sore and bewildered" on arrival in the Rotunda and did not know what was happening.
She recounted how a doctor came to her and said medical staff had done everything they could for her baby but were sorry they could not save him.
"I put Rob in my arms and I just broke down and cried. I kept shaking my head," said Ms Cashin. "He was a big baby and so perfect."
In response to questions from the coroner, Ms Cashin said she had made the choice of attending the Rotunda as it was where her first child had been born.
In preparation for the homebirth, she had passed all her obstetric medical records which she had received from the Rotunda to her midwife.
However, she confirmed they had not contained the detail about the issue with shoulder dystocia.
Ms Cashin said she was mistaken in thinking that a consultant would review her file when she applied to the HSE for approval to have a homebirth.
However, she said she had taken the HSE’s subsequent approval for a homebirth for her second child as "a nod and assurance that everything was OK".
Asked by Dr Keane what level of risk she felt there was about her having a homebirth, Ms Cashin replied: "Low".
The inquest was adjourned until a date still to be determined.