A woman whose baby was stillborn in the Midlands Regional Hospital in Portlaoise in 2021 because of a lack of oxygen following a placental bleed, has told an inquest that there was a spell of over four and a half hours when she was not checked by staff when she was admitted after her waters broke.
Hilary Murphy, of Mountmellick in Co Laois, said this was a "crucial" period of time and that if she and her baby, Ódhran, were checked during this period between 2.30pm and after 7pm on 27 December, 2021, there could have been an opportunity to save her baby.
Ms Murphy said that she went to the toilet at about 5.45pm that evening, after going for a walk in the corridor with her husband, Patrick, and there was a "mucus-like discharge" and water on her maternity pad, and there was blood. She said she was concerned about this because she hadn't had any bleeding previously during her pregnancy.
She met a midwife on the corridor and told her about this, and the midwife reassured her it was probably a "show" and a sign that her labour was progressing. The midwife told her she would be back at 7pm to monitor the baby.
Ms Murphy was 39 weeks pregnant by that date and during her pregnancy, at 17 weeks, there were signs from an ultra-sound scan that her placenta was "low-lying" in her body and taking up a lot of space and that there was a haematoma, or bruise, on her placenta. Her baby's heart rate and development were normal at that point. By 25 weeks gestation, her obstetrician told her that it looked like the haematoma was "resolving". The placenta was still "low".
She also had a mild case of Bell's Palsy during her pregnancy and was prescribed steroids and anti-viral medication to treat it, and was told by doctors that it had improved.
On the evening of 27 December, It was 17 hours since her waters had broken by the time she returned to her room after telling the midwife about the blood on her maternity pad.
She said that "no member of staff entered my room to check my vitals" at 6.10pm and that "this was crucial," as far as she was concerned. "If I was checked then, and Ódhran was checked, then maybe there was an opportunity to save him."
Barrister for the hospital, Will Reidy BL, told the inquest that the midwife in question did not remember meeting Ms Murphy on the corridor and that, if there a bleed had been mentioned, a CTG heart-rate monitor would have been organised and the obstetrician would have been contacted.
Ms Murphy said that she did have that conversation on the corridor with the midwife, and it was just after she went to the toilet.
The midwife did come into her room just after 7pm, she said, to monitor the baby and asked her if she could feel the baby moving. She said she could feel movements, but they seemed "lighter" than normal in the last 20 or 30 minutes. The midwife used a doppler machine to try and hear the baby's heartbeat but there was "silence," Ms Murphy told the inquest.
"The silence was not familiar to me." She became distressed, she recalled, and feared something was wrong. The midwife started a CTG trace and was "having a hard time" locating the baby's heartbeat. She then reassured her that she had found it and told her to relax, but then the midwife's expression "filled with worry" and she then hit the alarm button above the bed, twice.
She and her husband then realised that it was Ms Murphy's own heartbeat that she had found on the CTG monitor. About seven members of staff rushed into the room and they tried to detect the baby's heartbeat, but couldn't.
A 'perfect pregnancy'
A doctor performed an ultrasound but everyone in the room could clearly see that there was no heartbeat or movement from the baby, Ms Murphy said. The obstretrician, Dr Miriam Doyle, arrived in "some minutes later" and took over the ultrasound machine and "apologised" and said there was no heartbeat. At this point, all of the members of staff "apologised for our loss," Ms Murphy said.
Dr Doyle told her that she had had a "perfect pregnancy," but Ms Murphy said that was "untrue". Dr Doyle said she didn't know what happened to her baby. "I was extremely upset and my husband was comforting me as well as processing what happened himself."
She later gave birth to her "beautiful baby boy," Ódhran, at 7.14am in the labour ward, and she and her husband both cried as soon as they saw him. She also had to deliver her placenta and 500ml of blood was lost during this process, she said, and Dr Doyle also had to remove blood clots.
She was told that she could have suffered a placental rupture.
Ms Murphy said that she hadn't been offered a membrane sweep, a procedure designed to bring on labour, during the last weeks of her pregnancy but was booked in for an inducement of labour on 29 December. She asked for a membrane sweep on 8 December, she said, and Dr Doyle told her she would offer her one the following week.
The following day she had symptoms of Bell's Palsy and went to hospital and was told it was "mild" and was prescribed anti-viral medication, and steroids. An MRI scan on 10 December was clear but two days later she felt that her baby's movements were lighter than they had been, so went to the hospital and a midwife performed a CTG trace on the heartbeat, and told her it was fine.
She attended Dr Doyle on 15 December and asked for a membrane sweep, again, she said, but Dr Doyle told her "she didn't want to hurt me, because of the Bell's Palsy". Ms Murphy said she wasn't happy about this decision, and asked for a membrane sweep the following week, and Dr Doyle agreed.
The following week she again attended Dr Doyle and again asked for a membrane sweep, but Dr Doyle said "no" because the Bell's Palsy hadn't completely gone. "I was not happy with this outcome." Dr Doyle also told her that a c-section wasn't needed.
Her waters broke on 27 December at 12.45am and it was then that she went into hospital and was put on a CTG trace shortly after her arrival. She was given a CTG trace again during the morning, and a doppler test between 2.30 and 3pm for the baby's heartbeat, and at 5.30pm went for a walk on the corridor, went to the toilet and saw a mucus-like discharge and water which seemed to have blood in it, which she said she informed a midwife about.
Ms Murphy and her husband Patrick told the inquest that, after their baby was stillborn, they signed a form in the hospital in which they "objected" to their baby's organs being retained for research, following a post-mortem, but that the baby's brain, left lung and part of his intestine were retained from 30 December, 2021, until 21 December, 2022, "with no permission from us".
The post-mortem was carried out in The Coombe Hospital by perinatal pathologist Dr John Gillan and, on 26 January, they sent him a registered letter asking for results.
The following day, Patrick spoke to Dr Gillan on the phone and the pathologist told him that Ódhran seemed to have been a "big, perfectly-healthy baby" and that the cause of death seemed to have been a lack of, due to a "substantial amount of blood" behind the placenta. He said it could be "months" before the post-mortem results would be complete, because they were short-staffed.
They, and their solicitor, wrote several emails and letters to The Coombe, and to the Midlands Regional Hospital, over the following months, asking for an update on the post-mortem results and on their son's organs. It was December before they were told their son's organs were ready for release. This was all very distressing, they said, and Hilary Murphy suffered a miscarriage during this time.
Dr John Gillan told the inquest that the cause of death was a placental haemorrhage, causing hypoxia (lack of oxygen). It was likely that there was a haemorrhage lasting at least two hours but not more than six hours, in the time leading up to his death, he said. There was also evidence of earlier hypoxia "insults" to Ódhran's brain and lung but these were not fatal.
'Regrettable' delay
In reply to questions from Sara Antoniotti SC, for the Murphy family, Dr Gillan said it was "regrettable" that there had been a delay of nearly a year before the couple received their son's organs from the Coombe. He wasn't aware of all of the communications between the Murphys and the hospitals, he said, apart from the conversation he had in January with Patrick Murphy.
Asked if the organs were "stored unnecessarily" during this time, he said, "probably, yes" but that he and others in the system were working under "duress" because of a lack of resources. "The service was under extreme pressure."
He said that, if he was made known by a bereavement midwife in Portlaoise that the parents were anxious to have the organs back as soon as possible, he would have done his best to arrange that.
The post-mortem process itself needs to allow time for the brain and other organs to "fix" before they can be examined in a perinatal case, he said, which is a number of weeks.
Ms Antoniotti put it to Dr Miriam Doyle, consultant obstetrician, during the inquest, that Ms Murphy had twice asked for a membrane sweep, and Dr Doyle said she had no recollection of this happening, and it wasn't in her notes. When it was put to her that it was hospital protocol for women who reached 39/40 weeks gestation, without going into labour themselves, to be offered a membrane sweep, she said that Hilary Murphy was already booked in for an induction on 29 December, which was 40 weeks.
She wasn't offered a membrane sweep, Dr Doyle said.
It was normal for the patient to have a "show," she said, in relation to pink liquid discharged by Ms Murphy after her arrival at hospital early on 27 December, and the bleeding associated with a placental rupture is usually "very significant". The CTG trace was left on the patient for two hours and at first the baby seemed to be asleep, then woke up, then was asleep, then woke up again. The results were "reassuring" after two hours, Dr Doyle said.
She agreed that a blood test showed an elevated white cell count but this was just one element of the patient's presentation, and others were normal.
Asked by Ms Antoniotti if the pink and red discharge on Ms Murphy's maternity pad fed into the risk factors because of being indicative of a bleed that was occurring, Dr Doyle said she didn't know that a bleed was occurring at that time. The first indication of haemorrhage was when the placenta arrived, with the membranes full of blood. "That was very significant," she said.
The inquest continues on Thursday before coroner Eugene O'Connor in Portlaoise.
