A woman in a difficult labour had no pain relief, likely for hours, because her epidural line had come out and no one noticed.
Midwives told a junior midwife looking for advice the woman “just needs to push her baby out” as she became increasingly distressed.
The woman ended up suffering a large perineal tear and had significant post-partum pain and bleeding from the birth at Whanganui Hospital in 2022.
Health New Zealand Whanganui has been censured by the Health and Disability Commission for its care, for not having enough qualified staff and for not properly supporting the locum, graduate midwife who was leading the woman’s care and who had no epidural qualification.
The woman repeatedly told her midwife she was in an unbearable amount of pain during labour, the commission’s report said.
At times she had struggled to push.
She had had an epidural line inserted that had a pump for her to top up pain relief herself but it did not seem to be making a difference.
An obstetrician, called hours into the labour, realised it was because the line had become dislodged, meaning it was doing nothing.
The doctor noticed because they tried to deliver the baby by forceps but the woman was unable to tolerate the pain.
An anaesthetist was called to reinsert the epidural and, about half an hour after the first forceps attempt, the baby was born in good health.
The woman suffered a third degree tear – which means from the vagina, across the perineal muscles and to the muscles of the anus – and was in significant pain after the birth.
She felt the midwife was fixated on her pushing out the baby, she told the commission.
“[The woman] told HDC that she made multiple requests for pain relief medication and a review of her pain by the obstetrician and anaesthetist, but this was declined by [the midwife],” the commission’s report said.
The midwife said she had sought advice from senior colleagues but they told her “she just needs to push her baby out”.
The woman also said the midwife, and a more senior midwife, had “manhandled” her into a painful position in stirrups but the midwife denied that, saying they were helping the woman move into position and stopped when she objected.
The commission could not make a finding on whose account was correct when it came to that particular accusation.
The woman said she was never told the midwife looking after her was a graduate and felt she did not have a choice.
Deputy commissioner Rose Wall said even though Health NZ Whanganui was short staffed that day, it was its responsibility to ensure there was an epidural-certified midwife caring for her.
“This meant that Mrs A’s epidural was not monitored appropriately, and she was subject to unnecessary pain, which had a significant impact on her birth experience,” her report said.
Health NZ said it had three patients in the maternity unit that day, one which was a complex case that required a higher intensity of care than normal.
That meant there was a shortage of staff so it put out the call for community midwifes to come in on a locum capacity, something that was not unusual.
But it accepted that letting the mother know should have been a more collaborative and inclusive process.
The midwife said she had reflected a lot on the case and had since gained epidural qualification.
In future she would be more assertive asking senior colleagues for help.
“Every mother deserves to feel safe and cared for and most certainly does not deserve to feel negatively about her labour and birth,” she told the commission.
rnz.co.nz
