Mother's care in Causeway Hospital before her baby died was unacceptable and substandard, midwife admits during inquest
A senior midwife involved in the case of a mother whose baby girl died soon after birth conceded that both of them received "substandard care" during labour, an inquest has heard.
And an obstetrician involved in the birth of little Alexis Hook also told the court inquiry into her death that warning signs should have been picked up earlier.
A second day of evidence was heard at the Coroners Court in Belfast yesterday concerning the death of baby Alexis at the Causeway Hospital in Coleraine.
The court heard midwife Karen Armstrong say that Alexis' mother Tracy received "substandard care" in her labour leading up to the birth.
Evidence was also given by obstetrician Dr Tughral Rahman, who accepted that he should have spotted there was a danger to the baby more than an hour before a decision was made to perform an emergency Caesarean section.
Dr Rahman said that, in hindsight, he should have seen that the foetal heartbeat trace from baby Alexis – taken at six minutes past midnight on July 4, 2012, – was "pathological" and therefore "would have set alarm bells ringing".
Alexis was born by emergency Caesarean section in the early hours of July 4 – two weeks after her due date. Although alive initially, the infant developed breathing problems within minutes. Despite efforts to resuscitate her she died, leaving the lives of her parents "ruined".
The inquest, being conducted by Senior Coroner John Leckey, has heard that Alexis died as a result of asphyxia brought about when she inhaled meconium, described as "baby poo" by the pathologist who examined her body. The pathologist explained that if babies become distressed in the womb, they sometimes open their bowels, allowing faecal matter to float in the amniotic fluid.
The hospital consultant who was on call at the time, Dr Lorraine Johnston, said she was at home when Dr Rahman contacted her at 12.15am on July 4 to tell her there were difficulties interpreting the trace on Alexis' heart rate. She told the staff on the ward to wait until she examined Mrs Hook, which happened at 1.05am.
At 1.23am Dr Johnston made the decision to perform the emergency C-section and little Alexis was born 20 minutes later at 1.43am, weighing 3,743 grammes.
Dr Johnston conceded that a trace of Alexis' heartbeat taken at 12.27am was "pathological", but yesterday it was suggested to Dr Rahman that a trace taken 21 minutes earlier was pathological rather than "suspicious", as he had described it.
Mr Leckey put it to the doctor that while he realised the interpretation of heartbeat traces "isn't always black and white and sometimes a pathological trace can only be identified with the benefit of hindsight", he had two expert reports which gave the opinion there was a "failure to escalate concerns" at an earlier stage and that the trace taken at six minutes past midnight was pathological, so "therefore there was an urgent requirement to deliver the baby".
As Mrs Hook sat in court with her head in her hands, repeatedly wiping away tears, Dr Rahman conceded that the trace "should have been classified as pathological".
Later, senior midwife Mrs Armstrong said no decision was made about what stage of labour the expectant mother – who had been induced – was at until around midnight.
She agreed with the suggestion by the Hooks' solicitor Paddy Mullarkey that an internal examination would have determined that.
There was, however, no internal examination conducted for around 12 hours, the inquest heard, and the midwife agreed that was "unacceptable", especially as Mrs Hook was in increasing levels of pain and was experiencing frequent contractions, which were being timed by her husband Allistair.
She told the inquest that on the night of baby Alexis' death, the unit was short-staffed and extremely busy, dealing with seven high-risk deliveries and the birth of a premature baby.
Mr Leckey said yesterday: "Let's not beat about the bush – the care given to Mrs Hook was completely unacceptable and was substandard."
Mrs Armstrong replied: "On this occasion, yes."
The senior coroner added: "Mr and Mrs Hook are here because their baby died.
"They're not interested in any other occasion.
"As a result of this incident, their baby died."
The inquest continues.