31 Jan 2015

Coroner critical of midwifery training

6:37 am on 31 January 2015

Midwifery training has been criticised by a Coroner in his findings into the death of a mother and her new born child.

One of the Coroner's recommendations is that following starting in private practice midwives have clinical supervision for a year.

One of the Coroner's recommendations is that following starting in private practice midwives have clinical supervision for a year. Photo: 123RF

In May 2012 Casey Nathan, who was 20 died, six hours after giving birth to her son Kymani, who died two days later.

Ms Nathan was under the care of a midwife in Huntly before being transferred to Waikato Hospital after complications set in.

She died from an amniotic fluid embolism.

Coroner Garry Evans said the deaths might have been prevented if the midwife had recommended to her patient that she see an obstetrician.

He said it was plain that the midwife's failure to follow referral guidelines arose through inadequate training and experience.

Mr Evans is recommending a year long hospital internship for new graduate midwives, that midwifery education and training be reviewed, and that following starting in private practice they have clinical supervision for a year.

The midwife, who has permanent name suppression, is now practising overseas.

The Coroner has hit back at criticism by the New Zealand College of Midwives of his findings into the death of Casey and Kymani Nathan.

Garry Evans found that inadequate training of a midwife was partly responsible for the deaths.

Submissions from the college to the Coroner criticised how the Court formulated its findings.

The Coroner said the college's Chief Executive, Karen Guilliland in written submissions accused the court of selective deconstruction of the college's advice and that she objected in the strongest terms to the apparent dismissal of the Midwifery Council and the College's knowledge base in favour of particularly ill-informed medical opinion.

Mr Evans said Ms Guilliland's comments inappropriately mixed personal opinion with evidence and that the appropriate place for her to call or give evidence was at the inquest.

He said her submissions were notable for their failure helpfully and constructively to comment on the causes of any of the successive errors of clinical judgement and failures to follow proper midwifery practice that occurred in this case or offer any alternative explanation for their occurrence.

The college was not represented at the hearing held in February last year.

In a statement released by the New Zealand College of Midwives it said criticism of professional bodies which engaged in judicial processes in good faith, was not in the public interest and in this case, not in the interests of the well-being and safety of women and their babies.

The group Action to Improve Maternity wants the Health Minister to implement each of the Coroner's recommendations.

The group Action to Improve Maternity wants the Health Minister to implement each of the Coroner's recommendations. Photo: 123RF

The college's Midwifery Advisor, Norma Campbell said the College was at a loss to understand his comments.

She said training for midwives had been strengthened over the last five years and a number of the Coroners recommendations were out of date or unfeasible, such as an internship scheme.

Ms Campbell said the college was still considering a more detailed response to the Coroner's report.

She said the college stood by the midwife involved because it was such a rare medical event and that she did a remarkable job in the environment she was working in.

Ms Campbell said the Coroner missed an opportunity to raise and explore other serious issues such as the level of community violence which was evident in this case and its impact on health service delivery.

A maternity action group said the Government should urgently implement recommendations made by a Coroner to improve midwife training.

The spokesperson for AIM, Action to Improve Maternity, Jenn Hooper said they wanted the Minister of Health to implement each of the Coroner's very strong and specific recommendations.

She said if midwives had a longer hospital-based apprenticeship then the public would be reassured that mothers and babies were in safer, more experienced hands.

AIM said it had helped the family of Casey and Kymani Nathan to lodge a complaint with the Health and Disability Commissioner.

The Ministry of Health said it had noted the Coroner's recommendations.

It said it had been working closely over the past two years with the Midwifery Council and the College of Midwives around strengthening support for graduate midwives.

The Ministry said it would be formally responding to the Coroner's findings at a later date.