Shock at midwife's 'errors'

An obstetrician at a misconduct hearing for a South island midwife described a birth in which a mother needed 140 stitches as a "horrific event".

The midwife is in Queenstown facing a charge of professional misconduct relating to the ''horrific event''.

Auckland-based Keith Allenby said the mother sustained ''the most extensive and complex perineal tear'' he had seen in 20 years' obstetric practice.

The charge, under the Health Practitioners Competence Assurance Act, was the midwife, known as ''Ms P'', acted in such a way that it amounted to professional misconduct between January 20, 2010, and February 7, 2010, while caring for her client, Sara Gutzewitz, and her son Francis (Frankie), born on February 7, 2010.

During the first day of a Health Practitioners Disciplinary Tribunal hearing in Queenstown yesterday, Dr Allenby, an obstetrician and gynaecologist at Counties Manukau District Health Board, said the tear Ms Gutzewitz sustained was caused after the baby was born through her perineum.

In a letter written to the Health and Disability Commission in March 2010, her husband, Conan Wilcox, said Ms Gutzewitz required about 140 sutures following Frankie's birth.

Immediately after the birth, Ms P, a midwife based in the central South Island, allegedly left the couple with their newborn son before the umbilical cord was cut and the placenta delivered.

Evidence given yesterday stated the baby had not been dried or cleaned, had not been covered and had not been given appropriate skin-to-skin contact with his mother, who lost about a litre of blood following the birth.

Ms P's lawyer, Anita Miller, of Wellington, said her client - who is yet to give evidence - was suffering from an episode of supraventricular tachycardia, a heart rhythm disturbance, characterised by palpitations, causing her to feel faint.

She had been diagnosed with the condition in 2003, but it had never before affected her abilities to perform her duties as a midwife.

Ms Miller said her client had asked another midwife, Valerie Drake, of Invercargill, to assist with an episiotomy and then temporarily look after Ms Gutzewitz and her son as she needed to leave the room.

Ms Drake admitted preparing the tools for the episiotomy. She said she was then asked by Ms P to go to find an obstetrician, believing Ms P had stayed with the woman who had not yet delivered the baby. Ms P ''did not at any point'' hand over care of Ms Gutzewitz, nor advise her she was feeling unwell.

Ms Gutzewitz said following the episiotomy she was in so much pain her body was ''going numb'', with Frankie born soon after through a tear in her perineum.

''I remember that [Ms P] dumped Frankie on my tummy immediately after the birth.

''I was in such pain and was so exhausted that I could not even pick him up.

''[Ms P] left the room without saying anything to me.''

After her husband followed Ms P, her mother, Janis Gutzewitz, had to clear the mucus from the baby's mouth and nose.

''There was no-one else in the room to help us. I felt completely abandoned, exhausted and upset,'' Ms Gutzewitz said.

Dr Allenby arrived at the nurses' station and said Ms P was sitting with her ''head in her hands''.

''She was exclaiming to the room words to the effect of `Oh my God ... it was horrible ... her perineum exploded ... that was disgusting'.

''I noticed a man standing at the second door to the nurses' station immediately behind [Ms P], who was unaware of his presence. I now know that man was Conan Wilcox, who could hear every word that [Ms P] was saying.''

Dr Allenby went to Ms Gutzewitz's room to find her without medical staff and said he was ''shocked'' at what he saw.

Concerned the baby was getting cold, Dr Allenby said he went to pick the baby up and dry him ''at which point Sara cried out and I discovered the cord was still attached''.

''I was very upset on behalf of the patient.

''The fact that the cord had not been cut, the baby lay wet on the mother's abdomen uncovered and the patient was reported to have had a difficult birth was of concern.

''These factors also led me to believe that the midwife had exited the room very rapidly, leaving the delivery incomplete with no oversight of either the mother or baby.''

Dr Allenby demanded Ms P return to the birthing room and ''finish your job'', which she did, and said he was angry the patient had been left in so much pain without any midwifery support for the third stage of labour, which carried significant risks.

Later that day, he wrote to Southland director of midwifery Jenny Humphries about his concerns.

It was the first time in his career he had written a letter of complaint about a midwife, he said.

He said he was one of the most ''pro-midwife people you could come across'' and if something was ''sufficiently disconcerting that I'm prepared to write a letter to the director of midwifery ... then I can tell you I'm shocked''.

''It was a cluster of things ... we have a situation where something has gone wrong for a woman who's just delivered ... this was an horrific event that is a cluster of events concerning a delivery.''

The hearing continues today.