Warning over home birth risks

Women should be warned of the risks of breech births

A coroner has called for a change in the rules for midwives involved in home births following inquests into the deaths of two babies.

Westminster Coroner Dr Paul Knapman said he would write to the midwives' professional body recommending pregnant women should be warned of the risks involved with breech, or feet-first, births.

He spoke out after hearing research showed breech babies are 14 times more likely to die or be handicapped if they are not delivered by Caesarean section.

The inquests were into the deaths of Phoebe Baker and Christopher Gurney, who both suffered oxygen starvation after being delivered at home by midwives.

The guidance given should be extended to include explicit recording, in writing, in what terms the risks have been explained

Coroner Dr Paul Knapman

Phoebe's mother Penny Baker told the hearing her midwife, Susan Burville, had indicated the baby was very likely to be a breech.

Mrs Baker said she decided to go ahead with the home birth because she wanted a natural delivery.

"Susan was primarily concerned for the safety of my baby and me," Mrs Baker said.

"Had she at any point recommended any course of action, I would have taken it without questioning."

Phoebe was born at Mrs Baker's house in Battersea, south-west London, on 20 January.

The birth appeared to go smoothly, but afterwards Phoebe had to be resuscitated by Ms Burville and a second midwife, Brenda Van Der Kooy.

Lack of oxygen

On the morning of 22 January, Mrs Baker noticed Phoebe was not moving and Ms Burville, who had just arrived for a routine check, dialled 999, but the baby was dead on arrival at Chelsea and Westminster Hospital.

A post-mortem examination found she had died of an adrenal haemorrhage, brought on by lack of oxygen around the time of the breech delivery.

Dr Michael Marciewicz, consultant paediatrician at the Chelsea and Westminster, said: "If it had been born in hospital, even if delivered by a midwife, a paediatrician would have been called to look at this child."

The inquest into Christopher Gurney heard he had died just an hour after his birth at home in Pendennis Road, Streatham, south London.

Amend rules

The court heard Christopher suffered oxygen starvation.

The inquest into his death was adjourned until October.

Recording a verdict of misadventure on Phoebe, Dr Knapman said: "Following this inquest, I will be writing to the Nursing and Midwifery Council (NMC).

"I will be writing to say that perhaps consideration be given by the NMC to amend the midwives' rules and code of practice, that in respect of home birth the guidance given should be extended to include explicit recording, in writing, in what terms the risks have been explained, including a recommendation, if any, and perhaps even to encourage the mother to counter-sign."