The Courier & Advertiser (Perth and Perthshire Edition)
Sheriff rules 999 action could have saved baby
Child took ill shortly after pool birth and died despite the efforts of midwives
The death of a baby who died just four hours after she was born could have been prevented if an emergency ambulance had been made available to rush her to hospital when she took ill, a sheriff ruled yesterday.
Nevaeh Stewart died at Montrose Royal Infirmary’s community midwifery unit in September 2012, despite the efforts of midwives there and specialists who rushed from Dundee to her aid.
Her father Gary Stewart described the unit as an “emergency response blackspot” and accused NHS Tayside of “systemic failures” during a fatal accident inquiry being held in Forfar.
A sheriff ruled that Nevaeh had “simply languished” at the midwifery unit receiving only “basic resuscitation” because NHS guidelines would not allow a blue light ambulance to be sent.
The dedicated neonatal team that was allocated to cover Montrose at the time was on another job in Wick.
If Nevaeh had been a home birth and not born in the midwifery unit a blue light 999 ambulance would have been sent to pick her up.
The inquiry heard Nevaeh was born in a birthing pool but was immediately found to be “pale and floppy”.
An ambulance from Ninewells Hospital in Dundee took almost two hours to arrive.
Mr Stewart said: “I believe that if NHS Tayside told parents the truth about transfer times we would have made a different decision on obstetric care and we would have had timely access to specialist medical assistance if it was needed.”
His wife Kimberly added: “Had I been told in 2008 when I was pregnant with our second child that I’d have to wait an unlimited amount of time for specialist help if something went wrong with the birth, or after the birth, I think that’s enough information. I wouldn’t have risked it.”
Yesterday Sheriff Pino di Emidio agreed and ruled “more precise and evidence based information about birth site choice” could help parents make a more informed choice.
He said “provision of a 999 ambulance for retrieval of babies born unexpectedly unwell” could also have saved Nevaeh. He further ruled prospective parents should be told that there is “no good scientific evidence” that water births are as safe as giving birth out of water.
Kimberly, 32, of Auchenblae, Aberdeenshire, said when Nevaeh was born on September 29 2012 she was “pale” and was immediately rushed away for treatment.
She said: “I think a blue light ambulance should have been called straight away. That’s the quickest way to get help.”
Mr Stewart, 31, said: “I presumed that if there was an emergency an emergency response team – a flying squad – would be brought in to fix the situation.”
In a judgment, Sheriff Di Emidio said: “All professional medical and midwifery witnesses accepted that there is no way in which there can be a ‘flying squad’ on standby 24/7 to deal with any newborn that might be born at some distance from a recognised specialist medical centre.”
Professor Andrew Russell, medical director at NHS Tayside, said: “We will be taking the time to carefully consider today’s determination and the recommendations outlined in the report.
“Sherrif Di Emidio has acknowledged in his determination that we have made a number of changes since 2012. This includes updating the guidance on the use of a 999 ambulance for the retrieval of babies born unexpectedly unwell in community maternity units.”