Concern about different policies for over-term women opting for home births and those attending hospital maternity units about when they should be induced has been expressed at an inquest into the death of a baby boy shortly after he was delivered in a home birth three years ago.
Baby Rob Cashin died in the Rotunda Hospital in Dublin less than an hour after being born at his family home in Holywell Gardens, Swords, Co Dublin on August 27th, 2020.
His mother, Paula Cashin, told a sitting of Dublin District Coroner’s Court on Thursday that she had attended the hospital three days earlier for a check-up when she was nine days overdue after an uneventful pregnancy.
Ms Cashin said she was informed by a consultant, Rishi Roopnarensingh, that she would have been induced at seven days if she had been a patient of the hospital.
Under HSE policy for home births, however, Ms Cashin explained she would be allowed to go for 14 days past her due date before being induced.
Ms Cashin said the Covid-19 pandemic had been a big influence in her decision to opt for a home birth because of the pressure on hospitals.
Although everything had appeared fine with her baby when she attended the Rotunda, Ms Cashin said she had found the meeting “quite stressful and very confusing”.
She told the coroner, Clare Keane, that she had been left “angry and scared” on leaving the hospital after that visit because of what seemed to be different policies on when labour should be induced between women attending the Rotunda and those opting for home births.
Ms Cashin said Rob’s delivery was “a moment of pure relief and happiness” and she remembered thinking everything was OK with her baby.
However, she said two midwives assisting her had called for an ambulance shortly after his birth.
She described how she was subsequently informed at the Rotunda, where she had been brought after suffering major bleeding in labour, how efforts to save her baby had failed.
Ms Cashin said she broke down and cried as she held his body.
“He was such a big baby and so perfect,” she recalled.
Her husband, Colm Cashin, described the moment he was informed that their son had died as having “an overwhelming feeling this was not real.”
“It was a very traumatic experience. We will miss Rob forever,” he said.
'Very unpredictable'
Asked by the coroner about the concern he had voiced to Ms Cashin about home births, Dr Roopnarensingh said it was because obstetric problems were “very unpredictable”.
“Some situations require facilities provided in a hospital setting which cannot be replicated at home,” Dr Roopnarensingh said.
He added that some problems can develop quite quickly and are not always readily identifiable.
“It is important to plan delivery, preferably in a hospital setting,” the consultant remarked.
He agreed that the different policies as well as preferences among medical professionals on when pregnant women should be induced was confusing.
Dr Roopnarensingh also revealed that the Rotunda had recently begun testing women for Strep B infection at various stages during their pregnancy, including before induction.
However, he said he did not believe a positive test for Strep B should preclude a woman from having a home birth.
The Rotunda’s director of midwifery, Fiona Hanrahan, told the inquest that lots of women do not need to see a consultant during their pregnancy as there is no need.
Ms Hanrahan said an oversight group was currently looking at a review of guidelines for the HSE’s home birth service.
A previous sitting of the inquest was adjourned after Ms Cashin claimed that she might have been prevented from having a home delivery if the Rotunda had passed on details to a midwife about previous difficulties experienced during the birth of her first child, Sarah, in 2015.
Ms Cashin told an earlier hearing in January that she had obtained medical records which indicated that there was an issue during the birth of her daughter with a condition called shoulder dystocia where there is a problem with the shoulder getting stuck after a baby’s head has been delivered.
However, Dr Kate Glennon, a registrar at the Rotunda, confirmed there had been no difficulty with the delivery of a shoulder during Sarah’s birth.
Dr Glennon explained that staff had used a position to treat women delivering a baby with shoulder dystocia but it was just as a general aid to delivery in Ms Cashin’s case.
In a statement, the lead midwife at the home birth who did not attend the inquest, Carolyn Coughlan, said the baby was not breathing and had no pulse after being delivered in a birthing pool.
Another midwife who assisted at the home birth, Niamh Bates, became emotional as she described efforts to resuscitate baby Rob.
Ms Bates confirmed that all observations had been normal prior to his birth.
An advanced paramedic with the National Ambulance Service, Shane Mooney, said ambulance crews would have received a call-out to attend the birth of a baby every second day over the past 15 months.
Mr Mooney said he was unable to say how many were related to home births.
However, he said the need to resuscitate a newborn baby in such circumstances was “rare.”
The inquest was adjourned until Friday when it is expected to conclude.
Written by Seán McCárthaigh
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