A woman who worked as a midwife at The Coombe Hospital said she believed her baby “would likely be still with us” had there not been delays throughout parts of her treatment while in pre-term labour.
Sarah Lodola and her husband Darragh Leahy lost their son Ned in January 2020, less than an hour after he was delivered in an emergency operation at 31 weeks of gestation.
At Dublin District Coroner’s Court, Ms Lodola told coroner Dr Clare Keane she had been admitted to The Coombe after her waters broke on January 6th, 2020. She said she “felt comfort that I was in good hands and in a familiar environment at The Coombe Hospital, as things stabilised and [baby] Ned was doing well”.
“All tests showed Ned was a perfectly healthy baby, although in a breech position,” she said.
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However, by January 8th she said she “started to feel discomfort, which gradually and then more quickly progressed”. She said she was getting contractions every nine or 10 minutes. She sent a text to her husband to come to the hospital, and at about 7pm approached a member of staff at the hospital and asked for a consultant to review her situation.
However, Ms Lodola told the coroner there appeared to be a delay and she was eventually reviewed by her consultant Hugh O’Connor after 8pm. Mr O’Connor recommended an emergency Caesarean section, “the recommended delivery option for a breech baby”, she said.
There was a further delay when a hospital porter could not be found to bring Ms Lodola to theatre, and when she got there, two of the three operating theatres at the hospital were in use. The court was told the hospital did not have enough staff to open the third theatre.
She said “it was too late to have a Caesarean section” and therefore “a vaginal birth was the best option”.
Speaking on behalf of both herself and her husband, she said: “We feel if the delays had been avoided, there would have been a different outcome, and we have found that difficult to process. We feel that if there hadn’t been a delay to theatre we could have had a successful Caesarean, and Ned would likely be still with us.”
Mr O’Connor said Ms Lodola’s request for a review, which she said she made at about 7pm, was not relayed to him until 7.24pm. He told the coroner there was no “red flag” in the message. “You could be contracting every eight or nine minutes and you could settle down,” he said. “If I got the impression that Sarah was in labour I would have come straight away.”
Mr O’Connor said a postmortem on the baby showed some of the bones in his head had fused, which had likely led to difficulties with a vaginal birth or in using a forceps.
Rory White BL, for The Coombe Hospital, expressed his sympathy with Ms Lodola and her family. He said it was clear from the evidence that the baby’s head had got stuck. He said the fused bones had represented “a cranial abnormality” which was “the main causative factor”.
Dr Keane said she would record a narrative verdict in line with the evidence. She said she was looking forward to the publication of a HSE report on the care of pre-term women to be published by the National Women and Infants Health Programme.
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