Baby’s head injuries caused during delivery, inquest told

A baby suffered a skull fracture and head injuries likely to have been caused by instruments used during his delivery, an inquest has heard.

A forceps and a vacuum cup were used by medical staff assisting in the birth of baby Henry McMahon at the National Maternity Hospital (NMH) on September 18th, 2017. He died six days later.

The infant had been diagnosed with the congenital heart condition hypoplastic left heart syndrome. The condition is operable with high success rates and plans were in place to transfer baby Henry to Crumlin children’s hospital for surgery directly after birth.

The infant’s mother Sorcha McMahon was induced early on September 18th following what was deemed to be a high risk pregnancy complicated by diabetes, hypertension and the baby’s heart condition.

She had been pushing for almost an hour and was progressing well through labour when staff became concerned for the baby's heart rate at 3.50pm. The baby's head was low in the birth canal and specialist registrar Dr Maria Farren used a vacuum cup or ventouse device to aid delivery.

Beginning at 4.36pm three attempts using the vacuum cup were made but these were unsuccessful.

The inquest heard of a conflict of evidence at this point as Mrs McMahon claims the forceps was applied by the specialist registrar. Dr Farren said she did not attempt delivery using the forceps. Consultant obstetrician Prof Donal Brennan was called in and arrived at 4.48pm. He manually rotated the baby's position in the birth canal before delivery using a forceps at 4.53pm.

Prof Brennan told Dublin Coroner’s Court he had “no doubt” some of the baby’s injuries were caused during delivery.

Baby Henry suffered a fractured skull and haemorrhages inside and outside his skull. There were injuries to the right temple area and bruising around his forehead, right ear and mouth.

“There’s no doubt in my mind that some of the head injuries have to be attributed to the instrumental delivery. I cannot say which instrument or when they occurred,” he said.

A caesarean section at this point would have put both mother and baby at significant risk, Prof Brennan said.

The court heard that an “emergency event log” featured the word “Forceps” at 4.43pm, before Prof Brennan’s arrival to the delivery room. The word appears again in the log at 4.49pm, after Prof Brennan’s arrival.

Staff suggested the note may indicate the arrival of the forceps into the delivery room. Barrister for the family Richard Kean asked Prof Brennan if the arrival of a forceps was "commonly noted" in this way and Prof Brennan replied "No".

Asked about the mother’s allegation that the forceps was applied before his arrival, Prof Brennan said he didn’t know why the word forceps appeared on the emergency log at 4.43pm.

“The forceps I applied was clean,” he said.

The family’s barrister asked who had recorded the emergency log but this was not disclosed until the coroner specifically requested it.

Coroner Dr Myra Cullinane adjourned the inquest until October 10th to hear evidence from author of the emergency log and from the pathologist.