Forceps delivery defended as ‘reasonable option’ at Medical Council hearing

The attempted delivery by forceps of a baby, who died almost a week after his birth, was “a reasonable option” in the circumstances, a medical inquiry has heard.

Dr Michael Osasere is facing three separate allegations regarding the delivery of Kevin Kelly at the Midland Regional Hospital in Mullingar, Co Westmeath in August 2014.

Kevin was eventually delivered by caesarean section but died six days later. An inquest in 2016 found the cause to have been a shortage of oxygen supply to the brain.

Dr Osasere is accused of attempting a forceps delivery in circumstances where he knew, or ought to have known, such an approach was inappropriate with a high risk of failure.

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He is also accused of doing so on a labour ward rather than in theatre “in circumstances where he failed to ensure” arrangements were first in place for an urgent caesarean, and of failing to carry out a caesarean with due expedition or within an adequate timeframe.

There are no allegations at the inquiry, which were before a Medical Council fitness to practise hearing for a sixth and final day on Monday, that any actions by Dr Osasere resulted in injury to baby Kevin, or resulted in his death.

Dr Osasere, the locum registrar in obstetrics on duty at the time of the delivery, watched proceedings via a live video feed.

Addressing the inquiry, expert witness Dr Michael O’Hare, an obstetrician of over 40 years’ experience, said there was no evidence of inappropriate forceps use and that Dr Osasere had stopped after two attempts, in line with general guidance.

He said the four options open to Dr Osasere were to carry out an instrumental delivery in the position the baby was in; to manually rotate the head before an instrumental delivery; to use rotational forceps, something rarely done in Ireland; or to proceed straight to an emergency caesarean. He took the first option.

While acknowledging an increased risk of failure due to the baby’s position, Dr O’Hare said he “felt it was a reasonable option”.

He acknowledged a “degree of subjectivity” in an obstetrician’s assessment but felt the majority would consider a forceps delivery to be warranted.

However, he said, other doctors would go directly to caesarean or perform a limited attempt at forceps delivery in an operating theatre, as opposed to a labour ward.

Registrar

The committee hearing also addressed the issue of whether the registrar should have contacted the on duty consultant in relation to the case.

Dr O’Hare said it generally depends on circumstances but that in this case, with an experienced register, he felt it “not unreasonable” not to do so.

As regards the location of the delivery, he said emergency situations do arise in labour wards, often requiring an immediate transfer to theatre. In practice, he said, such facilities are required to be available on a full time basis and Dr Osasere was “entitled to believe that these arrangements were in place”.

Barrister Neasa Bird, acting for the Medical Council, challenged Dr O'Hare on the degree to which Dr Osasere was, and ought to have been, ready to get Ms Kelly to the operating theatre for caesarean.

“It’s not just about whether you have the room there, you have to have the people; and it’s not just about need, it’s about likely need,” Ms Bird said, adding that in this case there was a problem in finding a hospital porter.

However, Dr O’Hare rejected the “inbuilt assumption” that Dr Osasere had the overall responsibility for theatre readiness, saying this was a team effort and one in which a senior midwife would play a central role.

Ms Bird put it to Dr O’Hare that Dr Osasere’s later failure to reclassify Ms Kelly as requiring an urgent caesarean constituted a “serious failure”. He eventually conceded this but said he was unconvinced by what practical ramifications it would have had.

On conclusion of the evidence, the committee retired to consider the allegations, which much be proved beyond a reasonable doubt. Its finding will be made known at a later date.