Midwife blames her ‘extreme tiredness’ in tragic home birth

A midwife present during a tragic home birth has told an inquest “extreme tiredness” had impaired her judgment, and she regrets delaying the mother’s transfer to hospital.

Over hours of gruelling evidence on Wednesday, midwife Marie-Louise Lapeyre told a Victorian Coroners Court inquest into a baby’s death that she was grappling with fatigue and had not slept the night before overseeing his 2022 home birth.

Lapeyre said she believed this might have impaired her decision-making when the baby’s heart rate began to fluctuate.

“What I’m going to say is not an excuse, but it’s part of the reason ... it is extreme tiredness,” Lapeyre told the court.

The mother, who cannot be identified, tried to have the home birth until complications arose, and her son had to be delivered by caesarean at Bendigo hospital in August 2022.

The newborn, known as Baby R, was transferred to the Royal Women’s Hospital soon after his birth but died six days later from perinatal hypoxia, a condition in which a fetus or newborn does not receive enough oxygen.

Lapeyre told the inquest the mother had been in labour for hours and was in a bath while talking on the phone to her doula at about 6.55pm on August 19, 2022, when she took the baby’s heart rate and observed it was abnormally fast, indicating a potentially serious condition known as tachycardia.

“Things seemed to happen very quickly ... because when I took the fetal heart [rate] again, it was still tachycardic, and I knew there was something wrong,” she said.

“That’s when I decided ... that Baby R’s mother needed to be transferred.”

Lapeyre told the court she took the baby’s heart rate several more times at the woman’s house over the next 45 minutes. At one point, the baby’s heart rate hit 195 beats per minute when it should have been between 110 and 160.

The inquest heard Lapeyre had not slept the previous night and had come from another birth.

The court was also told Lapeyre was often travelling 1000 kilometres a week to assist women due to a lack of private midwives in central Victoria.

Lapeyre was one of two midwives present at the home birth, though her colleague, Elizabeth Murphy, was taking a break and sleeping in another room when the baby’s abnormally elevated heart rate was noticed.

Lapeyre said that in hindsight, she should have woken up Murphy, and also admitted she should have told the mother “in strong terms” sooner that she needed to be immediately transferred to hospital.

“The deep regret was not asking Baby R’s mother what she wanted to do at different points of the labour,” Lapeyre told the court as she broke down in tears.

“That is a regret that I will carry ongoing. It’s not something that goes away. Midwifery has been the love of my life and I failed ... it is devastating.”

A week-long inquest into the child’s death started on Monday. Coroner Dimitra Dubrow will seek to assess the mother’s suitability for a home birth and whether Baby R’s death was preventable.

Earlier this week, Baby R’s mother described in her statement a “what if” moment during the home birth, when she noticed meconium liquor as she made her way from her bedroom to the lounge room.

This waste fluid is typically passed after birth.

The mother said in her statement: “I remember Marie-Louise just saying, ‘We’ll monitor you more closely.’

“I wish I asked what ‘more monitoring’ looked like to discern if we were on the same page. I didn’t do this, and this is hard to live with.”

The court heard that as soon as meconium liquor was observed, a full assessment of labour progress should have occurred.

Following investigations by the Australian Health Practitioner Regulation Agency and the Nursing and Midwifery Board, Murphy and Lapeyre have been told they cannot practise as private midwives.

The inquest heard earlier this week, that the 35-year-old mother had experienced a traumatic birth with her first son, including having to be transferred from Castlemaine hospital to Bendigo hospital for an emergency C-section. She later suffered haemorrhaging.

In a statement read to the court by her lawyer, Andrea De Souza, the mother, who has a nursing and midwifery background, said she did not want to return to Bendigo Health following the previous birth.

However, she said she felt safe knowing that the hospital was nearby if something were to go wrong.

The inquest heard on Monday that Bendigo hospital rang the pregnant mother a month before her due date asking her to come in for an appointment because she was deemed to be at high risk and was planning a home birth.

But the woman said she thought it was “fearmongering” and a box ticking exercise for the hospital, so declined the 36-week appointment with an obstetrician.

The inquest continues.

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