The death of a newborn on the mid-north coast of NSW followed an attempted home birth in which the midwife failed to follow her profession's basic regulations and appeared to have an ideologically driven dislike of mainstream obstetrics, a coroner has found.
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The baby boy, who cannot be named for legal reasons, died on October 9, 2012, at Taree's Manning Base Hospital, after being delivered by caesarean section.
An inquest into the baby's death has heard that the caesarean followed a 36-hour labour, much of which took place at the mother's home, under the supervision of homebirth midwife Michelle Sheldrick.
In handing down his findings on Monday, Deputy NSW Coroner Hugh Dillion found that the baby died when, in a state of distress during the labour, he excreted a large amount of meconium, a viscous substance which entered his lungs and prevented him from breathing.
While the cause and timing of this distress could not ultimately be determined, it may have been caused by the fact that the baby was in breech position in the womb, but Ms Sheldrick allowed the labour to continue for an extended period before taking the mother to hospital, where proper monitoring and a caesarean could take place.
In doing so, the coroner found, Ms Sheldrick failed to adhere to basic elements of the Australian College of Midwives Guidelines, and indeed later admitted that she had no knowledge of these guidelines.
The guidelines clearly state that in the case of a breach birth, an obstetrician should be involved from a very early stage, and that there were serious risks of having such a birth at home.
"Having failed to provide the advice she should have under the guidelines before [the mother's] labour began, Ms Sheldrick then compounded the error at the onset of labour by failing to advise and, indeed, insist that [the mother] go to hospital without delay," Mr Dillon said in his findings.
Ms Sheldrick had a "false sense of confidence in her ability to manage [the baby's] delivery skilfully and safely," he said.
"The reality was that she had not the expertise, the support nor the instruments to ensure a safe breech birth at home ... it was naive and imprudent as well as unprofessional."
Additional failures by the midwife included that when she did eventually take the mother to the hospital, she refused to provide her notes to a registered midwife there.
The coroner said that, even in retrospect, it was impossible to say one way or the other whether earlier surgical intervention would have made a significant difference in the case.
However, he noted that "mothers and babies should never become or be used as pawns in a midwife's ideological crusade."
