Inadequate assessment led to woman giving birth unassisted at home

What happened

Ms H was under consultant-led care for her pregnancy because she was considered high risk. The plan was for her to give birth in hospital, on a consultant unit.

Ms H called the Trust's labour advice line, reporting contractions and discharge. The Trust told her it was likely this was Braxton Hicks contractions (intermittent weak contractions during pregnancy) and that she should not worry and should stay at home.

The next morning she called for advice again and the Trust invited her in for an examination. The Trust found that Ms H's discharge was the 'show' (a sign that labour had started) but insisted she was not in active labour and told her to wait at home. Ms H's husband called the advice line later that day as the contractions had become stronger and more frequent. A midwife assessed Ms H over the phone and decided that, based on her calculation of Ms H's contraction rate, Ms H was not in active labour and did not need to come to hospital. She told Ms H to wait at home, have a bath to ease the pain and call if she had any concerns or needed further advice.

Two hours later Ms H felt a change in her contractions and her husband called the advice line again. But while he was on the phone, Ms H gave birth to their baby. An ambulance was sent and Ms H and her baby were taken to hospital and checked, and both were fine. Ms H said that she and her husband were left traumatised by the experience of giving birth unassisted at home. She said the experience affected her husband's enjoyment of the birth.

What we found

Overall, we found the Trust did not handle phone assessments in line with the relevant guidance and established good practice. The fact that Ms H was under consultant care should have reinforced the need for her to come to hospital for an assessment on the consultant unit, to make sure she had the support that she needed.

The Trust's note taking and record keeping was inadequate because midwives did not record large amounts of conversations during the triage calls. There were no records of midwives asking about any medical complications or concerns in pregnancy and they did not keep Ms H's medical records up to date. This meant that when Ms H called the advice line she had to repeat the history of her previous calls so that the midwives could find any previous notes.

Putting it right

The Trust acknowledged the failings we found and apologised to Ms H. It also produced an action plan explaining how it had improved the service on the labour advice line, and its assessments and note taking to make sure there was continuity of care, to avoid a recurrence of the failings we identified.