Mrs E suffered a complication when she went into labour. She called 999 but complained that the paramedics did not give her proper treatment and took too long to transfer her to hospital. She gave birth to her son but he died a few days later. This caused Mrs E emotional distress and loss of faith in the 999 service.
What happened
When Mrs E went into labour, she suffered a complication when her umbilical cord prolapsed. Mrs E phoned 999 for an ambulance, which arrived promptly at her house. The paramedics that attended Mrs E undertook some observations and prepared her for transfer to hospital.
Due to the serious and time critical nature of the complication, the paramedics inserted a cannula into Mrs E's arm, transferred her to the ambulance on a stretcher and contacted the maternity unit at the hospital to pre–warn them of Mrs E's arrival, and to seek advice on how to manage Mrs E in the ambulance.
When Mrs E arrived at hospital she was taken to the maternity unit where she gave birth. Sadly Mrs E's baby died a few days later as a result of injuries caused by the prolapsed umbilical cord.
What we found
We did not uphold this complaint. The paramedics acted in line with relevant guidance when they inserted a cannula into Mrs E's arm and transferred her to the ambulance. We also found that they acted in line with established good practice when they contacted the hospital to inform them of Mrs E's arrival. The time taken to transfer Mrs E to hospital was also reasonable.
However, we also found that the paramedics were unaware that the relevant guidance suggests that a single attempt should be made to reinsert the umbilical cord. Although there are risks associated with handling the umbilical cord, we recognised that the paramedics needed to make a clinical decision whether to reinsert the cord. As the paramedics were not aware of this part of the guidance, they were not in a position to make a sound clinical judgment and as such we found that this was a failing and we considered the impact this had.
Our obstetrician adviser explained that a paramedic would not be expected to try and relieve pressure on the umbilical cord and that in such a situation there is a very short time frame within which the baby needs to be delivered in order to prevent serious damage.
Because this complication occurred while Mrs E was at home, she did not have immediate access to specialist care and while the paramedics should have been aware of the guidance to make one attempt to reinsert the umbilical cord, this action would not have relieved the pressure on the cord that caused injuries to Mrs E's baby. Even if the paramedics had been aware of the relevant guidance, it is likely that the outcome would still have been the same.
As such we concluded that the Trust's failing was highly unlikely to have caused or contributed to the death of Mrs E's baby.
Putting it right
The Trust appropriately acknowledged its failing during its consideration of the complaint and as a result arranged for the paramedics to attend training and a learning session about the incident. We found that this action was appropriate and proportionate to remedy the failing.
North West Ambulance Service NHS Trust
Cheshire