The “tragic and avoidable” death of a baby after a breech home birth has led to an overhaul of emergency labour guidelines. Baby Arthur was an undiagnosed feet first, or footling, breech. These babies are risky to deliver and normally require an immediate caesarean section.
When Arthur’s father Matt Trott called the hospital in the early hours of May 25 to say he could see his son arriving foot-first, the hospital midwife told him to call 999 to transfer his wife, Stephanie, immediately to hospital.
An ambulance and paramedic arrived at their home in Burgess Hill, Sussex, 12 minutes later, and the midwife was put on the phone. She repeated the instruction for immediate hospital treatment.
However the ambulance operator cited offical guidance from the Joint Royal Colleges Ambulance Liaison Committee. This states if a breech birth is “imminent” try to deliver the baby.
An advanced critical care paramedic arrived and questioned why Stephanie had not already gone to the hospital. By then baby Arthur’s legs had delivered to ‘mid shin’.
Five minutes later the ambulance control desk told paramedics to go to hospital. But because the delivery was so advanced a final effort was made to complete it.
When this failed Stephhanie, 33, was taken to hospital, arriving eight minutes later at 6.36am – more than an hour after the first call to the hospital.
Arthur had suffered catastrophic brain injury due to lack of oxygen and died three days later.
At his inquest last year solicitor Gail Waller, a partner at (must keep mention) Mayo Wynne Baxter, argued Arthur would have been saved had he been transferred to hospital as soon as paramedics first arrived.
She said: “This really is a heartbreaking and traumatic case. There was a window of opportunity, as highlighted at the inquest, when paramedics first arrived on the scene. Stephanie should have been taken to the hospital when Arthur was still pink and kicking. However, the delay in this happening starved Arthur of oxygen and materially contributed to his death.”
Assistant Coroner Dr Karen Henderson said “I don’t underestimate the difficulty of moving her but that is what should have happened.
“I am satisfied that there was a missed opportunity to transfer her to hospital. Arthur died following an undiagnosed footling breech where a delay in transfer to hospital materially contributed to him suffering severe hypoxic ischemic encephalopathy.”
She issued a Prevention of Future Deaths report to the Association of Ambulance Chief Executives. The association is now clarifying advice on footling breech to state that the mother should immediately be transported to hospital.
Arthur’s father, Matt Trott, a veterinary practice manager, 37, said: “It was the most traumatic thing we have ever experienced. You could hear the panic and confusion in everyone’s voices – one minute they were told to go to hospital, the next minute to stay. When the critical care paramedic arrived, he was surprised we were still at home because it was such a medical emergency.”
Stephanie, 33, said: “Life without Arthur is very painful – there is a real gap in our family where he should be and it will forever feel like a part of us is missing. He dominates our life and we are constantly thinking about him.
“My pregnancy was very straightforward – I seemed to glide through it. Everyone told me how much pregnancy suited me and no problems cropped up along the way. As I was classed as low-risk and we live less than 10 minutes away from our local hospital, I decided to have a home birth. I’d done a lot of research into hypnobirthing and I thought I could be more relaxed in a familiar environment.”
Since their son’s death Stephanie and Matt have bought a four-acre piece of land in East Sussex, named Arthur’s Patch, where they have planted native woodland trees, a vegetable patch, a children’s play area and a pond named after their eight month old daughter, Primrose. They hope to create a community space where grieving parents and people suffering other losses can visit in times of need.
A South East Coast Ambulance Service NHS Foundation Trust spokesman said: “We would like to take this opportunity to offer our sincere condolences to Mr and Mrs Trott and we welcome any changes to national breech birth guidance aimed at improving maternity care.”