Mother, 32, who died during natural birth of her second child after recommendation to have a C-section was ‘lost’ may not have survived even if she had the procedure, coroner rules
- Lucy Howell died after her caesarean recommendation was lost before the birth
A mother who died in childbirth after a recommendation she have a caesarean section was ‘lost’ may not have survived even if doctors had known about it, a coroner ruled today.
Lucy Howell opted for a natural birth for her second child despite a surgeon’s concerns she would be in danger if she did.
Tragically, during the delivery the 32-year-old suffered a uterine rupture resulting in an amniotic fluid embolism and, while daughter Pippa survived, she passed away.
Today the coroner concluded that even if she had had a C-section there was ‘no evidence’ to prove she wouldn’t have suffered the same fate.
Mrs Howell’s inquest heard she had undergone a caesarean for the birth of first daughter Rosie in 2017, which required specialist ‘niche’ surgery to repair.
Lucy Howell suffered a uterine rupture resulting in an amniotic fluid embolism during her pregnancy and died
Lucy Howell with her husband Matthew Howell shortly after the birth of their first child
Lucy Howell had undergone a caesarean for the birth of first daughter Rosie in 2017 (pictured together)
Following this procedure the specialist who operated on her advised against any having a natural birth with any future pregnancy, a recommendation that got ‘lost’ amid other ‘inconsistencies’.
Four years later when she was expecting her second child the consultant planning Mrs Howell’s baby delivery method did not ask the specialist about the surgery he had performed.
Coroner Mrs Rosamund Rhodes-Kemp concluded that even if she had had a C section there was ‘no evidence’ to prove she wouldn’t have suffered the same fate
Mrs Howell was also not made aware of medical literature that showed as many as 96 per cent of women who underwent the same procedure had gone on to choose C sections with later pregnancies.
The court heard the environmental engineer, of Bishop’s Waltham, had ‘wrestled’ with baby delivery methods but opted for a natural delivery having been ‘assured’ it was safe.
In March 2021 she was admitted to Royal Hampshire County Hospital in Winchester to be induced. However, she died in labour
The hearing in Winchester also heard a clinical director at the NHS trust that treated Mrs Howell, admitted telling staff to alter notes ‘retrospectively’ after her death.
Today, after a four day inquest, a narrative conclusion was recorded by Hampshire Area Coroner Rosamund Rhodes-Kemp.
She said: ‘Lucy Howell died on the 13 March 2021 due to a uterine rupture and amniotic fluid embolism following a trial of labour that was her preference.
‘This was on a background of a C section in 2017 and a laparoscopic niche repair surgery in 2019.
‘None of the obstetricians involved in her care had experience of that procedure.
‘Had they known and conveyed that information to her, she may have chosen to have an elective C section.
‘However, while this may have avoided the rupture, there is no evidence to say she would have avoided the amniotic fluid embolism and therefore her tragic death.’
The court heard following the birth of her first daughter, specialist consultant surgeon Mr Shaheen Khazali had performed ‘niche’ surgery on her in London, after her ‘extremely painful’ and ‘torrid’ time recovering from the caesarean.
Mrs Howell’s husband, Matthew, told the hearing despite having a preference on baby delivery method, she was happy to be ‘guided’ by the professionals and said she only continued with idea of natural birth, because she ‘had been assured’ it was safe.
Mr Howell said his wife worried of being ‘selfish’ for wanting a natural birth in order to prevent another long recovery, and texted him saying: ‘What if it all goes wrong? What if I die?’
Mr Howell said his wife worried of being ‘selfish’ for wanting a natural birth
Lucy Howell’s husband said she had been happy to be ‘guided’ by the professionals
The coroner said Avideah Nejad, of Hampshire NHS Trust, had come across as ‘defensive’ when giving evidence
Due to the risks, Mr Khazali had advised her to avoid a natural birth in any subsequent pregnancy. However, that advice was ‘lost’ when consultant obstetrician Jean Goodman, who was helping plan her delivery method, did not speak to him personally.
If she had, she said she would not have later recommended for Mrs Howell to have her labour medically induced, it was heard.
Mrs Rhodes-Kemp criticised Ms Goodman for not speaking to Mr Khazali himself, saying: ‘To me that was the obvious thing to do from the get-go.
‘To speak to the gentleman who had performed the procedure: ‘what are the pros and cons? What’s your advice to this lady? And I’d like to know more information’.’
Concluding the inquest Mrs Rhodes-Kemp said: ‘When specifically asked, it is clear none of the doctors had spoken to Mr Khazali, had access to his notes or come across a niche repair.’
She told the hearing Avideah Nejad, of Hampshire NHS Trust, had come across as ‘defensive’ when giving evidence.
She added: ‘What is most striking is the sheer devastation Lucy’s death has caused all of the family.’
The Healthcare Safety Investigation Branch concluded that a senior review should have taken place when risks appeared to be ‘accumulating’ during Mrs Howell’s labour.
It added that the support for Mr Howell after his wife’s death left him ‘very, very much alone in the early days’ following discharge from hospital.
The hearing was told Mr Howell was given the phone number of a charity to contact.
Addressing the family, Mrs Rhodes-Kemp said: ‘I’m very, very sorry for your loss.’
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