A mother died during the birth of her second child after a doctor’s advice she should not have a natural birth was ‘lost’, an inquest heard today.
Environmental engineer Lucy Howell passed away after suffering complications during the birth of her second child Pippa at Royal Hampshire County Hospital in March 2021.
The 32-year-old had previously had a caesarean for the birth of first daughter Rosie which needed surgery to repair, the hearing was told.
Following this she was told by a consultant not to have a natural birth when she next fell pregnant, it was heard.
However, such were the complications of the first C-section, Mrs Howell had wished to avoid another one and the doctor’s opinion was ‘lost’ in the making of birth delivery plans.
Lucy Howell, 32, (pictured) passed away after suffering complications during the birth of her second child, Pippa, at Royal Hampshire County Hospital in March 2021
When she into labour with new baby Pippa four years later, Mrs Howell suffered a rupture during the delivery and, while her daughter survived being born in her stomach, she passed away.
Hampshire Area Coroner Rosamund Rhodes-Kemp today told the hearing that had the consultant’s concerns been reiterated and highlighted further down the line, it might have ‘paused’ proceedings and different opinions might have been ‘acknowledged’.
Mrs Howell’s inquest follows a pre-inquest review last year which heard she was given ‘conflicting’ advice about the risk of delivery methods.
Today Winchester Coroner’s Court heard Mrs Howell, of Bishop’s Waltham, Hampshire, went into labour in March 2021 and was admitted to Royal Hampshire County Hospital in Winchester to be induced.
The court heard from pathologists, who said the cause of death was amniotic fluid embolism and uterine rupture – the former of which is a condition that happens to one in 100,000 women, equating to about six or seven a year.
Opening the inquest and addressing Mrs Howell’s family, Mrs Rhodes-Kemp said she was ‘very, very sorry’ for their loss.
‘It wasn’t a straightforward pregnancy or birth,’ she said.
The court heard Mrs Howell had had complications from the first c-section and had undergone surgery to deal with resultant scarring.
‘If she could, she wanted to have a natural delivery and as we know, she continued on that basis,’ Mrs Rhodes-Kemp added.
The court heard Mrs Howell did not fall into ‘spontaneous’ labour after her waters broke, and was given Syntocinon the following day – a medication given that causes the muscle of the womb to contract during labour.
Her family previously claimed Ms Howell was given ‘conflicting’ advice about the risks of a natural delivery (pictured: Lucy Howell, Rosie and Matthew Howell)
Mrs Howell then collapsed in the early hours of 13 March, before she sadly died.
The coroner said there were various aspects in the lead up to her death that needed to be assessed, including the various aspects of previous surgery and risk that posed, advice given for the delivery method of her second baby and the cause of death.
Consultant surgeon Mr Shaheen Khazali carried out surgery to repair Mrs Howell’s uterine scar niche that had formed after the birth of her first child.
Giving evidence, he said the surgery had gone well, with both he and Mrs Howell happy with the outcome.
In terms of complications, with 10 being the most complicated he had carried out and one the least, he ranked her surgery as a two.
However, giving evidence, he said the niche surgery is the equivalent of having another C-section, despite it happening when the woman is not pregnant.
This meant, when asked by Mrs Howell, what method she should use when she wanted to have another child – he advised a C-section.
‘It is normal to have differences of opinion,’ he told the court.
‘I did not dictate any method of delivery.’
‘Repair is equivalent to another C-section. I said it would be my advice to have another C-section.
‘That would have been my advice if she had had two c sections.
‘She asked, and it was my opinion.’
Mrs Howell suffered a rupture during the delivery and, while her daughter survived being born in her stomach, she passed away
When the coroner asked why he hadn’t been consulted further down the line by colleagues handling Mrs Howell’s care, he said: ‘My best guess if that they didn’t feel they needed more information.’
He told the court he had reflected ‘long and hard’ and said: ‘I believe my role is to make sure I share all the information with the clinicians looking after my patients.
‘I believe I have done my very best to do that in Lucy’s case.
‘I think I have given the right advice and communicated it.’
Mrs Rhodes-Kemp, however, said the message from him in 2019, after the surgery, was ‘lost’ as it was ‘not appreciated’ that there was a difference in views about a natural birth or C-section.
She said: ‘It was not appreciated there was a view that was different, your view got lost. No one spoke to you.’
When Mr Shaheen Khazali said he was ‘satisfied’ she understood the different view, corner said she did, but she had been a patient.
‘That voice got lost, and it might have helped her pause and acknowledge the difference to be apparent to those who were following.’
Mrs Howell worked at consultancy agency Soils Limited as an Health and Safety Coordinator and Geo-Environmental Engineer after joining as a graduate in 2011.
The inquest – which is expected to last four days – continues.
