Baby death inquest hears breech delivery method very unusual practice
The delivery position used by a doctor for a baby boy who was in a breech position was a "very unusual practice", an expert has told an inquest.
Dr Rohit Sharma delivered Troy Brady at Craigavon Hospital in August 2016.
Troy was born in a "state of collapse" and died six days later in the neonatal unit.
Obstetrician Dr Alyson Hunter said in her experience using what the inquest called the all-fours position was not usual for breech births.
If a baby is breeched it means they are lying bottom or feet first.
Another obstetrician told the inquest that women giving birth to breech babies would normally be encouraged to lie on their backs.
On Thursday, Dr Hunter told the inquest: "In the 30 years I've practiced, I've delivered 30 breeched babies and I don't think I am experienced in delivering breech babies."
She added: "In my experience an all-fours breech delivery is a very unusual practice."
The obstetrician also told the court that she questioned Dr Sharma's experience.
"In my reading of the case, delivery was slow and delayed," she said.
"Manoeuvres were not deployed by Dr Sharma and that made me feel that he didn't have an awful lot of experience in this type of birth.
"When things went wrong it was obvious that Dr Sharma hadn't been trained on how to manoeuvre the baby and there was a delay."
Placenta 'not operating as it should be'
Troy, who was born at 33 weeks, suffered severe brain damage due to a lack of blood and oxygen supply.
During the inquest hearing, experts told the court that Troy had a "smaller than usual" placenta and that it was not "operating as it should be".
Dr Caroline Gannon, a paediatric and perinatal pathologist, said it is known that "placenta infection and placenta deficiency can cause brain damage".
When asked by a solicitor if Troy would have been born alive if the placenta was fine, Dr Gannon replied: "More than likely he would have, in my view."
Consultant neonatologist Dr David Sweet told the inquest Troy's reduced reserves meant he was "less able to deal with vaginal delivery".
However, he said there was "no clue" there was a risk to Troy.
"No one could have known he had a deficient placenta," he added.
"Having half a placenta is like having one lung instead of two - he's going to get into difficulty quicker," he said.
Missed opportunities
Dr Hunter said there was a "delay" in Troy's delivery which caused issues.
"I think there were missed opportunities," she said.
"It was documented that it was a very busy day, but ideally the person doing the delivery should be talking to the woman.
"When you are a consultant, you have to take responsibility."
Obstetrician Dr Tara Fairley agreed, and told the court: "This was a high-risk case.
"I would expect colleagues to make more effort around keeping notes, we have a responsibility to be more careful.
"There were missed opportunities around consent that could have been taken."
Dr Fairley added: "Breech delivery on all fours isn't something we do in Scotland. It's simply something we're experienced in.
"We would normally deliver the baby in the lithotomy position".
The lithotomy position refers to lying on the back with knees bent above the hips and spread apart with stirrups.
The inquest continues.
