Doctor says mother who died during birth should have been told majority of women had C-section

A senior doctor admitted that a mother who died during the natural birth of her second child should have been told the ‘vast majority’ of women in her condition had undergone a caesarean section, an inquest has heard. 

Avideah Nejad, a clinical director at Hampshire NHS Trust, told the inquest that Lucy Howell should have been made aware of medical literature, which states 96 per cent of women in her condition had opted for a caesarean in their second pregnancies. 

Ms Howell, 32, had a C section for the birth of her first child, Rosie, in 2017, which required specialist surgery to repair. The specialist who operated on her advised against any future vaginal birth, but the recommendation got ‘lost’. 

When she went into labour with her second daughter, Pippa, in March 2021, she suffered an amniotic fluid embolism and uterine rupture during the attempted natural delivery. While her child survived the birth, she did not. 

Miss Nejad told the inquest in Winchester that ‘she should have been told’ about medical literature, which would have supported a decision for a C-section.  

Ms Howell, 32, had a C section for the birth of her first child, Rosie, in 2017, which required specialist surgery to repair. The specialist who operated on her advised against any future vaginal birth, but the recommendation got ‘lost’

Area Coroner Rosamund Rhodes-Kemp previously told the hearing that had the specialist’s concerns been reiterated and highlighted further down the line, it might have ‘paused’ proceedings and different opinions might have been ‘acknowledged’. 

The inquest previously heard that there were ‘inconsistencies’ in the advice that Mrs Howell and her husband, Matthew, received over the course of her second pregnancy. 

After the birth of her first child, consultant surgeon Mr Shaheen Khazali had performed ‘niche’ surgery on her. 

Due to the risks, he advised her to avoid a natural birth in any subsequent pregnancy. But, the advice was ‘lost’ when consultant obstetrician Jean Goodman, who was helping Mrs Howell plan her delivery method, did not speak to him personally. 

If she had, she said she would not have recommended for Mrs Howell to have her labour medically induced, it was heard. 

Miss Nejad told the court Mr Khazali’s notes had not been available for consultants to see. As a result, maternity records have been made electronic in the department, with a ‘clear checklist’ for mothers who are giving birth after a C-section. 

Consultants are now ‘obliged’ to fill this information out. 

The inquest heard that Ms Goodman had added factually correct but ‘retrospective’ notes at the request of Miss Nejad. The notes indicated that she had spoken with another consultant about Mrs Howell’s niche surgery and its possible implications. 

Ms Rhodes-Kemp described the clinical director’s decision to ask all staff working on the night of Mrs Howell’s death to look back at their notes and add anything missing as ‘slightly odd’ and ‘not appropriate’. 

Avideah Nejad, (pictured) a clinical director at Hampshire NHS Trust, told the inquest that Lucy Howell should have been made aware of medical literature, which states 96 per cent of women in her condition had opted for a caesarean in their second pregnancies

Matthew Howell told his wife’s inquest that Lucy had ‘wrestled’ with the decision of whether to go for a c-section or vaginal birth, given her ‘unique’ medical history

Ms Nejad told the inquest: ‘One question I had for Jean was ‘I’m sure you discussed this about the operation, I can’t see anything about it on your notes’. I said ‘can you please retrospectively document that’.’

Addressing Ms Nejad, Mrs Rhodes-Kemp said: ‘You can see the concern.

‘These events are going to be looked at by others. What one would expect is that notes remain as they were at the time.’

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. 

The court also heard that Mrs Howell’s husband did not continue to receive support after discharge. The Healthcare Safety Investigation Branch stated support for Mr Howell after his wife’s death left him ‘very, very much alone in the early days.’ 

The inquest continues.