Doctor overseeing mother who died in childbirth didn't know surgeon advised ... trends now
The doctor overseeing the pregnancy of a mother who died in childbirth admitted she didn't know a surgeon had previously advised against a natural delivery, an inquest heard.
Environmental engineer Lucy Howell, 32, had undergone a caesarean for the birth of first daughter Rosie in 2017 - which then required specialist surgery to repair.
The consultant obstetrician Jean Goodman opted not to speak directly to the doctor who had carried out the procedure, instead contacting a 'more available' gynaecologist who attended the surgery.
If she had, she said she would 'absolutely' have changed her plan and not recommended for Mrs Howell to have her labour medically induced.
Tragically, when the 32-year-old went into labour with new baby Pippa in March 2021, Mrs Howell suffered an amniotic fluid embolism and uterine rupture during the delivery and, while her daughter survived, she passed away.
Lucy Howell, 32, passed away after suffering complications during the birth of her second child, Pippa, at Royal Hampshire County Hospital in March 2021 (pictured: Lucy Howell, Rosie and Matthew Howell)
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
The hearing in Winchester, Hampshire, has heard there were 'inconsistencies' in advice the couple received from doctors during the course of her second pregnancy.
Mrs Howell had had a 'torrid' time following her C section and wanted a natural delivery, the inquest heard.
Her husband Matthew told the inquest yesterday that Mrs Howell had 'wrestled' with the decision of whether to go for a c-section or vaginal birth, given her 'unique' medical history.
At a pre-inquest review last year it was claimed she was given 'conflicting' advice about the risk of delivery methods.
Following the birth of her daughter, consultant surgeon Mr Shaheen Khazali had performed 'niche' surgery on her.
Due to the risks, he had advised her to avoid a natural birth in any subsequent pregnancy. However, that advice had been 'lost', the inquest has heard.
Area Coroner Rosamund Rhodes-Kemp 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'.
She said Mrs Howell wanted a natural delivery due to her previous experience.
'It wasn't an uncomplicated c-section,' she said. 'Lucy had had a terrible time afterwards and that was why she wanted to have a vaginal delivery because she had had such a torrid time after that first c-section.
'It's unusual not to be able to walk and move for weeks - that was what was driving her decision.'
Today, Ms Goodman told the court in hindsight, she would 'absolutely' do things differently in planning Mrs Howell's pregnancy plan.
The court heard Ms Goodman first met Mrs Howell face to face in November 2020 when she had fallen pregnant.
'When I initially spoke, my impression was someone who had had a straightforward c-section, with difficulties recovering and wanted to have a vaginal delivery,' Ms Goodman said.
'It was only disclosed at the end of the meeting that she had had a niche.'
Ms Goodman told the court her initial plan had been to write to the specialist surgeon who carried out the operation on Mrs Howell.
She told the court she had never found any notes from Mr Khazali and had instead opted to ask Renee Behrens, a consultant gynaecologist at Winchester's Royal Hampshire County Hospital about the procedure as she had attended the operation.
When asked why she had switched plans from writing to Mr Khazali to asking Ms Behrens, Mrs Goodman said: 'My impression was Ms Behrens was a lot more available.
'I had access to someone who was present at the surgery and aware of her care up until this point.
'She was there on the day and was aware of the advice that had been given.
Mrs Howell had previously undergone a caesarean for the birth of her first daughter, Rosie, in February 2017, which led to her needing surgery afterwards. She is pictured with Rosie
'I thought that was a reasonable alternative to writing to the operating surgeon.'
In response Mrs Rhodes-Kemp said: 'The key point about this is Mr Khazali is a specialist which is the reason Ms Behrens referred her to him.
'He carries out niche surgeries - he's very, very familiar with surgery and gets a lot of referrals because they don't have that specialist.'
The court heard Mr Khazali had recommended a C-section.
'Unfortunately, because there was no discussion with anyone at any time, that view never surfaced,' she continued.
'For Lucy, she had already been told one
