Consultant ‘no choice’ but to start baby’s delivery in labour ward

A consultant obstetrician has told a medical council inquiry that he was forced to begin delivering a baby in the labour ward at Cavan General Hospital as no theatre was available.

Dr Salah Aziz Ahmed faces allegations at a Medical Council Fitness to Practise Inquiry of poor professional performance and professional misconduct relating to three women who gave birth at the hospital between November 2012 and April 2014.

Last week, the inquiry heard details involving one of the patients, a 37-year-old woman, referred to as Patient One, whose baby died 32 hours after he was born.

The baby was born by emergency caesarean section on the night of November 22, 2012 and it is alleged that Dr Aziz failed to start the procedure in a timely manner.

Dr Aziz, who denies the allegations, began his evidence on Tuesday. He was the consultant on call on November 22nd, and received a phone call at 10.30pm, requesting that he come in to attend to Patient One. Upon arrival at the hospital at 10.45pm, Dr Aziz performed both an abdominal and a vaginal examination on the patient.

He said that during the abdominal examination, he felt that the baby’s head was high, but upon a vaginal examination, the head appeared to be much lower. When asked how he could be sure of the position of the baby’s head, based on the vaginal exam, Dr Aziz said: “I don’t have a measuring tape in my hand but I have 30 years of experience.”

Based on these and other factors, Dr Aziz said he decided that a trial instrumental vaginal delivery would be the best course of action. He told the inquiry that a “trial” meant this type of delivery might not be possible, and so he preferred to do them in theatre, where they could easily proceed to a caesarean delivery if necessary.

His notes at the time indicated that the theatre was busy with another section.

Dr Aziz said he had “no choice” but to do the trial instrumental birth on the labour ward because the theatre was not available.

He added that at the time there were industrial relations issues going on between theatre staff and management, and that he didn’t believe staff would come in from home to attend in theatre if somebody rang them.

Dr Aziz argued that at the time there was no system in place to call in a second theatre team after hours. “I needed to get that baby out and the theatre was busy so I did what I could to get the baby out,” he said.

Dr Aziz attempted to deliver the baby twice with the vacuum without success. He then manually rotated the baby, who was facing up. The ideal position for a baby in birth is facing down.

At 11.05pm, he attempted to apply forceps to the baby in order to achieve a vaginal delivery but the forceps did not lock onto the baby.

Dr Aziz told the inquiry he then asked a midwife to enquire about whether the theatre was available. He said that when she returned, she told him that the theatre was unavailable and that nurses would have to be telephoned at home.

He felt his only options were to continue the vaginal delivery on the labour ward or wait until a theatre was available, but he didn’t know when one would become available.

The inquiry heard that records indicated he then cut an episiotomy, and attempted another manual rotation of the baby’s head, and a second forceps delivery, which was again unsuccessful. Dr Aziz then made the decision to proceed with a caesarean section, and told staff he needed a theatre for an emergency operation.

At 11.25pm, Patient One was transferred to theatre, and the operation began at 11.32pm. Patient One’s baby was born at 11.40pm, in very poor condition, and died 32 hours later, on November 24.

Senior Counsel for Dr Aziz, Eileen Barrington, reminded the inquiry on Monday that the cause of death in the case of Patient One’s baby did not form any part of the allegations.

Dr Aziz, who first qualified as a doctor in 1980 in Egypt, was put on administrative leave in May 2014 following another case which will form part of the inquiry next week.

Dr Aziz, who is married with two children, said being placed on administrative leave had been “very stressful” for himself and his family, especially as his wife was from Cavan and knew many people in their community.

“I look forward to going back to work and I look forward to my name being cleared,” said Dr Aziz.

The inquiry continues on Thursday.