A senior NHS gynaecologist accused of causing an unborn baby to be accidentally decapitated inside her mother’s womb, has said she may have tried ‘too hard’ to complete a successful delivery.
Dr Vaishnavy Laxman, 43, who had been nearing the end of a 24 hour shift on a maternity unit, broke down in tears at a disciplinary tribunal this week.
It was heard she should have given the 30-year old patient an emergency Caesarean section as the premature infant was in a breech position.
But she instead attempted to carry out the delivery naturally and tragedy struck when the doctor urged the patient to push whilst herself applying traction to the baby’s legs.
The manoevre caused the infant’s legs, arms and torso to become detached leaving the head still in his mother’s womb.
Two other doctors subsequently carried out a C-section on the woman to remove the infant’s head.
It was then ‘re-attached’ to his body so his mother could hold him before she said goodbye. It is claimed the mother was not even in established labour at the time.
At the Medical Practitioners Tribunal Service in Manchester, consultant Laxman wept as she relived the bungled procedure and said the youngster would have died had a c-section been carried out.
She said: ‘I was trying to deliver a live baby, I was trying really hard, possibly too hard.
‘I did not intend to harm mum or the baby. I am distraught at the outcome and I am very sorry it did not come out the way I meant it.’
The tragedy occurred on March 16 2014 whilst Laxman was working at Ninewells Hospital in Dundee with a team of other doctors.
The woman’s waters had broken early at 25 weeks and upon examination her unborn baby was found to have a prolapsed cord, was in a breech position whilst the mother’s cervix was around 4cm dilated. It can be 10cm fully dilated.
Laxman had started work at 8.30am the previous day and went home at 6pm for five hours before returning to the hospital at 11pm.
She was told about the patient at 2am and was subsequently paged at 8.30am to take a look at her when her condition became more critical.
She told the tribunal: ‘The plan was for the baby to be delivered by a Caesarian section and I went down to the labour suite to discuss the situation.
‘I spoke to the patient saying I was sorry for the rush and and I remember saying the baby was quite small and I was going to examine her.
‘When I examined the patient I found that the uterus was quite small and I found the cervix was about 4cm dilated. I asked the patient to push to see if I could deliver the baby vaginally and I remember going through various options available with the patient.
‘I remember thinking should I try to deliver this baby. I still believe we had a very good chance of having the baby using other options than a c section but we had to act fast.
‘I thought with a c section we might not have a live baby and it would have been a difficult procedure.
‘This was her first pregnancy and she had a ruptured membrane. I thought it was possible to deliver the baby vaginally and I asked mum to push.
‘The bottom of the baby came out quite easily and when this happened I thought it was going to be possible. I started to encourage the patient to push.
‘Whilst she was pushing I applied some traction to the baby’s feet so I could deliver the baby. She was doing well.
‘After two to three pushes the baby’s bottom had been delivered all the way up to its chest. After that there was some difficulty in delivering the arms. The arms were behind the baby’s neck. I tried a manoeuvre to release the arms.
‘I lifted the baby’s head and rotated the body 90 degrees to tether the arm and then rotated 180 degrees to tether the other arm.
”The arms were then delivered and I went to deliver the baby’s head, I was trying to flex the baby’s head but I didn’t feel the baby move and the cervix started to close.
‘I tried to deliver a couple of times and asked for help. I said it was head entrapment by the cervix.”
Laxman said she to tried to cut the cervix but the incision had no impact. She added: ‘The patient was quite distressed by this point and she was verbally in pain.
‘I remember her saying “you need to stop, you can’t carry on” and she was given general anaesthetic.
‘We made another cut to the cervix and I used my index finger to flex the baby’s head to deliver the baby was using traction to deliver the baby.
‘But at some point between the general anaesthetic and the decapitation, the baby died – I’m not sure when.
‘I was told the neck was tearing and that’s when I knew the baby had died.’
Under cross examination she said: ‘During the course of my training I delivered a lot of babies in the UK and India.
‘Some in breech positions, some with prolapsed cords, some as premature babies. I did have experience with this. But I have never had everything with one patient before, it was a lot of complications.
‘The plan was, if we could keep the baby from being born rather than delivering by c section but this is when the cord prolapsed. I just wanted this baby out the quickest way possible.
‘I knew the baby’s head would struggle to get the cervix, this was a critical issue.
‘But the cord had to be protected, if the cord was compacted the baby would have suffered from a lack of oxygen.
‘It was a very small baby, very fragile, so I didn’t apply too much force. Too much force over a period of time probably would have led to the decapitation.
‘When the head was entrapped I should have desisted with my hands to keep trying to deliver the baby.
‘I don’t think a c section would have given us a live baby.
‘Over a period of time I did apply traction. I think I should have stopped trying to deliver the baby, I should have stopped.
‘But nobody told me the baby had died until it was decapitated.
‘If I was doing it again, and I knew what I knew back then, I think I still would have made the same decision, but I would have stopped trying to deliver the head sooner.’
Laxman denies misconduct.
The hearing continues.