THERE WERE “MISSED opportunities” to prevent the death of an unusually large baby who was “so wanted, so planned” after her mother’s uterus was ruptured during labour five years ago, a coroner has concluded.

The Midlands Regional Hospital in Mullingar issued an apology at a sitting of Dublin District Coroner’s Court on Friday for “deficiencies in the care” provided to the baby girl and her mother, Ceire Foran.

A verdict of medical misadventure was recorded into the death of the baby girl, Rú, who died at the Coombe Hospital in Dublin on June 5, 2020 three days after she was delivered by an emergency Caesarean section at the hospital in Mullingar.

The inquest heard a growth scan planned for 36 weeks into Ms Foran’s pregnancy, which would have alerted medical staff that the baby was large, had not been performed.

A pathologist, John Gillan, who carried out a postmortem on the infant’s body, said the rupturing of Ms Foran’s uterus was linked to the size of her baby who weighed 4.82kg at birth.

Dr Gillan said the baby had suffered multi-organ failure as a result of the lack of oxygen caused by the ejection of the placenta and the infant from her mother’s womb.

The pathologist also expressed surprise that the postmortem indicated that Ms Foran had developed diabetes in the latter stages of her pregnancy given nothing had shown up at an earlier glucose tolerance test in February 2020.

In reply to questions from counsel for Ms Foran, Alistair Rutherdale BL, Dr Gillan agreed that the baby, who had no physical abnormalities apart from her size, was “completely viable” earlier on the day of her birth.

Ms Foran gave evidence that the first time she got to hold her daughter was at the time she died in her arms.

She remembered wanting to hold Rú the previous day but was informed that her baby was after having seizures and could die if moved.

“My heart is forever broken. She was so wanted, so planned for,” said Ms Foran.

She added: “As a single mama, to have to explain to my then three-year-old that her sister had to go to heaven was, and still is, the hardest thing I will ever have to do.”

“To rear one child and grieve another is a burden some days that is crippling,” she observed.

Ms Foran (44) from Hillside Drive, Mullingar, Co Westmeath, who subsequently had another daughter, Croí, 20 months ago, outlined how Rú had been conceived through IVF and donor sperm.

She described how she was admitted to the hospital in Mullingar on June 1, 2020 and labour was induced the following day when she felt okay and “in control.”

However, the inquest heard that midwives attending her became unhappy with the progress of the delivery after they lost tracing with a CTG to measure the foetal heartbeat at 3.30pm.

“I started to struggle. Something felt different and I was not in control,” said Ms Foran.

At that stage, she said she felt the atmosphere among medical staff change and there were “worried glances.”

However, Ms Foran added: “Nothing was verbalised to me.”

She started feeling “excruciating pain like a hot knife down my right side” which led to a registrar being called by midwives to see her.

Ms Foran complained that she was not spoken to by any hospital staff apart from being asked to sign a consent form for an emergency delivery in a room she described as “mayhem.”

She said her “precious baby” was born 29 minutes later and transferred immediately to the Coombe.

Ms Foran said she left the hospital in Mullingar “feeling very confused and in the dark” until she was informed in the Coombe that her baby was in poor health without much hope of surviving.

She told the inquest that medical staff in Mullingar had never discussed any risk about the delivery and she was never informed that she was going to have a very large baby.

A retired consultant obstetrician and gynaecologist from the Midlands Regional Hospital in Mullingar, Nandina Ravikumar, told the hearing that she believed the growth scan at 36 weeks was probably not performed due to the Covid-19 pandemic.

“There were no obvious risk factors based on the [patient’s] history,” she recalled.

Dr Ravikumar noted that the patient’s previous pregnancy and delivery had been “perfectly normal” with “nothing alarming.”

She told the coroner, Myra Cullinane, that the patient’s body-mass index of 34.4 (which is classified as obese) was not considered a risk as only women with a BMI over 35.5 and particularly over 39.5 were considered high risk.

In reply to a question if Ms Foran’s previous instrumental delivery with her daughter, Evie, was a risk factor, Dr Ravikumar replied: “Not necessarily.”

She also denied that the patient’s hypothyroidism and IVF birth were risk factors.

The inquest heard evidence from a number of doctors and midwives that Ms Foran had a relatively uncomplicated pregnancy until she went into labour.

The on-call registrar at the time, Charles Kalu, said he was notified earlier that day by a midwife to “stay around” as it was suspected that Ms Foran might have “a big baby.”

However, he was only called to urgently review the patient after midwives struggled to get a trace of the foetal heartbeat for a period of around 30 minutes at which point he recommended an emergency Caesarean section.

Dr Cullinane said the one “sentinel event” in the case was the rupturing of Ms Foran’s uterus.

The coroner said the evidence had highlighted a number of issues including her elevated BMI and advanced age.

She observed that fewer assessments of Ms Foran and decisions about her care were conducted by senior obstetricians “than might have been expected.”

Dr Cullinane said there had been no discussions about alternative methods of delivery, despite a perception at the time of labour being induced that Ms Foran might have a large baby.

She claimed all these factors represented “missed opportunities.”

Recording a verdict of medical misadventure, the coroner stressed that such a finding did not represent anyone being blamed but that the baby’s death was “the unintended result of clinical care.”

Dr Cullinane also endorsed a series of changes that had been made at the hospital in Mullingar following the baby’s death including a more formalised approach to carrying out growth scans.

Barrister Caoimhe Daly BL issued an apology on behalf of the hospital’s manager, Margaret Kelliher, in which she acknowledged the profound and devastating effect on Ms Foran of the loss of her baby.

Welcoming the verdict of medical misadventure, Ms Foran said it was “a bittersweet day” for her and her family.

“I now know that her death was totally avoidable. It is a source of some small comfort to me that this was confirmed at today’s proceedings,” she added.

Accompanies by her solicitor, Niamh Ní Mhurchú of Callan Tansey Solicitors, Ms Foran said that while her heart would always ache for Rú, she hoped and prayed lessons would be learnt from the shortcomings in the care of her baby and they would result in improved maternity care in Mullingar and all maternity units nationwide.

“We must do better. Let that be Rú’s legacy,” she remarked.