Mother, 32, died in childbirth after ‘missing’ doctor’s advice against natural childbirth, investigation says

A mother died during the birth of her second child after she ‘missed’ a doctor’s advice that she should not have a natural birth, according to research heard today.

Environmental engineer Lucy Howell passed away after suffering complications during the birth of her second child Pippa at Royal Hampshire County Hospital in March 2021.

The 32-year-old woman had previously had a C-section for the birth of her first daughter, Rosie, who needed surgery to repair it, the hearing was told.

After this, a consultant told her not to have a natural birth the next time she got pregnant, it was heard.

However, such were the complications of the first caesarean section, Mrs Howell had wanted to avoid another and the doctor’s opinion was ‘lost’ in the making of birth plans.

When she went into labor with her new baby Pippa four years later, Mrs Howell suffered a rupture during childbirth and although her daughter survived being born in her stomach, she passed away.

Hampshire area coroner Rosamund Rhodes-Kemp told the hearing today that if the consultant’s concerns had been reiterated and highlighted later on, it could have ‘paused’ proceedings and different opinions could have been ‘recognized’.

Ms Howell’s inquiry follows a pre-inquest review last year that heard she was given “conflicting” advice about the risk of delivery methods.

Today the Winchester Coroner’s Court heard that Ms Howell, of Bishop’s Waltham, Hampshire, went into labor in March 2021 and was admitted to the Royal Hampshire County Hospital in Winchester for induction.

The court heard from pathologists, who said the cause of death was an amniotic fluid embolism and uterine rupture, the former of which is a condition that happens to one in 100,000 women, which equates to about six or seven a year.

Opening the inquiry and speaking to Ms Howell’s family, Ms Rhodes-Kemp said she was “very, very sorry” about her loss.

“It was not an easy pregnancy or delivery,” she said.

The court heard that Ms Howell had had complications since the first caesarean section and had undergone surgery to treat the resulting scars.

“If she could, she wanted to have a natural birth and, as we know, she continued on that basis,” Ms Rhodes-Kemp added.

The court heard that Ms Howell did not go into “spontaneous” labor after her water broke, and was given Syntocinon the next day, a medicine that causes the muscle of the uterus to contract during labor.

Ms. Howell then collapsed in the early hours of March 13, before sadly dying.

The coroner said that there were several aspects leading up to her death that needed to be considered, including the various aspects of the previous surgery and the risk it posed, the advice that was given about the method of delivery of her second baby, and the cause of death.

The consultant surgeon, Mr. Shaheen Khazali, performed surgery to repair the niche of Ms. Howell’s uterine scar that had formed after the birth of her first child.

Giving evidence, he said that the surgery had gone well, and both he and Mrs. Howell were happy with the result.

Regarding the complications, with 10 being the most complicated he had performed and one the least, he classified his surgery as two.

However, in testifying, she said that niche surgery is the equivalent of having another C-section, even though it happens when the woman is not pregnant.

This meant, when asked by Mrs Howell which method she should use when she wanted another child: she advised a caesarean section.

“It is normal to have differences of opinion,” he told the court.

‘I did not dictate any method of delivery.’

‘The repair is equivalent to another caesarean section. I said that it would be my advice to have another C-section.

That would have been my advice if she had had two C-sections.

‘She asked, and it was my opinion.’

Asked by the coroner why colleagues managing Ms Howell’s care had not consulted him later, he said: “My best guess is that they didn’t feel they needed more information.”

He told the court that he had thought ‘long and hard’, saying: ‘I think my role is to make sure that I share all the information with the doctors caring for my patients.

I think I’ve done my best to do that in Lucy’s case.

“I think I’ve given the right advice and communicated it.”

Ms Rhodes-Kemp, however, said his post-surgery message from him in 2019 was “lost” because it was “not appreciated” that there was a difference in views about a natural birth or caesarean section. .

She said: ‘It was not appreciated that there was a view that was different, your view was lost.’ Nobody talked to you.

When Mr. Shaheen Khazali said he was “satisfied”, she understood the different opinion, the corner said yes, but he had been patient.

“That voice was lost, and it might have helped her to pause and recognize the difference so that it was apparent to those who were following her.”

Ms Howell worked at the consultancy Soils Limited as a health and safety coordinator and geo-environmental engineer after graduating in 2011.

The investigation, which is expected to last four days, continues.