Do we need to revisit the homebirth deaths at the hands of midwife Lisa Barrett?

Evil Concept

Over the years I have written many posts about Australian homebirth midwife Lisa Barrett, and the astounding number of deaths at her hands.

I was pleased to see that she was recently fined $20,000 and court costs and reprimanded in the strongest possible terms for her involvement in 4 preventable neonatal deaths.

Should that be the end of it? After reading the report from the Nursing & Midwifery Board of Australia v Barrett, I’m beginning to wonder if these deaths are worth a second look. While reviewing the 4 deaths previously investigated by the Coroner, the Board learned of ANOTHER death that occurred months after the release of the Coroner’s report. I had received information about YET ANOTHER death back in 2009, leading to an extraordinary total of 6 newborn deaths at Lisa Barrett’s hands.

Of these deaths, 1 was a shoulder dystocia, 2 were second twins, and 3 were breech babies. All of the situations were high risk, but even in high risk situations, most babies do fine. We already know that the deaths were preventable; that’s why Barrett has been disciplined. I’m beginning to question whether we need to investigate these deaths further to determine whether Barrett actually let these babies die. In other words, did Barrett fail to provide appropriate homebirth care and make only ineffectual attempts to save the dying babies.

Reading the timeline of the 6 deaths, as well as a near miss twin death described in the board report, and an extraordinarily story of twin birth that Barrett herself has bragged about (49 hours between the birth of the first and second twin), raises the possibility that these babies died not merely because they were born at home, but because of midwife neglect.

The shoulder dystocia death:

The medical expert opined that Barrett had not applied the appropriate maneuvers to deliver the baby:

Professor Pepperell is critical of the respondent’s attempts to extract the baby. The respondent described performing the McRoberts manoeuvre. Professor Pepperell in his evidence said that such a manoeuvre involves placing the mother on her back and lifting her thighs up to her chest so that the angle of entry in the pelvis is different and is bigger in the hope that by doing so the shoulders will then descend into the pelvis. Professor Pepperell when commenting upon the respondent’s evidence34 as to the manner in which she performed the manoeuvre stated that he did not believe that initial traction had been applied appropriately and that it did not appear that adequate suprapubic pressure was ever applied…

A friend of the mother eventually delivered the baby:

A friend of “S” present at the time was asked by the respondent to assist given it was an emergency. The friend was able to put her hand in to grab under the shoulder and was able to pull the baby out…

An experienced midwife was unable to deliver the baby, but a friend of the family simply reached in and dislodged the baby’s shoulder?

Negligent management of twins:

In the near miss twin case, the second twin was ultimately delivered by C-section 8 hours after the birth of the first twin.

As the Board notes:

To allow at least six hours without foetal monitoring of the second foetus after the birth of the first baby is just unbelievable.

In the story on Barrett’s blog, a healthy second twin was delivered 49 hours after the first twin.

Apparently Barrett’s approach to the second twin in these cases was to do absolutely nothing, including no monitoring to determine whether the second twin was in trouble requiring expedited delivery.

The breech deaths:

One breech baby died when Barrett inexplicably stopped checking his heart rate for 24 minutes prior to birth.

So in at least 4 of the 8 cases that I know about, Barrett provided either negligent care, ineffectual care or no care care at all in the midst of obstetric emergencies.

6 confirmed deaths and 1 near miss is an extraordinary amount of bad luck even for an incompetent midwife, and while there is copious evidence that Barrett was reckless there is no evidence that she is incompetent or unaware of the measures used to handle obstetric emergencies.

And these are only the cases that we know about. There could be more.

6 babies are dead and no amount of investigation will bring them back. Barrett has been disciplined under the assumption that her recklessness led to deaths that were unavoidable at home, though easily preventable in the hospital.

But were those deaths at home unavoidable? Or was Barrett’s unwillingness to provide appropriate homebirth care the real cause of at least some of the deaths?