Reasons for the substantive hearing of the Conduct and CompetenceCommittee panelheld atNMC, 61 Centrium, Londonon16

- 20

March 2009Name: Deborah Marie PurduePIN: 80Y3449EPart (s) of register: Registered Nurse – AdultRegistered MidwifeFacts proved: Charges 1a, b, 2a, b, 4a, c, d, e & 5Facts not proved: Charges 3 & 4bFitness to practise: ImpairedSanction: Striking Off OrderInterim Order: Interim Suspension order for 18 monthsCharges as amended read out as follows:

That you, whilst working as an independent midwife, on the night of 18 and morningof 19 July 2005:(1) Failed adequately(a) to monitor(b) to safeguardthe foetal wellbeing of Patient A;(2) Failed adequately to asses(a) the condition of Patient A(b) the progress of Patient A’s labour;(3) Failed to communicate effectively with Patient A;(4) Failed to take appropriate action where the progress of Patient A’slabour fell outside normal parameters in that you :-(a) failed to consider all possible causes of foetal tachycardia at04:00 hours,04:30 hours, 0.5:30 hours, 05:55 and 06.00hours orto take appropriate action;(b) went for a walk at 04.30 leaving Patient A unattended;(c) delayed attempting to carry out vaginal examination until 05:30hours;(d) allowed Patient A to get into her birthing pool at around 06.05

hours and remain in the pool until approximately 06.15 hours;(e) did not consider transferring Patient A to an obstetrics unit until06:15 hours;(f) allowed Patient A to wait unaccompanied in her garden while anambulance was awaited;(5) Failed to maintain an adequate record of the care delivered to Patient A.AND in light of the above, your fitness to practise is impaired, by reason of yourmisconduct.

Reason for the finding of facts

The charges relate to the home delivery of Patient A, who was 36 years old,

prima gravida

. Gestation was 41 weeks + 5 days. The registrant was commissioned byPatient A to provide care throughout her pregnancy. The registrant is an IndependentMidwife.Charge 1(a)The RCM, Evidence based Guidelines for Midwifery led Care in Labour, Foetal HeartRate Monitoring Good Practise Points states:“

Intermittent auscultation with a hand held instrument is the recommended method for the woman who is healthy and has had an otherwise uncomplicated pregnancy.This consists of measuring the foetal heart after a contraction for a minimum of 60 seconds: Every 15 minutes in the first stage Every 5 minutes in the second stage.All values should be recorded.

Similar guidance is also contained within the WHO Safe Motherhood Guide and inNICE guidelines Care of Women and their Babies during labour.We find that the registrant has failed adequately to monitor the foetal well being ofPatient A. Her labour record notes, Exhibit 2, shows that she has not documentedregular auscultation as per the guidelines contained within the WHO and NICEdocuments. She has also stated in her evidence that she did not follow the guidanceof recording the auscultation of every 15 to 30 minutes during the first stage oflabour.Therefore the panel finds the facts in Charge 1(a) proved.Charge 1(b)The WHO document states that a vaginal examination is one of the essentialdiagnostic actions in the assessment of the start and the progress of labour.The registrant has explained that she wanted Patient A to go through the process ofchild birth with minimum intervention from herself. However the registrant did notconduct a vaginal examination until 4 hours and 25 minutes after her arrival. In herlabour notes the registrant has recorded that Patient A had vomited on a number of

occasions. In her evidence she has stated that vomiting could be an indication thatthe baby could be born very soon. She has also stated that Patient A was not inestablished labour. Had the registrant conducted a vaginal examination on arrival orshortly afterwards at Patient A’s home then this would have provided her with anaccurate clinical picture of what stage of the labour Patient A was in. Therefore thepanel is satisfied that the registrant failed adequately to safeguard the foetal wellbeing of Patient A. We therefore find the facts in charge 1(b) proved.Charge 2(a)The NICE guidelines, Care of Women and their Babies during labour states:-

Your midwife will check you and your baby’s progress by monitoring your blood pressure, temperature and pulse and checking when you have emptied your bladder,how often you are having contractions and how far your labour has progressed.

The registrant has recorded in Patient A’s notes an initial set of observations whichwere taken not long after her arrival. However the labour notes do not record anysubsequent observations. Had the registrant conducted regular observations thenshe would have been in a better position to assess adequately the condition ofPatient A and therefore we find the facts in Charge 2(a) proved.Charge 2(b)The registrant did not conduct a VE of Patient A until 4 hours and 25 minutes afterher arrival. A VE is the prime method of measuring the dilation of the cervix and ofthe patients’ progress in labour. We find that her failure to conduct a VE at an earlierstage constitutes a failure to assess the progress of Patient A’s labour. Deviationsfrom an arbitrarily defined normal rate of dilation should be an indication for a reviewof the labour management plan. Therefore we find the facts proved in Charge 2(b)proved.Charge 3.The panel has taken into account that Patient A was not communicative, she alsostated that she did provide updates to the patient. Therefore the facts are not proved.Charge 4.In order for us to find any of the charges in charge 4 proved the panel has to be surethat Patient A’s labour fell “Outside normal parameters”.Appendix D, of the Safe Motherhood document which is produced by the WorldHealth Organisation provides guidance on definitions of establishing what the baseline should be for Foetal Heart monitoring. It states that a normal base line should be110 to 160 beats per minute.The NICE document, Electronic Foetal Monitoring, provides a table categorisngFoetal heart rate features. It states that a baseline of 110 bpm to 160 bpm isconsidered to be reassuring. A reading of 100bpm to 109bpm and 161bpm to180bpm is non reassuring. Additionally it states that a reading below 100bpm andabove 180 bpm is abnormal. It also states that a reading falling outside thereassuring category is considered to be suspicious.The registrant in her evidence stated that she followed the guidance contained within