Paramedic tells baby death inquiry of equipment gaps

A paramedic has told a fatal accident inquiry (FAI) into the deaths of three babies that better communication and equipment would have helped during one attempted delivery.

Mirabelle Bosch died on 2 July 2021 at Wishaw General Hospital, 12 hours after a difficult breech delivery.

Her mother, Rozelle Bosch, went into labour at home late the day before.

Paramedics were called to the scene but were unable to deliver the baby themselves.

The FAI is looking into the deaths of three babies in two North Lanarkshire hospitals between 2019 and 2021.

Giving evidence at Glasgow Sheriff Court on Tuesday, paramedic Paul Coyle said that in the case of Mirabelle, visual equipment and prior communications would have been helpful to allow the paramedics and doctors advising from the hospital to see one another.

"We'd have to explain most of what we're doing so the consultant can see it and he could advise instantly," he said.

Babies lying bottom or feet first in the uterus instead of the usual head-first position are known as breech babies.

The inquiry heard that the breech position had been known prior to the paramedics' arrival on the scene.

Under questioning by advocate depute Lisa Gillespie KC, Mr Coyle agreed that it would have been helpful if there has been some communication with the hospital at the point at which the breech was known.

The inquiry heard that while paramedics receive training in how to deliver babies, there was no specific training on how to deliver a breech baby.

Mr Coyle said ambulances do not carry specialist birth equipment such as forceps.

The inquiry also heard that it is rare for ambulance crews to be involved in the actual delivery of a baby without a midwife present and that not many breech deliveries happen outside of a hospital.

Mr Coyle confirmed that upon arrival, the baby was already being born and that the feet and legs were visible.

He also confirmed that at that time, the baby was pink suggesting that it was not in any distress and was getting plenty of oxygen.

The inquiry was read guidelines from the Joint Royal Colleges Ambulance Liaison Committee (JRCALC), the body which produces guidelines for the UK's paramedics.

The guidelines, which Mr Coyle and his colleague followed, advised them in the event of an imminent breech delivery to request assistance from a midwife if available.

However, they were unable to get midwife support and Mr Coyle said there was no guidance at all for what to do if the head is not birthed spontaneously.

The paramedic stated that he was advised by a consultant to carry out a manoeuvre to turn Mirabelle's head, which was stuck. Once he turned her head they decided to move mother and baby to the hospital.

The inquiry heard that it took between five and eight attempts to reach the maternity unit at Wishaw General Hospital before anybody answered the phone. The hospital has since installed a red telephone box for direct access for ambulance crews.

The FAI is also looking into the deaths of Ellie McCormick and Leo Lamont.

Ellie died at Wishaw General on 5 March 2019, five hours after her birth.

Leo was two hours old when he died at Monklands Hospital on 15 February 2019.

The inquiry continues before Sheriff Principal Aisha Anwar.