Baby died after ‘traumatic’ delivery into toilet at Rotunda, inquest hears – The Irish Times

A baby girl was delivered into a toilet in the Rotunda Hospital by her mother and died 10 days later after the mother’s sister and a nurse had struggled to prevent the placenta and the baby’s umbilical cord from being flushed down the toilet, an inquest has been told.

At the inquest of Sarah Virlan, the baby who was born by Mirela in a hospital bathroom on November 26th 2019, an open verdict was returned. She was admitted to intensive care, but she had suffered a severe brain injury. She passed away on December 6th.

Sarah was born unexpectedly by Ms. Virlan, whose membranes had burst earlier in the day. She went to the bathroom to change her pads after the breaking of her waters.

Normal pregnancy

Ms. Virlan was born in Romania and arrived in Ireland in January 2019. She had a normal pregnancy, but she began to feel pains around November 25th.

Her sister-in-law Luliana serban called an ambulance when she felt the pain getting worse. The two women were then taken to the Rotunda. Ms. Virlan received a bed, and staff said she didn’t communicate any signs of labor or distress throughout the day.

Ms Serban told the inquest she asked “constantly” for staff to check on her sister-in-law. She claimed that they should have checked her dilation.

Later, Ms Virlan’s waters broke and a nurse advised her to go to the bathroom. According to her, she felt her waters continue to break while sitting on the toilet seat. She saw blood after four to five minutes and flushed the toilet. She saw Sarah’s leg in the bowl.

Ms. Serban claimed she saw the placenta when Ms. Virlan stood up and flushed the toilet. The water then disappeared down the bowl. She said that instinctively, she grabbed it “with a scooping action”. The two women shouted for help.

Karen Behan, staff midwife said she heard Ms Serban call for help at 8.58pm. She saw Ms Serban, the baby in her arms, between the sinks and the toilet when she went to the bathroom. The baby was cold, limp, grey, and wet.

The umbilical line was down the toilet so she could not go to the bathroom with her baby. There was traction on it and it was connected to the placenta, which was “around the bend”. Ms. Serban removed the placenta, and the baby was brought to the hospital for resuscitation.

Staff from intensive care immediately started cardiopulmonary resuscitation, or CPR (cardiopulmonary resuscitation), and intubation. They stopped CPR after 20 minutes and were about to declare Sarah dead when they detected a slow heartbeat. She died the next month, but she didn’t recover.

Rotunda policies prohibit family members from acting as interpreters. But this was not the case in this case. Ms Serban was willing and able to provide translation.

Delivering an open verdict, Dublin city Coroner Clare Keane gave the cause of death as hypoxic-ischemic encephalopathy (HIE — lack of oxygen to the brain), secondary to foetal vascular malperfusion and ascending infection.

Dr Keane said it was difficult to understand clearly what the nature of Sarah’s death was.

There were some issues that could not be resolved in evidence. These included who had taken the placenta out of the toilet, and whether Google Translate was used by staff to communicate with Ms Virlan or her sister-in law.

“It was an absolutely traumatic event for everyone involved and that may be the reason for the conflicting versions,” said the coroner.

Monitoring patients

While acknowledging the “exceptional” work done by midwives and doctors, she said it was at the busiest times that staff needed to use the objective tools for assessing patients that are available.

Conor Halpin, for the Rotunda, had earlier acknowledged the hospital’s policy on monitoring patients had not been followed “to the letter” in the case of Ms Virlan.

“However, we simply don’t know if a lack of monitoring, or delivery in an alternative manner, would have made any difference,” he told the inquest.

“The hospital has apologised to the parents of baby Sarah for any aspects of care that may have contributed to the death of their baby girl and has acknowledged the emotional distress suffered at the time of her birth and her death,” he said.

The case has been reviewed by a senior management team, which has recommended more staff education on monitoring signs of early labour and the use of the hospital’s 24/7 interpretation service, Mr Halpin added.

Ms. Virlan made a statement at the inquest but declined to attend because she said she had no plans to return to Ireland. She has now given birth to two more kids.