'I'm not a butcher,' says struck-off midwife

Susan Rose was vilified for presiding over a birth that sounded more like a bloodbath. Now, in her first interview since being struck off, she tells Emma Mahony why she feels let down by her profession

Monday 22 February 2010 01:00

Susan Rose had no idea she had been struck off the Nursing and Midwifery Council register until she received a call from a fellow independent midwife on 28 January. "She told me to pick up the newspapers. My husband, David, immediately looked on the internet and I stood over his shoulder to read the word 'butcher'. I couldn't read any more. How could anyone think I would 'butcher' someone? I was just trying to get the baby out," the 55-year-old said.

The baby in question was Daisy Anderson, now five, whose mother, Victoria, took her story to the media last month hoping to win compensation and force a change in the law which would compel self-employed midwives such as Ms Rose to take out insurance.

Although it took her five years to bring the case – during which time a local supervisor had found that Ms Rose was fit to practise – the Nursing and Midwifery Council found in favour of the mother and Ms Rose was struck off.

She is not alone in being investigated by the NMA. Today, the council will hear an appeal by another midwife, Deborah Purdue, who attended the last two births of J K Rowling, the Harry Potter author, but was struck off last year after being found guilty of professional misconduct.

Their services do not come cheap: independent midwives are self-employed and operate outside the NHS, charging private clients around £3,000 for their attentions during pregnancy, labour and after the birth.

Ms Rose, who agreed to speak to The Independent for the first time about the Victoria Anderson case, said she had been put under immense strain by the NMC investigation and stopped practising in February 2008 when "the stress was too much". She said she felt "overwhelmed" and began seeing her doctor after suffering from high blood pressure, palpitations and panic attacks.

At the hearing, the mother, Ms Anderson, 39, told the committee about the delivery of her third daughter at home in Poynings near Brighton in September 2004.

"I got in the birthing pool but I was struggling to get the head out. I've got a history of having big babies, so I asked Sue to cut me to get the baby out. She did cut me and I could see the head so I thought I was home and dry – but then nothing happened. Suddenly Sue started to get stressed. She was sweating.

"Then she threw me across the room on to all fours and started cutting me with scissors. She cut me randomly. It was as if I was a piece of meat. I was shouting: 'Get the baby out', and she literally just cut her out of me. There was so much blood everywhere it looked like a murder had taken place in my living room."

Daisy Anderson still suffers from paralysis of the arm caused by her birth. At the hearing, NMC panel chairman, Catherine Hinton, said: "This is a case of serious professional misconduct, involving multiple failures of care and professional standards at all stages."

But Ms Rose's version of events tell a different story of a difficult birth, skillfully handled. The baby was overdue, and as she had an overseas teaching assignment two days later, she was aware that Ms Anderson wanted to give birth before she left.

The midwife, who has attended more than 1,000 births since she qualified in 1987, said: "Victoria asked me to break her waters to start labour. I was reluctant to do it, but agreed, and went home to fetch my amnihook. I only lived 15 minutes away, so when nothing much happened, I left her with her husband and birth partner to go for a walk, making arrangements for her to phone me as soon as she needed."

Three hours later, Ms Rose got the call and arrived to find Ms Anderson in established labour, contractions only two minutes apart. "She was in the bath and labour was going really quickly," she said. "I didn't call for backup because I didn't have time – I needed to get set up immediately because I thought: 'This baby is coming any minute'." From the midwife arriving to Daisy being born, there was a space of just half an hour.

When Ms Anderson got out of the water, she asked the midwife to give her an episiotomy, which they had discussed antenatally, because of scar tissue from previous births. The baby's head appeared, but then Ms Rose realised something was wrong: she was looking at a rare case of shoulder dystocia, which occurs when the baby's shoulder is stuck behind the mother's pubic bone. What happened in the next eight minutes would test her to the limits of her ability.

According to the Royal College of Obstetricians and Gynaecologists, shoulder dystocia affects only one in 200 births and "cannot be prevented because it cannot be predicted". Even with large babies such as 12lb Daisy, for whom the problem is more common, the RCOG still advises mothers to plan for a normal birth. If the baby is not born within eight minutes, the lack of oxygen caused by a compressed umbilical cord can cause brain damage or death. Due to the great pressure on the neck during the trauma, studies show that around 18 per cent of babies with shoulder dystocia end up with Erb's palsy from nerve damage in the neck.

For all the seriousness of this condition, which in Daisy Anderson's case resulted in partial paralysis in the arm, The Obstetrician and Gynaecologist journal states: "Ultimately it is better for the foetus to suffer an OBPP [Erb's palsy], than cerebral palsy."

Working without backup, Ms Rose said she followed the "Helper protocol", moving Ms Anderson on to her hands and knees. "I was sweating," she said. "I had to get my hands inside the mother to free that posterior arm, and needed to enlarge the episiotomy to free the shoulder." Extending the episiotomy under the baby's head, she freed the shoulder and the baby was born with the next contraction. The eight minutes were up, but the drama was not yet over.

"When the baby was born, she was white," Ms Rose said. "She wasn't breathing, there was only a faint heart rate, and I started doing resuscitation immediately." The ambulance arrived and took the baby to the hospital with the father, while the mother stayed for stitching. Everyone was in shock. "I was still doing what I needed to do, but almost in a surreal state," Ms Rose said.

Before the second ambulance arrived to allow Ms Anderson to be reunited with her daughter, a phone call came through from her husband saying the "baby was doing fine".

"It was the greatest relief," said Ms Rose, who visited her patient in hospital later, receiving a hug from the father. "There was nothing at that point to show me that they would later sue me. Nothing to make me feel like I was to blame." The supervisor of midwives and area supervisor were satisfied with her emergency measures, only finding her note-keeping wanting.

Ms Rose did not attend the NMC hearing because she had recently moved house and did not receive the committee's letter. Ms Rose's written submissions denying the allegations were heard in her absence but Ms Anderson's version of events was on the whole accepted. In a typical extract from the final ruling, the committee said: "We find Ms A [the mother] to be a truthful and reliable witness and accept her evidence that the registrant did not tell her that she did not have and could not obtain indemnity insurance."

Ms Rose's former clients have since rallied behind her, expressing their anger at the way her case has been handled. Hannah Shurlock, 39, employed the midwife for her first birth, which was booked in Brighton at around the same time as Ms Anderson's.

"It's tragic that Sue can't practise any more – what a waste of a wonderful midwife," she said. "Sue saved a baby's life – she did what any midwife or doctor would do to get that baby out – and this is how she is repaid? Her career is in tatters, not to mention the emotional damage this case has inflicted on her and her family."

The NMC was criticised last week in a successful case brought by an NHS midwife against her striking off order. The judge ruled the order could not stand when it became clear "that no efforts were made to secure the attendance of [the midwife's team leader] Mrs Pilgrim at the hearing – either in person or via a video link."

The court was informed that video link facilities were not available and were not used at hearings, which the judge called "a surprising statement in 2010". The hearings usually take place in hotels, presided over by three NMC representatives, none of whom are required to be an expert in normal births.

Summing up the case, the judge said: "It was another example of a failure to have due regard to the fact that the appellant was unrepresented and disadvantaged by the presentation of her case."

Independent self-employed midwives work outside the NHS and are forced to practise without insurance after the Royal College of Midwives dropped its commitment to cover them in 1994. Their service is seen as difficult to supervise, hence the frequent referrals to the NMC.

High-profile negligence cases involving independent and self-employed midwives such as Ms Rose, who offer the only alternative to the NHS hospital route, has led to an upsurge in disapproval across the country.

The writer is the author of Stand & Deliver (And Other Brilliant Ways to Give Birth), published by HarperCollins

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