A trainee obstetrician did not raise her concerns about a mother's caesarean because she thought it would make her "look silly", an inquest into a baby's death has heard.
First-time mother Simone Tonkin underwent an emergency caesarean at Royal Brisbane and Women's Hospital in June 2014 after her baby Nixon got stuck during labour.
A fifth-year obstetric registrar told the Brisbane Coroners Court on Tuesday she was initially concerned Mrs Tonkin's surgery would be difficult.
However, she did not raise that with an experienced obstetrician after she was told the baby would not be "hard to get out".
"I thought it might make me look silly," the registrar said.
The registrar also turned down the superior's offer of help in surgery twice and said they did not have a good working relationship, although the obstetrician later disputed that.
"I was there to support her," the obstetrician said.
The court heard when the registrar tried to get the baby out she was "scared" at how deeply jammed his head was in the pelvis.
"As soon as I put my hand into the uterus I felt like things were going to be difficult in terms of delivering," the registrar said.
"I felt like his head was very impacted into (Mrs Tonkin's) pelvis and I didn't think there was a lot of room between the two of them."
A midwife then attempted to help break the suction by pushing on the baby from below using her index and middle fingers in a 'v' gesture.
It is believed that action inflicted significant head injuries on Nixon including skull fractures, haemorrhages and brain swelling.
The court has previously heard the midwife had not been trained to carry out the manoeuvre and approached it like she would a vaginal examination.
"It's such a small space, there wasn't really anywhere to go," the midwife said on Monday.
Mrs Tonkin had inquired about an elective caesarean earlier in her pregnancy but she progressed to a vaginal birth once admitted to hospital.
A different obstetric registrar told the inquest Mrs Tonkin - who had gestational diabetes, hypertension, depression and was carrying a large baby - did not meet any of the guidelines for an elected caesarean section.
The second registrar said she believed requests for caesareans were "frowned upon" across Queensland Health because normal vaginal births were "more cost-effective".
"There's always a pressure to aim for vaginal birth over caesar," she said.
But two other medical staff told the inquest they were not under any cost pressures to dissuade mothers from c-sections.
In a statement, clinical director of obstetrics and gynaecology Karin Lust said cost was never a factor when deciding whether to carry out a caesarean section.
None of the medical staff involved in Mrs Tonkin's case can be named for legal reasons.
The inquest continues.