Midwives who cared for Melbourne mother Caroline Lovell, who died hours after giving birth to her daughter at home, were "grossly incompetent", an expert believes.
Gaye Demanuele and Melody Bourne were alongside Ms Lovell when she delivered her second daughter in a birthing pool in her Watsonia living room in January 2012.
Ms Lovell fainted getting out of the birthing pool and later went into cardiac arrest. She was resuscitated by paramedics and rushed to hospital but died from multi-organ failure.
Demanuele and Bourne are charged with manslaughter, allegedly a result of gross negligence in their care of her.
Euan Wallace, who was the head of obstetrics and gynaecology at Monash University before becoming Department of Health secretary last year, found their actions were "grossly incompetent and significantly below the standard of care expected" by Australian midwives.
Professor Wallace, who describes himself as a major supporter of home births, said extra time needed to be factored in when monitoring patients because of a delay in the response if something goes wrong.
He believes Ms Lovell died from a massive post partum haemorrhage, a conclusion reached by others including the pathologist who examined her body.
But defence lawyers for Demanuele and Bourne have suggested a rare amniotic fluid embolism may have been the case, a claim backed up by intensive care specialist Professor John Cade.
Professor Wallace was clear in a Melbourne Magistrates Court hearing for the women on Friday that "this was not an AFE".
He said Ms Lovell's blood pressure reading of 85/50 at 9.50am was consistent with significant blood loss. Professor Cade said the AFE occurred at 10.10am.
That blood pressure reading was the first taken after Ms Lovell gave birth to her daughter, and it was taken an hour after delivery.
Professor Wallace said that delay was not consistent with competent practice in 2012.
Other factors also should have run alarm bells, including evidence of active bleeding and the fact Ms Lovell hadn't delivered the placenta in a time frame that went well beyond the average for a woman in her second birth.
Ms Lovell had a history of post partum haemorrhage and also had a 5cm fibroid on he uterus.
"I think when 30 minutes had passed, there's evidence of blood and the uterus is still high and not contracting - those are alarm bells," he said.
"My view is ... that intervention should have happened by then and it hadn't. In my view that's just not competent care."
Whether the care was negligent was a question for the court, he said.