Small window to act before mum's death

·3-min read

An intensive care expert believes there was only a narrow window of opportunity to correctly diagnose and treat a Melbourne mother with a rare birth complication before she died.

Caroline Lovell died shortly after the birth of her second daughter, in a birthing pool at her Wantirna home in 2012.

Midwives Gaye Demanuele and Melody Bourne were with the 36-year-old when she delivered a healthy baby, and when Ms Lovell collapsed afterwards.

They're now charged with her manslaughter, allegedly a result of gross negligence in their care of her.

Ms Lovell went into cardiac arrest within hours of the natural birth. She was resuscitated by paramedics and rushed to hospital but after a period of stability in ICU her condition deteriorated and she died from multi-organ failure.

Experts including the pathologist who examined Ms Lovell's body say she most likely died from a post partum haemorrhage, which she had also experienced after her first daughter's birth.

But defence lawyers have suggested a rare amniotic fluid embolism - when amniotic fluid enters the mother's bloodstream - may have been the cause.

Intensive care specialist John Cade agrees, saying Ms Lovell's collapse and the consequences that followed were "typical" of an AFE.

At 9.50am on the day of the birth Ms Lovell fainted and had low blood pressure and at 10.10am she suffered more "dramatic" symptoms including restlessness and shortness of breath.

"This is the onset of the AFE - it is well before any of the major haemorrhage has stated and it is the clinical clue that we have the onset of this condition," Professor Cade said.

Ms Lovell had asked her husband for anti-anxiety medication and told the midwives "I'm dying".

Professor Cade said a number of conditions including AFE can cause a sense of doom.

"The patient feels dreadful, they feel as if they're going to die and they can be entirely correct," he said.

He said the 10.10am symptoms were signs something was amiss and the window in which to act was "really quite small".

In the past AFE have had an 80 per cent mortality rate, with death occurring within an hour while at a major hospital the condition has a 90 per cent survival rate.

"I think outside a major hospital ... even at a rural hospital or somewhere else that is less equipped, the speed and severity is such that it's a very difficult condition to handle," he said.

Euan Wallace, who was the head of obstetrics and gynaecology at Monash University before becoming Department of Health secretary last year, said post partum haemorrhage was much more common.

A haemorrhage of more than 500ml of blood occurs in around one in five pregnancies, while a severe haemorrhage of more than a litre of blood lost occurs in about one in 20 pregnancies.

By contrast, he said AFEs occur in about one in 20,000.

He said he had personally been involved in two AFE cases, including one where the mother died.

The hearing is continuing.

Our goal is to create a safe and engaging place for users to connect over interests and passions. In order to improve our community experience, we are temporarily suspending article commenting