A teenage mother who died after giving birth to a baby much larger than expected should have been induced weeks before, an inquest heard today.
Teegan Barnard, 17, who was 5ft 6ins and weighed eight stone (52kg), lost almost four litres of blood in just 10 minutes when she gave birth to her 9lbs 9oz son, Parker.
On September 7, 2019, she began to have contractions while 41 weeks pregnant, so went to St Richard’s Hospital in Chichester, West Sussex, but midwives said she wasn’t dilated enough so sent her home.
The next day her contractions became ‘very strong and she was in a lot of pain’, so went back to hospital.
Around 11pm on September 8, she vomited and in the early hours of September 9, her pulse raised to 119 beats per minute.
At 1am on September 9, Teegan showed signs of infection and was given an emergency caesarian.
Just two hours later her condition dramatically worsened and ‘her lips turned’ blue as she suffered breathing issues. The first-time mother suffered a devastating cardiac arrest and brain damage.
She died at home in Havant, Hants, on October 7, after being discharged to spend her final days there.
Today an inquest heard that under NHS guidelines Teegan could have been offered induced labour at 38 weeks, three weeks before she gave birth, but was not.
The teenager – who was pictured cradling her newborn in hospital in tragic last photos before she passed away – was looking forward to becoming a parent and would have been a ‘fantastic mother’, her family said.
Teegan’s parents are bringing up Parker – who is now two – alongside his dad, Leon Forster.
Investigators from the Healthcare Safety Investigation Branch (HSIB) said it would have been ‘best practice’ and ‘appropriate’ for health workers to offer Teegan an induced labour, where a mother is given drugs to help kickstart a birth.
Instead, Teegan’s baby son grew in size and ‘in retrospect it would have contributed to the risk of Postpartum (after birth) haemorrhaging’, investigators said.
Just two hours after delivering her healthy baby – who weighed more than four kilos – Teegan suffered unsurvivable brain damage.
Dr Ahmed Elgarhy, the senior registrar at St Richard’s Hospital in Chichester who carried out her c-section, said the 3.8 litres of blood the 17 year old lost came in a short space of time.
Dr Elgarhy said: ‘She lost two thirds of her blood volume in 10 minutes, so it was pretty intense.
‘It was quite a stressful experience, it was a life and death situation.’
The teen was only given two units of blood to replace it. One unit of blood is equivalent to around a pint.
Coroner Dr Karen Henderson quizzed Dr Elgarhy on why Teegan was only given two units after such a dramatic blood loss.
Dr Elgarhy said: ‘Sometimes two units can be enough for them.’
At the inquest, Adam Walker, representing Teegan’s family, said: ‘Teegan was relatively small and had a large baby.’
Mr Walker said she was ‘borderline underweight’ and that a post-mortem examination of her body showed Teegan was around 5ft 6ins and weighed 52kg (eight stone).
Today, as her four-day inquest opened at West Sussex Coroner’s Court in Chichester, her mother Abbie Hallawell said: ‘She was booked in to have her labour induced on September 9 but on the 7th began to have contractions so went to St Richard’s, she was checked over but midwives said she wasn’t dilated enough so sent her home.’
Ms Hallawell told how doctors told her Teegan ‘suffered a bleed and cardiac arrest’. Subsequent scans showed she suffered brain damage.
Ms Hallawell and Teegan’s father Trevor Barnard have instructed expert medical negligence lawyers as they demand answers at the inquest.
Teegan was given ‘lots of support’ by midwives throughout her pregnancy. Midwife Sally Walters, who cared for her from eight weeks, said: ‘When I was looking after her I was not expecting a big baby.’
At St Richard’s Hospital, at 41 weeks pregnant, Teegan lost 3.8 litres of blood during childbirth in what is known as Postpartum haemorrhaging (PPH) in medical terms.
According to NHS Inform, blood loss is normal during childbirth however it is considered ‘heavy’ if more than 500ml is lost within the first 24 hours.
Teegan suffered obstructed labour – when a baby cannot exit the pelvis – and was given a C-section as well as being given two units of blood.
Matt Mansbridge, lead investigator for HSIB, said: ‘Teegan was bleeding, there was a major haemorrhage which was treated. She remained under general anesthetic. The haemorrhage was managed in line with guidance, there was a calm atmosphere in the medical room.’
After, while doctors moved her to a bed, they recognised her condition had deteriorated.
Mr Mansbridge said: ‘A bed was requested and she was transferred to that… While rolling her, on the second roll, it was recognised there was an issue with ventilation.
‘Her lips turned blue and the alarm sounded on the ventilation machine.’
At 38 weeks Teegan visited St Richard’s and could have been given the chance to be induced by hospital staff but wasn’t.
Debbie Laing, maternity investigations team leader at HSIB, said the baby ‘would have been smaller’.
‘That’s the only thing that may have had a causal affect on the outcome’, she said.
‘The significance of [not being offered induction at 38 weeks] is that the baby had an opportunity to grow and increase the risk of Postpartum haemorrhaging.
‘We are able to say it would have been best practice to offer the induction earlier. It would have been down to Teegan and her family to make a decision as to whether it would have been done.’
She added it would have been ‘appropriate’ to have made a decision to offer induction at 38 weeks.
Ms Laing said: ‘What we know with retrospect is that the baby grew and that would have contributed to the risk of PPH. What we [wouldn’t] know at that time is that it was going to happen.’
Ms Laing said it was ‘unpredictable’ that Teegan would suffer PPH when she was seen by midwives at 38 weeks.
She also said the baby’s wellbeing is the primary consideration when deciding whether or not to offer induced labour, rather than the mother’s.
Lawyer Adam Walker, representing Teegan’s family, suggested that, at 38 weeks, it would have been ‘forseeable’ that the baby would have been greater than 4kg.
HSIB said it made a safety recommendation to ensure induction of labour is offered appropriately.
The inquest also heard Teegan may have had an underlying infection which contributed to a raised temperature and may have suffered anaphylaxis during childbirth.
The inquest continues next week.