Lucy Howell Inquest: Medical notes not seen by doctor

Lucy Howell died while giving birth to her daughter

A doctor who treated a woman who died in childbirth never saw any medical notes about a previous unusual surgery, an inquest has heard.

Lucy Howell, 32, died at the Royal Hampshire County Hospital in 2021.

Dr Jean Goodman told an inquest into her death that she relied on a conversation with a colleague to decide if a natural delivery would be safe.

Mrs Howell died of a cardiac arrest and uterine rupture while giving birth to her daughter, who survived.

The environmental engineer had undergone a niche repair procedure in 2019 after developing complications from a Caesarean section to deliver her first daughter.

The inquest in Winchester heard both the surgeon who carried out the operation and Mrs Howell herself considered it to be the equivalent of a second Caesarean section.

Dr Goodman told the court that after speaking to a colleague who had been present at the operation, she was happy to support Mrs Howell's request to have a natural delivery, and to treat her as a normal patient who had only undergone one C section.

"I didn't consider her as a two-section patient," she said.

Lucy Howell, 32, died at the Royal Hampshire County Hospital in Winchester.

After her initial consultation with Mrs Howell, Dr Goodman, who was a locum obstetrician and gynaecologist at the hospital at the time, intended to write to the surgeon who carried out the niche surgery.

But on hearing that a senior colleague had observed the procedure, she discussed it with her instead and was told it was appropriate for Mrs Howell to have a natural birth.

Asked if she was aware of guidance at the time that pregnancies after the surgery should be delivered by C section as a precaution, Dr Goodman replied: "No."

Dr Goodman also admitted that if she had appreciated that the surgery was the equivalent of a second Caesarean section, she would have been more cautious in the use of oxytocin, a drug that encourages labour but puts strain on the uterus.

'Clear information'

The inquest previously heard from Mrs Howell's husband Matt that she had "struggled to get the midwives and doctors to understand the nature and seriousness of her operation".

He told the inquest she had expressed a desire for a natural delivery when she became pregnant, but had always wanted to do for what was safest for her and her baby.

Mr Howell said his wife had agonised over whether to have a natural birth and he felt she had been left to make the decision without "clear information and expert advice".

He said his wife had written in a Whatsapp message: "What if it all goes wrong, what if I die?"

Later in the inquest, a midwife on the unit told the court that she and a colleague were "not happy" with the use of the drug syntocinon.

Anne Aitken, a midwife for 43 years, said they had expressed reservations about using the drug on Mrs Howell as "we were in the frame of mind that it's dangerous" even for a woman who had only had one Caesarean section.

One of the doctors who had approved the use of the drug, Dr Susan Bell, said it was "reasonable" to treat Mrs Howell as having undergone one Caesarean section as she understood the procedure had "repaired" her uterus.

She acknowledged that she had not come across the procedure before, but told the inquest she had the clear impression from Mrs Howell that she wanted a natural delivery because of complications following her previous Caesarean.

"If I hadn't been happy with the plan, I wouldn't have proceeded with it. It wasn't unreasonable," she told the court.

"I've seen horrific things happen when patient choice is ignored," she added.

The inquest continues.