In the bustling city of Adelaide, Australia, a tragic event unfolded in the Flinders Medical Centre’s maternity ward. Newborn baby Bodhi Leo Searle passed away on August 31, 2021, merely a day after his birth, as a result of a “potentially preventable” oversight. The nursing staff at the hospital accidentally monitored the heart rate of the baby’s mother, Diana Searle, instead of the newborn, leaving his abnormal heartbeat undetected for twenty-six crucial minutes.

Australian Coroner Naomi Kereru spearheaded an investigation to shed light on the circumstances that led to baby Bodhi’s heartbreaking death. The inquiry revealed that the medical staff at the delivery hospital had mistakenly monitored Diana’s heart rate rather than her ailing newborn’s.

A report in the Adelaide Advertiser cited counsel Sally Giles, who was assisting the coroner, as stating that the baby’s death might have been preventable if only the hospital staff had correctly monitored his heartbeat instead of his mother’s.

Diana Searle had an uneventful pregnancy leading up to Bodhi’s birth. Coincidentally, she went into labor on her 30th birthday, August 29, 2021. Eager to meet her little one, she rushed to Flinders Medical Centre to be under the care of the in-house experts.

However, Searle’s assigned midwife fell ill, and she was instead placed under the supervision of midwife Stephanie Geyer and first-year student midwife Thea Koke. Searle arrived at the hospital at approximately 5:30 pm, ready to welcome her newborn.

At around 11:26 pm, Geyer observed an anomaly in Bodhi’s heart rate. Swiftly, the medical team moved the expectant mother to the ward and initiated CTG monitoring at 11:44 pm. Sally Giles recounted, “But at about 12:15 am, they discovered that for around 30 minutes, the CTG trace had been recording the maternal heart rate and not the fetal.” Upon correction, Bodhi’s heart rate was found to be severely abnormal.

The only obstetrician in the ward, a registrar, admitted to feeling unsure about performing a complicated instrumental delivery by herself. Consequently, Bodhi was delivered without instrumental intervention shortly before 1 am.

Giles noted that it was immediately evident that the newborn was in dire straits. Baby Bodhi was blue and pale, with no signs of respiratory effort or a detectable heart rate or pulse. It took a distressing eighteen minutes for the newborn to draw his first breath. He was then rushed to the neonatal intensive care unit, where doctors discovered abnormal brain activity.

Sadly, despite the medical team’s efforts, baby Bodhi succumbed to his condition and passed away at 1:18 pm on August 31, 2021. The tragic loss of baby Bodhi is a sobering reminder of the critical importance of vigilance and accuracy in monitoring the health of both mother and child during labor and delivery.

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Source: AWM

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