The inquest being held in Hamilton is set down for almost three weeks, with the spotlight on those involved in Neho’s labour, from her midwife, who has interim name suppression, to responding St John staff, Waikato Hospital staff, and experts who will also give evidence.
In explaining the circumstances, Becroft said Neho was cleared by an obstetrician to give birth in a primary birth unit in January 2023.
At 11.20pm on February 1, Neho and her partner met with the midwife at the centre while experiencing light contractions.
She was examined, noted to be 2cm dilated, and discharged home to allow labour to progress further.
At 5.07am, the following morning, the midwife was called to Neho’s home in Huntly because labour had progressed and she did not feel able to travel to the birth centre.
Labour continued, and at 6.46am, the midwife deemed Neho fully dilated but with the baby’s face presenting.
An ambulance was immediately called.
Becroft explained that soon after, and as Neho was being prepared to move, she experienced what was thought to be a seizure.
Neho arrested, and cardiopulmonary resuscitation (CPR) began in the ambulance.
Over the next hour, attempts were made to stabilise Neho before she was transferred to Waikato Hospital at 8.15am.
There, Neho’s baby was delivered by emergency caesarean, but shortly afterwards, both mother and baby were declared dead. The cause of the baby’s death was not discussed during the opening day of the inquest.
Neho’s cause of death was thought to be a ruptured uterus, which led to severe blood loss and a catastrophic haemorrhage, the inquest heard.
Becroft said the inquest was not a forum to lay blame, but to identify the cause of her death and assist the coroner in making recommendations to reduce the chances of something similar happening again.
Rupture is rapid and fatal in most cases
Pathologist Dr Duncan Lamont said the rupture “caused the patient to bleed to death”.
Asked by Becroft to talk the inquest through how that happened, Lamont said when a baby implants on the lining of the uterus, the placenta starts to form.
“The placenta is an extremely aggressive phenomenon which … destroys blood vessel walls so that the blood flow becomes low pressure, very high volume flow to sustain that baby.”
That blood flow then cascaded over the baby to exchange oxygen and nutrients.
There was usually a tissue, the decidua, between the “invading” placenta and baby, which protected the mother.
However, sometimes the placenta invades deeply into the uterine muscle, weakening it, he said.
As the muscle around the lower wall of the uterus contracted, it weakened and eventually ruptured.
“This rupture is extremely rapid, and fatal in almost all cases.”
As for when the rupture happened, Lamont said it would have been within minutes before Neho died.
Asked if CPR would have caused the rupture, Lamont said it wouldn’t have, because it was the rupture that caused her to collapse, and CPR was then carried out.
Neho’s multiple previous pregnancies would also have weakened her lower uterus, he said.
When questioned about epilepsy, Lamont said he did not think it would have caused the rupture.
Maria Neho’s baby was delivered by emergency caesarean at Waikato Hospital, but shortly afterwards, both mother and baby were declared dead. Photo / Alan Gibson
When the midwife was giving evidence, Becroft asked for details on the seizure Neho suffered.
The midwife said it was when Neho stood up from a chair that she collapsed.
“It looked like a seizure.
“She collapsed to the floor, appeared to go stiff …”
She believed it lasted for about two minutes.
During questioning by her counsel, Catherine Deans, the midwife said she only found out about Neho’s history of epilepsy a month before Neho’s death.
Neho initially told her that she took medication to treat seizures she experienced after a head trauma.
However, she had not taken the medication for five years and was asymptomatic for seizures, the midwife recalled being told by Neho.
However, she discovered Neho’s epilepsy history after receiving a report from an obstetrician.
In that letter, the doctor had cleared her to give birth in the community, so she didn’t think anything more of it from then on.
When asked by Becroft, with the benefit of hindsight, if she would still encourage Neho to give birth at the centre, the midwife said she would not have, and instead would have recommended a hospital birth.
“But she was open to birthing in the hospital if it was recommended.”
Becroft suggested to her that, being the lead maternity carer, or LMC, she was still in charge when they got in the ambulance.
However, the midwife said that was an “understandably muddy” area at that point, and they were all instead focused on trying to keep Neho alive.
In her statement to the coroner, the midwife had said she was told by a doctor at Waikato Hospital who tried to save Neho that Neho’s abdominal cavity was “full with Ms Neho’s entire blood volume”.
The doctor told her that the source of that blood loss was a “rare and extreme rupture on the posterior aspect of the uterus”.
“He said that he suspected this would likely have been abrupt and catastrophic.
“[The doctor] explained that even if they were in a hospital setting, the outcome may not have been different.”
In the coming weeks, the inquest will hear from people involved in Neho’s care, including midwives, St John staff, Waikato Hospital, and obstetric staff.
Issues in focus for the coroner include the sufficiency of note-taking during Neho’s pregnancy, and consideration of her history, decision-making around where the birth took place, the adequacy of midwifery care before and during labour, who the lead carer and decision maker was, adequacy of care by St John, and the decision not to transfer Neho to hospital immediately.
Belinda Feek is an Open Justice reporter based in Waikato. She has worked at NZME for 11 years and has been a journalist for 22.