The initial advice from the labour ward and the consultant midwife employed by the ambulance service was to bring the mother into hospital as an acute obstetric emergency but on arrival at the mother's home a decision was made to attempt delivery from JRCALC guidelines indicating that it may be possible for breech presentation babies to be delivered at home. Whilst this was recognised as possible in different breech (bottom first) presentations it was not advisable nor should an attempted delivery be made for footling breech presentations. This resulted in a delay in transferring mother and baby to the nearest obstetric unit which played a material contribution to the baby's death.
1.The JRCALC guidance on the emergency management of footling breech presentation by the emergency services is insufficiently robust in that it should be recognised as different from other breech presentations and considered an acute obstetric emergency requiring immediate transfer to the nearest hospital obstetric unit. That is, no attempts should be made to attempt a home delivery due to difficulties with the baby's head not being able to be delivered.
2. On evidence heard in court there are only two consultant midwives employed by the Ambulance services despite there being 11 Ambulance organisations within England. This leaves the majority of ambulances services having no obstetric support, guidance or ongoing teaching and training. As a matter of urgency there is a need to provide resources to employ more consultant midwives - at least one to two per service - throughout all the Ambulance organisations.