Jen Cahill died just hours before her baby daughter after giving birth to her second child (Image: MEN)
A mum died just hours before her baby daughter after giving birth at home, an inquest has been told. The tragedy happened on June 3, 2024, at the family home in Prestwich in Manchester during a home birth of baby Agnes. Jen Cahill, 34, died the day after giving birth and never got to hold Agnes, who lived for four days before she too tragically died. The cause of death for both has not yet been heard at Rochdale Coroner’s Court.
Mrs Cahill’s husband Rob told the hearing of calling 999 at about 6.45am on June 3 as Agnes was born unresponsive and had not been revived by the nurse’s resuscitation attempts. He went to the hospital with Agnes and was only told later that his wife was also being rushed there after suffering complications giving birth. Mr Cahill said they held Agnes’ first and only birthday party as she neared the end, and he held her and told her how much her mummy and brother loved her, and said goodbye.
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When he thinks of Agnes, he is just happy he got to spend any time with her at all after everything that happened that week, as she was their comfort and he will never forget that.
After their deaths, the choice to have a home birth has been described as out of guidance and against advice by hospital trust staff because of concerns stemming from the birth of Jen’s first child.
But Mr Cahill told the court he believes the out of guidance and against advice phrases were never raised directly with the couple throughout the pregnancy, and he never heard that terminology until after the event.
That red flag could have prompted a revision of their decision to have their second baby at home, according to the heartbroken father.
A community midwife who saw Jen the most during her second pregnancy, Caroline Nixon, admitted in court an out of guidance referral should have been made to a senior midwife by her because of Jen’s high risk.
The couple had met as Jen, originally from Worcester, was studying in her final year at the University of Manchester in 2011. They married in 2018 and welcomed their first child, Rudy, in 2021. The young family were enjoying their first years of parenthood and were thrilled to be expecting a sibling for Rudy.
Jen Cahill gave birth at home (Image: MEN)
But after giving birth to Rudy, Jen had suffered a postpartum haemorrhage, losing more than 800ml of blood as a result of an episiotomy and tear, and Rudy was a large baby.
Jen had required a blood transfusion and was also a carrier of group B strep, which can spread to babies during delivery and cause problems like meningitis. Rudy had suffered sepsis after being born.
The complications meant that for her second child, Jen was given an appointment with a consultant at North Manchester General Hospital, run by the Manchester University NHS Foundation Trust, to come up with a treatment and delivery plan.
That plan with Dr Rice included Jen being advised she should have a hospital birth, with active management and a drip of medication designed to prevent bleeding as she delivered her placenta, the court heard.
Ms Nixon said she also discussed those risks to Jen and her unborn baby with the expectant mum during midwife appointments in December 2023. But by February 2024, Ms Nixon said she was informed by Jen that she had come up with a different birth plan, including a home birth.
Mr Cahill explained that the traumatic birth of Rudy left Jen struggling with the prospect of delivering a baby in hospital, which she found very stressful. Jen felt that she did not have enough midwife support during her first hospital delivery, which could be eased by having two midwives present for her if she chose a home birth for her second child.
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Mr Cahill added that Jen felt she might be able to better control her surroundings with a home birth and create a more familiar, calmer environment that would be easier to give birth in and cause less distress to the baby.
Ms Nixon said she followed trust policy by referring Jen back to a doctor, Dr El-Adwan, as she was a high risk lady requesting a home birth which would deviate from the first birthing plan, including having injections instead of a drip of medical treatment to stop any bleeding Jen might have while delivering the placenta.
The midwife said she expected that Jen would again discuss the medical and management concerns of a home birth with the doctor, like the increased risk of time spent transferring to hospital in the event of a complication. After speaking to the doctor, Jen still intended to have a home birth, but the midwife said she would continue to review the risks and plan with her.
The midwife said she never specifically addressed that the choice to have a home birth was against medical advice. Asked why by Coroner Joanne Kearsley, Ms Nixon replied they were told they had to respect women’s choices in training by the hospital trust.
The trust would not say no to any lady who wanted a home birth, so community midwives were becoming increasingly anxious about ladies being higher risk which had been raised verbally to senior leaders, the court heard.
All community midwives were concerned about high risk ladies having home births. That’s not what they were trained for. They were trained to look after low risk ladies in home births, Ms Nixon said. The risk of death wasn’t something you were ever told to talk about with ladies.
Out of guidance was also not a phrase in heavy use at the time, claimed Ms Nixon. Phrases as direct as this is against medical advice were to be avoided by midwives, as this was the purpose of the consultant to whom Jen had been referred, added the midwife.
Asked by the coroner if she thought Jen fully understood the risks the midwife continued to highlight at their appointments, Ms Nixon replied yes.
However, the midwife admitted she should have referred Jen back to a doctor once she declined to be tested for group B strep, which can come and go from the bodies of carriers, as this was another decision regarded as out of guidance.
Mr Cahill said his wife’s medical notes throughout her pregnancy never mentioned the phrase out of guidance regarding her choices or her own birth plan. He was aware that the hospital’s preference was that she had a hospital birth, his understanding was that it was related to her being a strep B carrier in case that came up. The emphasis was on the strep B, not postpartum haemorrhage.