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A consultant obstetrician and leading advocate of natural birth has been cleared of wrongdoing by the General Medical Council, after she was accused of failing to arrange a timely caesarean section for a patient whose labour showed signs of becoming problematic. The baby was later delivered stillborn by caesarean section.
Susan Bewley, of St Thomas' Hospital, was also accused of failing to adequately examine the mother and child on the morning of 30 December 2004, when she led the morning round in the hospital's birth centre. The GMC alleged that she failed to examine the mother's cervix, failed to use a sonicaid to listen to the baby's heart, failed to obtain a cardiotocograph reading, and failed to arrange delivery.
Hospital notes showed that the baby's heart rate had been checked by sonicaid shortly before Dr Bewley's visit. After hearing expert testimony, the panel concluded that her immediate duty had been to arrange a cardiotocograph reading. Dr Bewley told the GMC that she had orally instructed the midwife to take a reading, which experts confirmed was standard practice. No cardiotocograph was performed, but Dr Bewley interpreted the absence of a report to signify a normal result.
The panel's chairwoman, Judith Worthington, told Dr Bewley: “On the expert evidence before it, the panel is satisfied that it was reasonable for you to expect that the CTG [cardiotocograph] would be carried out as instructed.”
She added: “There was no reason to expect that the readings of the CTG would be anything but normal. Had it not been so, the panel is satisfied that it was reasonable for you to expect that you would be informed immediately.”
An ultrasound examination carried out the next afternoon (31 December) showed no heart beat, and the dead fetus was then extracted by caesarean section.
The patient, named only as Mrs HL, had delivered two previous children by caesarean section and had been told to expect a caesarean section in this case. A senior house officer who saw Mrs HL at 3 am, before Dr Bewley's morning round, had planned for a caesarean section later that day, but Dr Bewley said she was unaware of this, and there was no record of her being told.
The GMC found proved an allegation that Dr Bewley told Mrs HL that she could eat and drink normally, taking her off the “nil by mouth” order that is normal procedure before an elective caesarean section. But the panel did not uphold a further charge that this amounted to misconduct. It heard that she had advised the patient that she could try for a vaginal delivery.
Summing up, Mrs Worthington said, “In all the circumstances, taking those facts found proved and those already admitted by you at the outset, there is nothing to suggest that your conduct indicated a serious departure from the standard of good medical practice. The panel has not found that your conduct fell below that of a reasonably competent consultant obstetrician.”
Dr Bewley is on leave and could not be reached for comment.
Eileen Sills, director of clinical services at Guy's and St Thomas' NHS Foundation Trust, said, “We are very pleased that Dr Susan Bewley has been exonerated of all of the charges made against her by the General Medical Council.
“Susan is highly regarded by her patients, the clinical staff who work with her, and the wider medical community. She has always shown the utmost commitment to her patients, many of whom have high risk conditions.
“Susan is one of the country's leading obstetricians, with an international research reputation, and is highly regarded for her work on high risk pregnancy and older mothers to be.”