Midwife Lisa Barrett outside the District court in Adelaide, Wednesday, March 13, 2019. Picture: AAP Image/David Mariuz
Midwife Lisa Barrett outside the District court in Adelaide, Wednesday, March 13, 2019. Picture: AAP Image/David Mariuz

Midwife on trial for homebirth deaths

A FORMER midwife present at the home births of two babies who subsequently died failed to appropriately advise each of their mothers of the "true dangers they were facing" in their high-risk births, a court has heard.

Lisa Jane Barrett, 52, of Petwood in the Adelaide Hills, is standing trial in the Supreme Court charged with two counts of manslaughter. She has pleaded not guilty to both counts.

Opening the trial, prosecutor Sandi McDonald SC said the two babies - Tully Kavanagh and another unnamed baby - "died as a direct result of the manner in which they were born" at home and Barrett's "gross negligence" meant neither baby was alive today.

She said Barrett was charged with manslaughter "by criminal negligence" because she failed to properly advise either mother or the risks prior to birth and need to transfer to hospital urgently when further problems were encountered during their births.

"As these babies tried to struggle their way through birth and in the process started to die, the accused made no efforts to save them either by telling the mothers of the true dangers they were facing, or by advising the mothers of the need to get to hospital as a matter of urgency if there was any hope of the children surviving," Ms McDonald said.

Tully was the second of twins born at her parent's home on October 7, 2011, but died two days later. The other unnamed baby was born at home 15 months later on December 30, 2012 and died after his life support was turned off the following day.

"It's the prosecution case that, put simply, but for the accused involvement and the antenatal care and birth both of these babies would have survived," she said.

Ms McDonald told the court Barrett had befriended Tully Kavanagh's mother, Sarah Kerr, and told her "just because you are having twins, doesn't mean you need to birth in a hospital" and downplayed the risks of a homebirth with twins.

The court heard Barrett knew Ms Kerr had a prior traumatic birth in a hospital and "exploited her fears" of hospitals and encouraged her to birth at home.

The first twin, a girl, was born healthy, but the second twin, Tully, became distressed and his heart rate dropped.

Despite this, Ms McDonald said Barrett was "calm, composed and almost casual in her approach" and went outside to smoke a cigarette as she called a hospital to advise Ms Kerr would be brought in to the Women's and Children's Hospital in North Adelaide.

The court heard Barrett had not advised of the urgency of the situation and that an ambulance should have been called. The court heard Tully's parents were so unaware of the urgency, they stopped for each red light and even considered stopping to get a drink at a service station.

Tully was born en route to hospital and arrived not breathing and without cardiac activity. He later displayed some signs of cardiac output and was taken the hospital's neonatal intensive care unit. He died two days later.

In 2014, Barrett sent an email to Ms Kerr expressing her regret. Ms Kerr then contacted police who organised a conversation between the pair to be recorded. During that conversation Barrett is heard to say "I'm sorry I didn't make you go to the hospital earlier, that would have been the right thing".

The court heard the second baby who died was born to a mother who had multiple health complications, of which Barrett had been made aware.

Barrett had told the mother throughout the pregnancy, and as late as two days before she went into labour that the baby was head down but on the day of the birth the baby was found to be breech.

Despite discovering the baby was presenting feet first during labour and more than two hours before the baby's eventual birth, Barrett did not advise she attend hospital urgently. The baby was born at home a minute before ambulance officers arrived.

Ms McDonald said Barrett failed to provide appropriate timely advice about the baby's change in situation and the baby was born "extremely unwell" and "sluggish" and suffered a brain injury.

Ms McDonald said experts would tell the court Barrett should have refused to provide services for each of the births because they were high-risk.

"The consensus of all the experts is that the conduct of the accused fell well short of what it should have been," she said.

The court heard Barrett was the subject of a coronial inquiry into the deaths of two other South Australian babies. The inquest also heard evidence about the death of a twin who died during a home birth attended by Barrett in Western Australia, as well as Tully. The unnamed baby was born subsequent to that inquest.

Barrett began practising as a midwife before her arrival in Australia in 2003. She worked for almost five years at Ashford Hospital, from 2003 to 2008, before leaving dissatisfied with working in a traditional obstetrics setting.

She began advertising her services for home births in 2005 and surrendered her registration in 2011.

The mothers of both babies will give evidence during the trial, which is expected to last eight weeks.

Scott Henchliffe SC, for Barrett, said "every element of each of the offences is in dispute".

The trial, before Justice Ann Vanstone without a jury, continues.