In an almost dream like state, the birth goes ahead without a contingency plan should something go wrong. As if trying to defy nature itself, basic midwifery practices are pushed aside so the dream can be fulfilled. What should have been a happy and exciting time for the couple turns into a tragedy with the death of the newborn. In perhaps one of the most bizarre aspects of the case the parents faith in the ideology of a natural birth never appeared to diminish.
14 JUNE 1986 – POLICE INVOLVEMENT
It had been a typical busy Saturday morning shift for Constable Anthony Kirwan at Randwick Police Station when a call came in from the Intensive Care Ward of Prince of Wales Hospital that a young infant had died and police were required. Attending deceased’s was not unusual for the police at this busy police station on the verge of the city> but the death of a young child was always a traumatic and difficult task to investigate.
When he arrived at the hospital with his partner Constable Peter Byrne, he was led into the children’s section and shown a new born deceased baby girl lying in a crib. To the constable it looked as if the baby was asleep, bound in a hospital blankets with life support tubes still attached. The police stood motionless as the doctor undressed the child so they could check for any injuries and bruising. As the doctor did this he explained that the child had been born at home, was brought to the hospital about 2.30pm the day before by the parents together with a midwife who was present at the birth. In a softly spoken voice he added that the child had experienced respiratory trouble at birth and that it was his belief that the child had died of severe brain damage. Constable Kirwan took out his notebook and began to record the details, it was clear to him this would be no ordinary investigation.
When he returned to the station he told the detectives on duty what had happened. There was to be no delay as arrangements were made to interview the midwife. Nurse Gabbie Garten arrived at the police station about 10.00am the next day (15 June), dressed in tidy conservative wear, she looked awkward and out of place in such surroundings. Detective Constable Smith took her into an interview room and sat her down.
Since taking over the job the detectives had calked amongst themselves how they would handle such a sensitive investigation and felt prepared for the tears and high emotion they expected to hear when interviewing the people concerned. It came as somewhat of a surprise then when Nurse Garten, in a cool and composed manner, expressed how surprised she was that police had been notified about the death at all! She would provide a statement about the matter but made it quite clear that she felt police had no business in what she clearly felt was an unfortunate act of nature. For the next two hours the detective would be typing one of the most unusual and puzzling accounts he had ever recorded in his policing career.
Her story began when she was first contacted by a Mrs Sylvia Denum on 5 February, 1986 who was then 24 weeks pregnant and looking for an alternative to traditional birthing practices. Gabbie Garten had been a practicing nurse for 16 years and had specialised in midwifery since arriving in Australia from England in 1971. Her interests in home birth midwifery began several years later, thereby making herself available to parents pursuing this form of childbirth. She met with Sylvia and her husband Darryl at her home a short time later and from this point they decided to remain under her care for the remainder of the pregnancy and a birth they could enjoy in their home environment.
lt would later become apparent that Gabbie Garten became quite close friends with Sylvia and Darryl during this time, a point which the Coroner would highlight as a significant factor which contributed to the demise of this child.
Around 4am on the morning of13 June, Gabbie Garten was contacted by Darryl and told of the impending birth. After giving some advice over the phone she arrived at the house about 4.45am. The steps leading to the actual delivery were proceeding normally and family and friends began to arrive to witness the event. This included a friend who was asked to attend in order to video the event which would become a particularly valuable exhibit in the inquest. About 6am another midwife, Jenny Fish, who was to act as a support nurse during the birth, had arrived to help. About 8am Sylvia had her first urge to push. The foetal heart rate at this stage was 150 and regular and her cervix found to be fully dilated. Sylvia was in a squatting position in the bedroom and at 8.50am the head of the baby was visible.
The foetal heart rate was repeatedly checked at 8.10am, 8.30am and 8.40am with normal readings. However at 8.50 and 8.55, no foetal heart sound could be detected and, in a decision that would surprise the many experts who reviewed the case, Nurse Garten stated that she continued to massage the area around where the head was crowning. This was despite the fact that there should havee been clear concerns for the well-being of the child and measures taken to expeditie the labour as a matter of urgency.
At 9.17am, nearly 35 minutes after failing to find a foetal heart sound, the baby was born with no visible signs of life. Resuscitation attempts were made straight away and Gabbie stated thar she was able to detect a heartbeat about a minute later. At 10.00am the baby began to breath, but only about 16 breaths per minute, there were no other signs of activity and her eyes remained closed.
At 11am, Gabbie Garten claims that she telephoned a midwife at Prince of Wales Hospital for advice and then continued to try and resuscitate the child. In one of the most surprising aspects of the case she then asked Darryl what he wished to do with his child. In her words she explained to him, ‘As I see it we have two choices, the baby’s colour and heart rare are stable at this time, there are no other signs of life. We could either transfer her to hospital where further tests would be performed or we could remain at home and observe the baby ourselves.’ Gabbie then stated that Darryl discussed the matter with his wife and told her that Sylvia would prefer to ‘keep the baby and home and wait.’
At about midday there had still been no significant improvement in the baby’s condition and some muscle spasm began in her arms and legs. According to Gabbie, Darryl then decided to place the baby in a bath to try and relax the spasm. At about 1.15pm the baby’s colour began to deteriorate and in Sylvia’s words, ‘appeared mottled’. Another check was made for any neurological responses before suggesting to the parents that the infant be taken to hospital. She and Darryl then took the baby to the children’s section of Prince of Wales where medical staff continued attempts to revive the child. Gabbie drove home sometime after this and Darryl remained at the hospital.
When the interview was completed, Gabbie was asked to check and sign her statement. After she handed it back to Detective Smith, she looked away and told him that she had been contacted by Darryl and Sylvia in the very early hours of the following morning and was informed that the baby had died. Despite the cool tone she had maintained throughout this meeting, there was no doubt that she had been disturbed by the child’s death .
The next day, 16 June, Plain Clothes Constable Brett Henderson arrived at work after being away for several days. He was handed the statement made by Gabbie and as he read through it he knew instinctively that this investigation would be quite different to any other he been in charge of. It was now two days since the infant died and Constable Henderson was keen to contact the father as soon as possible to record his version of events. He was well aware of the distress that Darryl would be still be suffering and was unsure how he would cope with going over the tragedy and how he now felt towards the two midwives.
Darryl arrived at the police station at about 5pm that afternoon, he was a tall thin man who had a very calm and sure manner about himself He was immediately ushered into the interview room and despite his exhaustion, was able to provide an incredibly accurate account of the whole event. He would also surprise police during the interview by expressing no ill-will towards Nurse Garten and even made a point of adding into his statement that he still had complete faith in her ability as a midwife.
As he gave his account, it became very obvious to the constable that Darryl and his wife seemed to have been very much involved, if not in complete control, of any decision that had to be made during the birth. On several occasions would go over some of the advice that had been given by Gabbie during the birth but would quickly add that the final decision ‘was mine and Sylvia’s.’
It was about an hour into the statement when a startling piece of information began to emerge. Up until this point, the version of events given by Darryl had been almost identical to the one supplied by Nurse Garten. He began by explaining that the baby’s head had crowned and that no foetal heart rate could be located. According to him, ‘Susan then informed us that it had reached the stage where, to make the birth easier, Sylvia would have to be cut for the head to be born otherwise she would tear.’
He then went on to talk about testing the temperature in the ‘birthing tub’ and speaking to his wife about trying to finish the birth under water. With the assistance of others in the room he described placing Sylvia in the birthing tub followed by himself and Nurse Garten. He estimated the time spent in the tub was about 20 to 25 minutes during which Nurse Garten continued massaging the area around the head of baby before it was born about 9.16am.
Nurse Garten had never mentioned placing Sylvia in the birthing tub at this crucial moment in the labour. At the conclusion of his statement Constable Henderson quickly re-checked the statement by Gabbie Garten and consulted with his colleagues. A decision was made to contact Nurse Garten immediately and ask her to return to the police station.
Gabbie arrived at Randwick Police Station less chat one hour later, it was clear that she resented being asked to return to the station and offered no explanation for her omission. A two page amendment was typed out in which she explained that about 9.00am, after two failed attempts at gauging a foetal heart sound, Sylvia, Darryl and herself climbed into the tank where she remained until the placenta had been delivered.
The next day Constable Henderson and his partner arrived at thee Glebe Morgue to witness the post-mortem. The pathologist conducting the examination was Dr Sylvia Hollinger. They explained that there was a video of the birth and Dr Hollinger requested that she view the video as soon as it was available to assist her in establishing the cause of death.
The next day police arranged to see Darryl at his home address. Before he handed the video to Constable Henderson he made it very clear that it was not to be shown to anyone who did not have to view it, “it’s really personal stuff and I don’t want it passed around.”
In an interesting twist the video was given limited viewing during the inquest at the insistence of the parents and was suppressed for any future publication under Section 44 of the Coroner’s Act. Just over two years later the order was lifted by Mr and Mrs Denum so it could be given to a TV current affairs program.
It was now five days since the birth and Constable Henderson had arranged for Nurse Fish to attend Randwick Police Station. As far as the police were aware, Nurse Jenny Fish had played a very peripheral role during the birth, in fact she had hardly rated a mention in the two statements already obtained. It was hoped that by obtaining a statement from her she could be used to corroborate the times and events in the statements already obtained.
Jenny was in her late thirties at the time, she was very similar in appearance to Gabbie Garten but her manner very different. She was a shy lady and came across far less assured and confident about the situation. She explained that she had met the couple through Gabbie and had got to know them both, ‘on a social level’, in the months leading to the birth. She had arrived at the house about 7am after receiving a call from Darryl that the labour was well under way and began by assisting Sylvia with some pain management techniques.
Her version of events leading up to the actual delivery at 9.16am were very similar to the versions already obtained, however, about an hour into her statement some surprising admissions began to emerge. She explained that about 30 minutes after the birth she and Darryl had placed the baby on the bed and were trying some revival techniques when she decided to give the baby some drops of, what she described as, ‘rescue remedy’ onto its tongue through an eye-dropper . A short time later when the baby was placed in a bath to relieve muscle spasms, she admitted placing crystals on the baby’s stomach and head in an attempt to bring it to life. Before concluding her statement she reiterated that her role had been purely ‘as an observer’ and that she had merely ‘given assistance to Gabbie at her direction’.
The brief had entered a new level of the extraordinary and a decision was made to refer the matter to the Coronial Investigation Unit. Before this was done however, Constable Henderson had already arranged to interview Sylvia Denum who had delayed speaking to police because of her health. Her sentiments were very similar to Darryl’s and expressed no ill-will towards either of the two midwives and even added in her statement that she continued to hold the belief that Gabbie Garten was ‘very professional’ in every regard.
It also became apparent in her statement that one of her greatest fears was to be subjected to an episiotomy during the labour (cutting of the perineum to hasten delivery). She stated that, ‘There was no way l wanted to be cut’, a point which would later prove crucial in the demise of this infant.
Constable Phil Baldwin from the Coronial Investigation Unit received the brief a short time later. He had been with the CIU for several years and had become quite accustomed to investigations involving medical mismanagement in varying degrees. According to his colleagues, however, after reading through the brief even he was left bewildered and amazed. Once he had gained a proper understanding of the issues involved, his task was to arrange for experts in the field to review the case. Because of the complex nature of the case and being aware that the subject of home births was open to personal bias, it was decided to get no less than five independent reviews of the case.
As the birth involved two midwives rather than a medical practitioner, it was appropriate that one of the experts should be a nurse specialising in the field of midwifery. There were also issues which he wanted to clear up with the parents and the two nurses, however since taking over the case all parties had gained legal representation and were refusing to answer further questions prior to court. It was also clear that a rift had developed between the two groups and although all parties seemed to be, ‘sticking to their guns’ in terms of what they had already told police, there was not the same personal support that had existed earlier for each other.
Once these had been completed and the remaining statements from witnesses to the birth obtained, the date for an inquest was set. This would be no ordinary inquest, all parties were quite aware that depending on the evidence given, the brief could be forwarded at any time to die Department of Public Prosecutions so that criminal charges could be brought against one or both of the midwives involved.
The inquest began on the morning of 29 October 1987 with submissions from legal representatives acting for both the midwives and the parents requesting that the inquest be dispensed with. According to the solicitor acting for Nurse Garten, Mr Greenwood, the expert evidence gathered to date was from doctors he believed were ‘anti home birth’ and would simply turn the inquest into, ‘a contest between whether one should have hospital births or home births’.
The solicitor acting for the parents, Mr Drake, agreed and added that the family were, ‘satisfied in their own minds that no wrong, whether civil or criminal was done,’ and then requested that die matter be dispensed with.
After considering the submissions, the State Coroner, Mr Glass, responded that it was in the public interest that he examine the circumstances that led to the death and that as he had understood the facts so far, ‘the death of this young baby should not have occurred.’ A short adjournment followed and on return the solicitor for Nurse Fish, Mr Higgs, asked that the Coroner disqualify himself from hearing the matter as his comments had led him to believe that he had pre-judged the case. Mr Glass responded that he had not pre-judged the matter in any way and stated again that he made the comment on the basis of information currently before him. On this note he declined the application to disqualify himself and the first witness was called.
Dr Sylvia Hollinger was the first to take the stand, the main line of questioning centring around her post-mortem results and the fact that she had consulted an expert in the field, Dr Alan Bradfield, to assist her find a cause of death. The expert she consulted was one of the most highly regarded obstetricians in the field and had sadly passed away before the inquest.
Under the rules of evidence allowed in the Coroner’s Coiurt Dr Bradfield’s opinion was able to be presented as part of Dr Hollinger’s evidence and his written report able to be submitted along with the other expert reports before the court. Dr Hollinger’s evidence concluded with her opinion that the most likely cause of death was due to cerebral hypoxia (lack of oxygen) due to die baby’s head being left on the perineum for too long.
The next witness to be called was Darryl Denum whose evidence revealed some interesting insights into the background of the case. When asked about his decision to opt for this form of childbirth he said that he had been influenced by “literature he had read on the subject and a segment on home births they had watched on (the TV show) Sixty Minutes. At one stage, he stated that, “we believe that the birth process has an effect or can have an effect on the psychology of the child and even its growth to an adult human being, even to society as a whole.”
In response to questions about the decision to keep the child at home some hours after the birth he replied, ‘I realised that if I sort of whipped the baby off, Sylvia wouldn’t be able to come with me because she was too weak. I would be taking her baby away at that point, at a very delicate time – so at that point we had decided not to go to hospital’. He also added, ‘When I took her to the hospital she was taken away and that was it and I guess it would have happened if we’d taken her anytime and that would have been pretty sad for us and in retrospect nothing else could have been done for her. I’m certain of that, so it was valuable for us to have that experience with her.’
Questions then focussed on his opinion of the standard of care he felt had been provided by the midwives, to which he indicated that he continued to hold them in the highest regard.
The subject of an episiotomy was then raised with Daryl and he stated that, ‘Sylvia was extremely afraid of that. Our intention was not to have an episiotomy and having a water birth was to assist in the stretching so that she wouldn’t need to be cut.’ Darryl was then asked if the issue of an episiotomy had ever been raised during the labour and he replied, ‘Yes, Gabbie Garten told my wife that it was very tight and that she could cut Sylvia or she could tear, Sylvia decided that she didn’t want to be cut so we just proceeded from that point.’ He would later add that, ‘If advice regarding having an episiotomy was given to us in a manner which gave us cause for concern I suppose we may have made that choice.’
Darryl concluded his evidence by restating his view that, ‘the birth of a human being is a natural occurring event and within reason doesn’t need to be treated like a disease which I see occurring in a lot of Western Civilisation birthing processes.’
Evidence was then given by Dr Ron Alexander, the paediatric specialist who had attended to the child when she was admitted to Prince of Wales. It was suggested in his evidence that the child had suffered considerable cerebral damage and that had the child survived it would have remained in a comatosed state, Intervention at any time following the birth would have merely served to prolong the inevitable death of this child.
Sylvia Denum was next to take the stand and was onlv questioned enough to ascertain that her recollection of certain aspects of the birth matched the account given by Darryl. Once again she expressed the sentiments of her family that they were very satisfied with the treatment and support given by the midwives. Sylvia added that had the birth occurred in a hospital, ‘prompt action could have been taken out of fear that there was some problem with the baby and maybe she would have been born in time to prevent her from dying, but not in time to prevent extreme brain damage and I would have an extremely brain damaged child.’
Some months before this matter had reached the court Sylvia and Darryl had given birth to a healthy boy in a hospital environment. The obstetrician who had attended to Sylvia throughout this pregnancy was next to give evidence and explained the special care which had been given during this pregnancy because of her previous experience. He went on to say that initially both parents had agreed to use a ‘foetal scalp electrode monitor’ during the labour as it was considered the most accurate means of recording a baby’s heart sound. When labour began, however, Mr and Mrs Denum withdrew their consent and opted instead for a monitoring system which was less intrusive but less accurate.
The various experts who had reviewed the case were next to take the stand covering three days of testimony and providing the Coroner with the following main points:
- That regular checks of the foetal heart sounds were not made during the second state of labour and when the few sporadic counts were done showing nothing, the midwives failed to expedite the delivery, instead placing her in the birthing tub which would have hampered further attempts to locate a heart sound.
- It should have been dear to both nurses that the baby’s head was under pressure for too long, in the final stages there was a delay for approximately 26 minutes. If a mother refuses an episiotomy, a midwife should advise her in the strongest terms that the baby’s life might depend upon prompt delivery and carry it our without delay.
- An assessment of the child’s wellbeing after birth should have been of great concern to the midwives and immediate outside assistance should have been sought. Further to this, it was improper for the nurses to offer the father a choice of whether or not his baby should be moved to hospital.
- That they used ‘rescue remedy’ and ‘crystals’ to the exclusion of recognised medical treatments.
Following this evidence both midwives declined to answer any questions or provide further evidence than the statements they had already provided on the grounds that they might incriminate themselves.
The hearing would conclude the following Monday, it would be a nervous weekend for both nurses who faced the real possibility of criminal charges when the Coroner handed down his findings.
The Coroner began his summing up by reiterating the reasons why he chose not to dispense with the inquest. ‘Society has an interest in knowing what causes deaths and particularly in this case society was entitled to know how and why this death occurred.’
He then summarised all of the areas of concern regarding the management of this birth into two principal areas.
- The failure of the midwives to demonstrate a foetal heart rate in the period of 37 minutes prior to delivery.
- The failure of the midwives to take steps to ensure that the child was taken to a hospital for urgent medical attention, when it became obvious, following delivery, that the child was ill.
He elaborated by stating that according to me standard practice of midwifery, if no heart beat could be detected, delivery should be expedited because of concern for the foetus. Unfortunately in this case the midwives did not follow the accepted standards of midwifery.
On the second principle area of concern, in response to a submission from council, the failure to transfer the child to hospital soon after birth should not be an issue because it was considered that the child could not be saved, the Coroner stated that, ‘every child is entitled to a chance to live and it is not within the province of midwives or any other person who do not possess me necessary qualifications to assume that a child will definitely die. Jennie was not given mat chance. A child as an individual surely has rights, who was looking after the rights of this child?’
Following on from this he stated that, ‘the question remains why would two midwives said to be caring, responsible and experienced act so improperly? As both have exercised their rights under the law not to answer such questions it can only be surmised that both nurses had become too emotionally involved in this birth.
Both Mr and Mrs Denum have expressed to the court their fierce loyalty to the natural process of giving birth at home and to have control over the birth, it would seem that when the time came for the nurses to make a professional judgement they were unable to as they knew in their hearts that it would upset the parents.’
‘It is all very well for a midwife to have a rapport with the parents, and of course that is very desirable, but there must be established a degree of detachment, so that in the event of an emergency arising, then the midwife can take over and inform the parents not only what has to be done, but do what must be done even though the parents do not agree and it causes unpleasantness. It is a matter for the midwife to make professional decisions, not the parents.’
The two midwives were not charged with a criminal offience as it was the belief of the Coroner that the evidence would not support a prima facie case of an indictable nature. All papers were however forwarded to the then Minister for Health to review the professional performance of both midwives
Before handing down his final verdict, the Coroner made further statement. ‘It is my view that the manner in which Mr and Mrs Denum have given their evidence, their faith in the ideology of the natural process has not diminished one iota. I think it would be wise for Mr and Mrs Denum and others with similar convictions to keep in mind that relying solely on nature does not always have happy ending.’
ABOUT THE AUTHOR
When she wrote this article in 2000 Harriet Kelly was an Assistant Editor at the APJ and a Senior Constable in the NSW Police Force, attached to the Coronial Support Unit.