Matthew Howell (left) told his wife's inquest yesterday that Lucy (right) had 'wrestled' with the decision of whether to go for a c-section or vaginal birth, given her 'unique' medical history
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A mother who died during the birth of her second child after previously having a C-section had made the decision to have a natural birth based entirely on ‘guidance’ from medical experts, an inquest heard.

Environmental engineer Lucy Howell, 32, passed away after suffering complications at Royal Hampshire County Hospital in March 2021.

Her husband Matthew told the inquest yesterday that Mrs Howell had ‘wrestled’ with the decision of whether to go for a c-section or vaginal birth, given her ‘unique’ medical history.

He revealed that his ‘beloved’ wife only continued with idea of natural birth, because it ‘had been assured’ it was safe. 

The inquest also heard there were ‘inconsistencies’ in advice the couple received from doctors during the course of Mrs Howell’s second pregnancy. 

Matthew Howell (left) told his wife's inquest yesterday that Lucy (right) had 'wrestled' with the decision of whether to go for a c-section or vaginal birth, given her 'unique' medical history

Matthew Howell (left) told his wife's inquest yesterday that Lucy (right) had 'wrestled' with the decision of whether to go for a c-section or vaginal birth, given her 'unique' medical history

Matthew Howell (left) told his wife’s inquest yesterday that Lucy (right) had ‘wrestled’ with the decision of whether to go for a c-section or vaginal birth, given her ‘unique’ medical history

Lucy Howell, 32, (pictured) passed away after suffering complications during the birth of her second child, Pippa, at Royal Hampshire County Hospital in March 2021

Lucy Howell, 32, (pictured) passed away after suffering complications during the birth of her second child, Pippa, at Royal Hampshire County Hospital in March 2021

Lucy Howell, 32, (pictured) passed away after suffering complications during the birth of her second child, Pippa, at Royal Hampshire County Hospital in March 2021

Mrs Howell had previously undergone a caesarean for the birth of her first daughter, Rosie, in February 2017, which led to her needing surgery afterwards, the hearing at Winchester Coroner’s Court was told.

Mr Howell explained that his wife’s recovery from the procedure was ‘extremely painful’. She ‘hardly left the sofa’ and was still suffering from cramps and pain – which was so bad she nicknamed it Frank – a year later.

She went to her GP and was eventually referred to a Renee Behrens, a consultant gynaecologist at The Royal Hampshire County Hospital, who identified a niche that would need repairing.

Ms Behrens told the hearing the niche was such that it needed to be dealt with via laparoscopy and not a simpler hysteroscopic procedure.

It was around this time that Mrs Howell was also told by a consultant not to have a natural birth when she was next pregnant, but the doctor’s opinion was ‘lost’ as delivery plans were made. 

Mr Howell said his wife fell pregnant in July 2020, more than a year after the surgery which was carried out by Mr Shaheen Khazali, and that he had not been allowed to attend many pre-natal clinics because of the covid pandemic.

He continued: ‘She would have preferred to have vaginal delivery because of how painful and slow her recovery from the c-section had been.

‘But, she said she wanted to the safest and wasn’t set on it.’

Her family previously claimed Mrs Howell was given 'conflicting' advice about the risks of a natural delivery (pictured: Lucy Howell, Rosie and Matthew Howell)

Her family previously claimed Mrs Howell was given 'conflicting' advice about the risks of a natural delivery (pictured: Lucy Howell, Rosie and Matthew Howell)

Her family previously claimed Mrs Howell was given ‘conflicting’ advice about the risks of a natural delivery (pictured: Lucy Howell, Rosie and Matthew Howell)

But when Mrs Howell went into labour with her second daughter, Pippa, she suffered a rupture during the delivery and, while the child survived, the mother passed away. 

Mr Howell said: ‘She had never been given any indication it would be unsafe to have a VBAC,’ which is a vaginal delivery of a baby after a previous caesarean.

He told the court of his concern at the ‘lack of information’ offered to them both about the dangers.

He continued: ‘She knew there was risk, but she was told by the consultants her risk was no higher than any woman after one c-section and this understanding guided her decision.

‘I know she wouldn’t have wanted to attempt VBAC if a consultant said c-section would be safer.’

The court heard messages between Mr and Mrs Howell, in which she said ‘wrestled’ with delivery method and said she felt ‘selfish’ for wanting a natural birth – worrying about things if they went wrong.

Mr Howell reassured her and they decided to follow guidance they were given.

He told the inquest he had a number of further concerns about his wife’s treatment during her pregnancy, including her struggling to get medical staff to ‘understand’ the niche surgery repair she had undergone.

The father-of-two told the court after a check-up in January 2021, she was advised past operations represented only ‘minor additional risks’.

Recounting events of Mrs Howell’s labour, he told the inquest she had been ‘surprised’ when put on a labour inducing hormone, and commented to Mr Howell about the midwives being in ‘disagreement’ about putting her on it.

He said she then deteriorated and her pain became worse, adding: ‘She began coughing and was unable to speak and to my horror she collapsed.’

Doctors carried out an emergency c-section just moments later and found baby Pippa in Mrs Howell’s abdomen. They were able to safely deliver the child.

‘I vividly remember the pain shock and numbness of being told the news,’ he said.

He cited the ‘inconsistent advice’ the couple had received throughout her second pregnancy as it ‘started to become apparent’ people hadn’t been aware of her previous complications.

Mr Howell expressed concern about whether information given was ‘correct’.

‘It seemed the choice was placed fully on Lucy rather than on clinical information and advice.

‘At no point were Lucy and I warned about any higher risk she faced due to her unique position.’

However, he told the inquest his ‘biggest concern’ was the failure to prepare for a c-section, meaning her rupture and amniotic fluid embolism ‘could have been avoided and she would still be with us today’.

He reiterated to the coroner despite having a preference on baby delivery method, she was being ‘guided’ by the professionals.

Environmental engineer Lucy Howell, 32, passed away after suffering complications at Royal Hampshire County Hospital in March 2021

Environmental engineer Lucy Howell, 32, passed away after suffering complications at Royal Hampshire County Hospital in March 2021

Environmental engineer Lucy Howell, 32, passed away after suffering complications at Royal Hampshire County Hospital in March 2021

Mrs Howell had previously undergone a caesarean for the birth of her first daughter, Rosie, in February 2017, which led to her needing surgery afterwards. She is pictured with Rosie

Mrs Howell had previously undergone a caesarean for the birth of her first daughter, Rosie, in February 2017, which led to her needing surgery afterwards. She is pictured with Rosie

Mrs Howell had previously undergone a caesarean for the birth of her first daughter, Rosie, in February 2017, which led to her needing surgery afterwards. She is pictured with Rosie

Hampshire Area Coroner Rosamund Rhodes-Kemp on Monday told the hearing that had the consultant’s concerns been reiterated and highlighted further down the line, it might have ‘paused’ proceedings and different opinions might have been ‘acknowledged’.

The court also heard from pathologists, who said the cause of death was amniotic fluid embolism and uterine rupture – the former of which is a condition that happens to one in 100,000 women, equating to about six or seven a year.

Opening the inquest and addressing Mrs Howell’s family, Mrs Rhodes-Kemp said she was ‘very, very sorry’ for their loss.

‘It wasn’t a straightforward pregnancy or birth,’ she said.

The court heard Mrs Howell had had surgery to deal with resultant scarring from her first C-section.

‘If she could, she wanted to have a natural delivery and as we know, she continued on that basis,’ Mrs Rhodes-Kemp added.

The court heard Mrs Howell did not fall into ‘spontaneous’ labour after her waters broke, and was given Syntocinon the following day – a medication given that causes the muscle of the womb to contract during labour.

Mrs Howell then collapsed in the early hours of March 13, before she died.

The coroner said there were various aspects in the lead up to her death that needed to be assessed, including the various aspects of previous surgery and risk that posed, advice given for the delivery method of her second baby and the cause of death.

Consultant surgeon Mr Khazali repaired Mrs Howell’s uterine scar niche that had formed after the birth of her first child.

Giving evidence, he said the procedure had gone well, with both he and Mrs Howell happy with the outcome.

In terms of complications, with ten being the most complicated he had carried out and one the least, he ranked her surgery as a two.

However, giving evidence, he said the niche procedure is the equivalent of having another C-section, despite it happening when the woman is not pregnant.

This meant, when asked by Mrs Howell, what method she should use when she wanted to have another child – he advised a C-section.

‘It is normal to have differences of opinion,’ he told the court. ‘I did not dictate any method of delivery.

‘Repair is equivalent to another C-section. I said it would be my advice to have another C-section.

‘That would have been my advice if she had had two C-sections.

‘She asked, and it was my opinion.’

When the coroner asked why he hadn’t been consulted further down the line by colleagues handling Mrs Howell’s care, he said: ‘My best guess if that they didn’t feel they needed more information.’

He told the court he had reflected ‘long and hard’ and said: ‘I believe my role is to make sure I share all the information with the clinicians looking after my patients.

‘I believe I have done my very best to do that in Lucy’s case.

‘I think I have given the right advice and communicated it.’

Mrs Rhodes-Kemp, however, said the message from him in 2019, after the surgery, was ‘lost’ as it was ‘not appreciated’ that there was a difference in views about a natural birth or C-section.

She said: ‘It was not appreciated there was a view that was different, your view got lost. No one spoke to you.’

Mrs Howell suffered a rupture during the delivery and, while her daughter survived being born in her stomach, she passed away

Mrs Howell suffered a rupture during the delivery and, while her daughter survived being born in her stomach, she passed away

Mrs Howell suffered a rupture during the delivery and, while her daughter survived being born in her stomach, she passed away

When Mr Khazali said he was ‘satisfied’ she understood the different view, the coroner said Mrs Howell said she did, but she had been a patient.

‘That voice got lost, and it might have helped her pause and acknowledge the difference to be apparent to those who were following.’

Mrs Howell worked at consultancy agency Soils Limited as a health and safety coordinator and geo-environmental engineer after joining as a graduate in 2011.

In a statement read in court, Mr Howell spoke described her as his ‘cheeky, inquisitive’ wife who was full of ‘love care and patience’.

‘Lucy was a beloved wife, daughter and friend who devoted her life to her family,’ he said.

‘Lucy cherished being a mother above all else and I was in awe about how naturally she took to motherhood.’

The inquest – which is expected to last four days – continues.

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