Jennifer Cahill’s husband Rob said his wife’s medical notes never stated that her choice to have a home birth was ‘out of guidance’, a court heard
A mum and her newborn daughter tragically died within hours of each other following a home birth, an inquest has heard.
Jennifer Cahill, 34, died the day after giving birth to her second child, Agnes. The baby girl lived for four days before she also passed away. The tragedy unfolded on June 3, 2024, at the family home of Jennifer and Rob Cahill in Prestwich, of Bury, Greater Manchester.
Following their deaths, hospital trust staff described the decision to have a home birth as “out of guidance” and “against advice”, citing concerns based on the birth of Jennifer’s first child. However, Rob claimed these phrases were never communicated directly to the couple. “I never heard that terminology until after the event,” he told the court.
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In court on Monday, Rob recounted the devastating moment he had to call 999 at around 6.45am on June 3, when baby Agnes was born unresponsive and could not be revived despite the nurse’s resuscitation attempts, Manchester Evening News reports.
He then accompanied Agnes to the hospital, where he later learned that his wife – described by her family as the “queen of acts of kindness” – was also being rushed to hospital after suffering complications during the birth.
The inquest, held at Rochdale Coroner’s Court, has not yet heard the causes of death for either Jennifer or Agnes.
Rob said: “We held Agnes’ first and only birthday party as she neared the end. I held her and told her how much her mummy and brother loved her, and I said goodbye.
“When I think of Agnes, I’m just happy I got to spend any time with her at all, after everything that happened that week – she was our comfort, and I’ll never forget that.”
Community midwife Caroline Nixon, who saw Jennifer the most during her second pregnancy, admitted in court that “an ‘out of guidance referral should have been made to a senior midwife” because of her high-risk status.
The heartbroken father told the court that this might have prompted Jennifer to reconsider a home birth.
Jennifer, originally from Worcester, met her husband while in her final year at the University of Manchester in 2011. They married in 2018 and welcomed their first child, Rudy, in 2021. The couple were excited to be expecting a sibling for Rudy.
But after giving birth to Rudy, Jennifer had suffered a postpartum hemorrhage, losing more than 800ml of blood due to an episiotomy and tear and Rudy being a large baby.
She required a blood transfusion and, as a carrier of group B strep, faced the risk of passing the infection to her newborn. Rudy subsequently suffered sepsis.
Because of these complications, Jennifer was referred to a consultant at North Manchester General Hospital, run by Manchester University NHS Foundation Trust (MFT), to develop a delivery and treatment plan for her second child.
The plan, overseen by Dr Rice, advised Jennifer to have a “hospital birth” with “active management”, including a medication drip to reduce the risk of bleeding while delivering the placenta, the court heard.
Ms Nixon said she also discussed these risks with Jennifer during midwife appointments in December 2023. But by February 2024, Ms Nixon said Jennifer informed her she had come up with a different birth plan, including a home birth.
Rob explained that the “traumatic” birth of Rudy left Jennifer anxious about delivering a baby in hospital. She felt that having two midwives present at home could provide better support and a calmer environment for her second delivery, reducing stress for both her and the baby.
Ms Nixon said she followed trust policy by referring Jennifer to Dr El-Adwan, as “she was a high risk lady requesting a home birth”, which deviated from the first birthing plan. This included substituting injections for the recommended drip to prevent bleeding.
The midwife said she expected Jennifer to discuss the medical and logistical concerns with the doctor, such as the risks of transferring to hospital if complications arose.
After speaking to the doctor, Jennifer remained committed to a home birth. But Ms Nixon said she continued to “review the risks and plan with her”. She added that she never specifically addressed that the choice to have a home birth was against medical advice.
When asked why by Coroner Joanne Kearsley, Ms Nixon replied: “we were told we 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 we were trained for. We 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 used much at the time, said Ms Nixon, adding that direct phrases like “this is against medical advice” were to be avoided by midwives, as this was the role of the consultant.
Asked by the coroner if she thought Jennifer fully understood the risks, Ms Nixon replied “yes”. However, she admitted she should have referred Jennifer 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’.
Rob said his wife’s medical notes throughout her pregnancy never mentioned the phrase ‘out of guidance’ regarding her choices or her birth plan.
“I was aware that the hospital’s preference was that she had a hospital birth, my understanding was that it was related to her being a strep B carrier in case that came up,” said Rob, regarding his conversations with Jennifer after her doctors’ appointments. “The emphasis was on the strep B, not postpartum haemorrhage.”
