The senior doctor in charge of planning the pregnancy of a mother who died in childbirth today admitted she didn't know that a surgeon had previously advised her against a natural delivery, an inquest heard today. 

Environmental engineer Lucy Howell had undergone a caesarean for the birth of her first daughter Rosie in 2017 - which then required specialist surgery to repair. 

However, when consultant obstetrician Jean Goodman was helping her plan the delivery method of her second baby she opted not to speak directly to the doctor who had carried out the procedure.

If she had, she said she would not have later recommended for Mrs Howell to have her labour medically induced.

Mrs Howell had a 'torrid' time following her C-section and wanted a natural delivery, the inquest heard.

Tragically, when the 32-year-old went into labour with new baby Pippa in March 2021, Mrs Howell suffered an amniotic fluid embolism and uterine rupture during the delivery and, while her daughter survived, she passed away.

The hearing in Winchester has heard there were 'inconsistencies' in advice the couple received from doctors during the course of her second pregnancy. 

At a pre-inquest review last year it was claimed she was given 'conflicting' advice about the risk of delivery methods.

Following the birth of her daughter, consultant surgeon Mr Shaheen Khazali performed 'niche' surgery on her.

Due to the risks, he had advised her to avoid a natural birth in any subsequent pregnancy. However, that advice had been 'lost', the inquest has heard.

Area coroner Rosamund Rhodes-Kemp told the hearing that had the specialist's concerns been reiterated and highlighted further down the line, it might have 'paused' proceedings and different opinions might have been 'acknowledged'. 

She said Mrs Howell, from Bishop's Waltham, wanted a natural delivery due to her previous experience.

"It wasn't an uncomplicated c-section," she said. "Lucy had had a terrible time afterwards and that was why she wanted to have a vaginal delivery because she had had such a torrid time after that first c-section.

"It's unusual not to be able to walk and move weeks - that was what was driving her decision." 

Today, Ms Goodman told the court in hindsight, she would 'absolutely' do things differently in planning Mrs Howell's pregnancy plan. 

The court heard Ms Goodman first met Mrs Howell face to face in November 2020 when she had fallen pregnant.  

"When I initially spoke, my impression was someone who had had a straightforward c-section, with difficulties recovering and wanted to have a vaginal delivery," Ms Goodman said. 

"It was only disclosed at the end of the meeting that she had had a niche." 

Ms Goodman told the court her initial plan had been to write to the specialist surgeon who carried out the operation on Mrs Howell. 

She told the court she had never found any notes from Mr Khazali and had instead opted to ask Renee Behrens, a consultant gynaecologist at Winchester's Royal Hampshire County Hospital about the procedure as she has attended the operation. 

When asked why she had switched plans from writing to Mr Khazali to asking Ms Behrens, Mrs Goodman said: "My impression was Ms Behrens was a lot more available. 

"I had access to someone who was present at the surgery and aware of her care up until this point. 

"She was there on the day and was aware of the advice that had been given. 

"I thought that was a reasonable alternative to writing to the operating surgeon." 

In response, Mrs Rhodes-Kemp said: "The key point about this is Mr Khazali is a specialist which is the reason Ms Behrens referred her to him. 

"He carries out niche surgeries - he's very, very familiar with surgery and gets a lot of referrals because they don't have that specialist." 

The court heard Mr Khazali had recommended a C-section.

"Unfortunately, because there was no discussion with anyone at any time, that view never surfaced," she continued. 

"For Lucy, she had already been told one thing by him but then everyone else said she could try.

"Ms Behren said she could try, you said she can try, which is what Lucy wanted to hear." 

Mrs Rhodes-Kemp told Ms Goodman about Mr Khazali's assessment that his niche surgery was the equivalent of another caesarean, effectively meaning Mrs Howell's uterus had been subject to two c-sections. 

Asked if this would have changed her treatment plan, Ms Goodman conceded that it would have done, regarding inducing Mrs Howell's labour using the drug Syntocinon. 

"I would not have advocated for induction of labour with hormones after two c-sections," Ms Goodman said. 

"I wouldn't have been comfortable suggesting Syntocinon." 

Asked if there was anything she would do differently, Ms Goodman admitted she would. 

"Absolutely," she said. 

"I would have contacted Mr Khazali directly to ask him for the operation notes and any other information he thought I should pertain in terms of mode of delivery in any further pregnancy having had the procedure he had performed. 

"That then would have led to some very different counsel." 

READ MORE: Bishop's Waltham mother died in childbirth, inquest hears

Mrs Rhodes-Kemp said: "We may be beginning to see the benefit of speaking to the person who carried out the specialist surgery." 

Ms Goodman added that she has subsequently seen a letter from Mr Khazali but said it 'does not give an opinion' on Mrs Howell's delivery method - but only that there 'should be a discussion'. 

She told the court she had had these discussions with Mrs Howell in the run-up to her giving birth.  

The four-day inquest continues.