A baby girl who died after her head became trapped during labour would "almost certainly" have survived if her mother had been brought into hospital hours earlier, an inquiry has been told.
Dr Rhona Hughes, a retired consultant obstetrician, said the way in which NHS Lanarkshire interpreted medical guidelines for induction was "likely to have contributed" to the death of Mirabelle Bosch.
The inquiry at Glasgow Sheriff Court has heard that Mirabelle was an undiagnosed breech baby.
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Her mother, Rozelle Bosch, was 38 weeks pregnant when her waters broke at around 4pm on June 30th 2021.
She was called to attend the maternity triage unit at Wishaw General hospital later that day.
The midwife who carried out an abdominal examination of Mrs Bosch concluded that Mirabelle's head was engaged and that she was in the cephalic - head-first - position ready for delivery, something Dr Hughes said is "very unlikely" to have been the case given subsequent complications.
Mrs Bosch - who was not yet in labour - was discharged home with an appointment to return to be induced at 9am on July 2.
However, paramedics were called out to her home in Shotts at around 11pm on July 1 following a 999 call by her husband, Eckhardt Bosch, who reported that that his daughter had been partially delivered in a legs-first breech position.
NICE guidelines stipulate that a mother at full-term whose waters break without contractions having begun - something which occurs in around 8% of pregnancies - should be booked for an induction approximately 24 hours later.
Dr Hughes, a former clinical director of obstetrics at NHS Lothian who delivered then-Chancellor Gordon Brown's son, John, at Edinburgh Royal Infirmary in 2003, said it was acceptable to wait 24 hours "but not much beyond that".
Under NHS Lanarkshire practice, however, women would be booked into hospital for the next 9am slot after 24 hours had elapsed.
Dr Hughes - who retired in 2018 - noted that this could mean some women spending up to 47 hours at home if their waters had broken at 10am.
She said it would have been "reasonable" to book Mrs Bosch's induction for 4pm on July 1.
Dr Hughes said: "By then, it would have been obvious that she was in labour. She would have had a vaginal examination.
"At that point, hopefully, somebody would have realised that she was breech, but if it wasn't picked up during the vaginal examination, she would have reached this point of the legs being delivered when skilled personnel were around who would have known how to deliver a breech baby."
She added that this would "almost certainly" have resulted in the safe delivery of Mirabelle by an obstetrician.
Asked why she believed NHS Lanarkshire had adopted its 9am-only policy for inductions, Dr Hughes said it "reduces pressure on beds".
She said: "I may be cynical but it's possible that part of the reason for that is that the majority of women would have gone into labour by 36 hours, so it reduces pressure on beds.
"All maternity units are pressed for beds."
The inquiry heard that around 3-4% of babies are breech at term, but that this is more common among first-time mothers - as Mrs Bosch was.
An abdominal examination, or palpation, prior to birth is an "inexact science" which successfully detects just 70% of breech cases, said Dr Hughes.
A breech birth detected late in delivery is an emergency, she added, but if picked up pre-labour after a mother's waters have broken is usually managed by arranging a caesarean.
Dr Hughes said vaginal breech deliveries were more common in the 1980s but towards the end of her career was something she would see "once a year or less", and was not something she would expect paramedics to have expertise in.
When ambulance crews arrived at the Bosch home on July 1 2021 they found Mrs Bosch on all fours, "in a lot of pain", with baby Mirabelle "partially delivered" legs-first.
Dr Hughes said there was a "strong chance" Mirabelle - who had been healthy prior to birth - would not have survived due to oxygen deprivation and a lack of specialist equipment even if paramedics had been able to deliver her at home.
An obstetrician consulted by paramedics via telephone advised that Mrs Bosch should be urgently transferred to hospital by ambulance, with a post-mortem report later concluding that delays in doing so contributed to Mirabelle's death.
Dr Hughes said: "I can understand why the paramedics were reluctant - it did seem inhumane - but I think the obstetrician was right, to give the baby the best chance."
Mirabelle was 12 hours old when she died at Wishaw General on July 2 2021 after life support was withdrawn due to a severe hypoxic brain injury.
The inquiry, which is expected to continue until March 1, will also probe the deaths of two other infants in Lanarkshire in 2019 - Leo Lamont and Ellie McCormick - whose deaths the Crown Office say give rise to "serious public concern".
The inquiry, before Sheriff Principal Aisha Anwar, resumes on Monday.
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