A Sydney hospital was so short staffed expectant parents were forced to deliver their baby alone, an inquest into their daughter's death has heard.
Manusiu Amone was born with the umbilical cord wrapped around her neck on November 25, 2014, at Fairfield Hospital, and although her breathing was induced she died soon after.
Her mother Sharon Amone says no medical staff were present in the birth room, causing her husband to frantically call for help with an emergency buzzer.
"He was pressing the buzzer, no one came," she told Glebe Coroners Court on Monday.
Ms Amone's husband Sam Amone broke down as he gave evidence via phone, saying when no staff answered the emergency button he tried to deliver the baby himself.
"As soon as she had the baby I just ran outside and just screamed for someone to come," he said.
Ms Amone wiped tears from her eyes in court as her husband said a nurse arrived at the birth room within two minutes, but it felt like "an age".
The court heard the nurse was able to induce breathing by slapping the baby on the buttocks, but Mr Amone's voice broke as he remembered flagging concern over his newborn's breathing and pink colour.
"Her breathing seemed short, as if she was gasping for air," he said.
A midwife took the baby to the special care unit where resuscitation efforts continued for some time, however, she could not be revived.
Staffing, workloads and rostering at the hospital will be investigated during the inquest, and a lawyer representing South Western Sydney Local Health District acknowledged that aspects of the care provided were "deficient".
The court heard that shortly before the child's birth Ms Amone was given 150 milligrams of pain-relief drug pethidine, which is expected to be described as an excessive dose during advanced labour by an expert medical witness.
An autopsy report found the toxic effects of pethidine most likely caused the otherwise healthy baby's death.
The doctor who rushed into the birthing unit and finished delivering Manusiu told the court that 100mg of the drug is usually only used in the early stages of pregnancy due to the risks of respiratory depression if administered later on.
"Normally we don't give pethidine late in the labour," Fairfield Hospital obstetrics registrar Chee Tan said.
Dr Tan said nurses are usually understaffed at the hospital, but that night was especially busy.
