logo
Newborn baby died after mother was left to give birth alone on NHS hospital ward by midwives and doctors, inquest told

Newborn baby died after mother was left to give birth alone on NHS hospital ward by midwives and doctors, inquest told

Daily Mail​09-07-2025
A newborn baby died after the mother was left to give birth alone by midwives and doctors, an inquest told.
Liliwen Iris Thomas was born at the University of Wales Hospital but died just hours later after her mother's cries for help were ignored during labour.
An inquest into the death of Liliwen was held at Pontypridd Coroner's Court on Tuesday. The assistant coroner for South Wales Central, Rachel Knight, explained that Emily Brazier was admitted to hospital for an induced labour on October 8, 2022, at '40+1 weeks'.
Ms Brazier was given pethidine and codeine for pain relief, however she was 'not attended to or subjected to physical checks regularly enough', the inquest heard.
The mother was not attended to by anyone from the midwifery team for almost an hour during the early hours of October 10, which is when she cried for help, and 'the fact she had moved to active labour was missed'.
Staff eventually came to find that Liliwen had been delivered unattended. The newborn was described as being in a 'very poor condition' and died later that same day.
The heartbroken mother previously said how she was 'angry' at being left completely alone during childbirth. She said she remembered 'being in a cycle of puffing gas and air, passing out, and repeating'.
She added: 'So many happy memories and special family moments are tinged with sadness. I dread family events and Christmas as Liliwen will never be there, she will always be the missing piece, her death should never have happened and that's hard to live with.'
The inquest heard that Cardiff and Vale University Health Board admitted that when Ms Brazier was admitted to hospital there not enough midwives on duty, with only 17 present when the required number was 24. Two on-call midwives then arrived for duty to take the number up to 19.
Liliwen's father Rhodri was not present during his daughter's birth because partners were not allowed on the ward during that time due to the hospital having strict rules about visitors overnight between 9pm and 9am.
Summing up at the hearing, Ms Knight said: 'Liliwen died from a hypoxic brain injury following an unattended delivery in hospital'.
She added that the death was a culmination of the mother 'not being attended to as frequently as she should have been', 'the absence of resuscitation at birth', and 'a bacterial infection of the placenta'.
The official cause of death, as recorded by Dr Andrew Bamber following an investigation, was given aa a lack of oxygen at birth, known medically as perinatal asphyxia.
Abigail Holmes, director of midwifery and neonatal services at the University of Wales Hospital, told the hearing that Liliwen's death represented 'the most tragic case I've ever been involved with'.
She said new policies had been put into practice and that investment had been made into staff and training.
Dr Rachel Liebling, a consultant obstetrician and specialist in fetal and maternal medicine, said failings by the health board 'more than minimally' contributed to the death of Liliwen.
Ms Knight concluded the inquest by offering her condolences to Liliwen's family and said that, having read extensive evidence, she had decided not to issue a Regulation 28 Prevention of Future Deaths report.
She said that Liliwen's death had a 'seismic impact on the largest hospital in Wales' and was 'satisfied that protocols and guidance have been thoroughly reviewed and that staff within the health board have been significantly retrained'.
However, Ms Knight added that she 'remains concerned' that the learning from this case might not have reached other health boards across England and Wales.
Therefore a report will be rafted to target the National Institute for Health and Care Excellence so that it can consider the findings made following Liliwen's death.
Following the conclusion of the inquest, Lara Bennett, senior associate at Slater and Gordon, a Cardiff law firm representing the baby's family, said: 'This case is truly shocking and Emily, Rhodri and their family have been left absolutely devastated by Liliwen's death.
'To have to relive the trauma again at the inquest, and to hear how their beloved baby was failed, has been hugely distressing. Liliwen and Emily were abandoned at a time when their care should have been the hospital's top priority.
'While it is claimed that lessons have been learned, and changes have been implemented, this tragic case highlights concerns regarding understaffing on maternity wards and the absence of basic care and monitoring for mothers and babies at their most vulnerable.
'Had this been provided, Liliwen would not have suffered as she did and would be with her family today.'
'Liliwen's death must not be in vain and the maternity care standards across Wales must be improved to ensure no mother or baby ever suffers in this way again.'
On Tuesday, a spokesperson for Cardiff and Vale University Health Board, said: 'Our sincere thoughts and heartfelt condolences remain with Liliwen's family during this incredibly difficult time.'
Orange background

Try Our AI Features

Explore what Daily8 AI can do for you:

Comments

No comments yet...

Related Articles

Grandmother died of sepsis after being misdiagnosed with stomach complaint
Grandmother died of sepsis after being misdiagnosed with stomach complaint

Telegraph

timean hour ago

  • Telegraph

Grandmother died of sepsis after being misdiagnosed with stomach complaint

A grandmother died of sepsis after doctors failed to recognise signs of a urinary tract obstruction, a coroner has found. Suzanne Edwards, 71, of Leighton Buzzard, Bedfordshire, visited her GP on Nov 29 2024 with abdominal pain and vomiting but despite urgent blood and urine tests she was not sent to hospital. Later that day her symptoms worsened and she went to A&E at Milton Keynes University Hospital, Bucks. Her test results were indicative of systemic inflammation and dehydration but she was diagnosed with gastroenteritis and discharged. Her condition deteriorated further and the following day her family called NHS 111. She was directed to an urgent care centre and transferred to Bedford Hospital where clinicians identified a 7mm stone in her urinary tract and sepsis. She underwent emergency surgery but died later on the evening of Dec 1 from septic shock. 'Heart of our family' Stacey Edwards, her daughter, said: 'My mum was the heart of our family – full of warmth, compassion and humour. 'It's devastating to know that her death may have been avoided if the signs of sepsis had been recognised sooner.' Her family described her as 'an unbelievably kind and caring woman with a wicked sense of humour and fun'. She leaves behind husband Terence, two children and two granddaughters. Stacey said: 'When she visited her GP she was so unwell she used a wheelchair. 'After she was taken to A&E we were told it was likely gastroenteritis. She was given IV fluids and pain relief but she was still in pain and struggling. 'There was very little communication from doctors and when she was discharged we were simply told to come back if symptoms returned. 'At home, things got worse. But because she'd been examined by medical professionals we thought she just needed time to recover. 'The call we received later that evening asking us to come in urgently is something we'll never forget. 'Neither is watching her suffer in those final days.' Jewellery went missing Soon after her death Mrs Edwards' family realised her jewellery worth thousands of pounds – three necklaces and four bracelets – were missing. Stacey said: 'Mum never took off her jewellery. 'It is heartbreaking to think someone may have taken advantage of such a tragic situation.' Bedfordshire Hospitals NHS Foundation Trust launched a full investigation and search at the time but the items were never found. Tom Osborne, the senior coroner for Milton Keynes, recorded a narrative verdict saying there was a failure to recognise the signs of a urinary tract obstruction, leading to missed opportunities to treat Mrs Edwards before sepsis developed.

Top medical body concerned over RFK Jr's reported plans to cut preventive health panel
Top medical body concerned over RFK Jr's reported plans to cut preventive health panel

The Guardian

time2 hours ago

  • The Guardian

Top medical body concerned over RFK Jr's reported plans to cut preventive health panel

A top US medical body has expressed 'deep concern' to Robert F Kennedy Jr over news reports that the health secretary plans to overhaul a panel that determines which preventive health measures including cancer screenings should be covered by insurance companies. The letter from the the American Medical Association comes after the Wall Street Journal reported on Friday that Kennedy plans to overhaul the 40-year old US Preventive Services Task Force because he regards them as too 'woke', according to sources familiar with the matter. During his second term, Donald Trump has frequently raged against organizations and government departments that he considers too liberal – often without any evidence. The US president, and his cabinet members such as Kennedy, have also overseen huge cuts and job losses across the US government. The taskforce is made up of a 16-member panel appointed by health and human services secretaries to serve four-year terms. In addition to cancer screenings, the taskforce issues recommendations for a variety of other screenings including osteoporosis, intimate partner violence, HIV prevention, as well as depression in children. Writing in its letter to Kennedy on Sunday, the AMA defended the panel, saying: 'As you know, USPSTF plays a critical, non-partisan role in guiding physicians' efforts to prevent disease and improve the health of patients by helping to ensure access to evidence-based clinical preventive services.' 'As such, we urge you to retain the previously appointed members of the USPSTF and commit to the long-standing process of regular meetings to ensure their important work can be continued without disruption,' it added. Citing Kennedy's own slogan of 'Making America healthy again,' the AMA went on to say: 'USPSTF members have been selected through an open, public nomination process and are nationally recognized experts in primary care, prevention and evidence-based medicine. They serve on a volunteer basis, dedicating their time to help reduce disease and improve the health of all Americans – a mission well-aligned with the Make America Healthy Again initiative.' According to the Affordable Care Act, public and private insurance companies must cover any services recommended by the Preventive Services Task Force without cost sharing. In a statement to MedPage Today, Department of Health and Human Services spokesperson Andrew Nixon did not confirm the reports, instead saying: 'No final decision has been made on how the USPSTF can better support HHS' mandate to Make America Healthy Again.' Reports of Kennedy's alleged decision to overhaul the taskforce come after the American Conservative published an essay earlier this month that described the taskforce as advocating for 'leftwing ideological orthodoxy'. It went on to accuse the panel of being 'packed with Biden administration appointees devoted to the ideological capture of medicine', warning that the 'continued occupation of an important advisory body in HHS – one that has the capacity to force private health insurers to cover services and procedures – by leftwing activists would be a grave oversight by the Trump administration'. In response to the essay, 104 health organizations, including the American Medical Association, issued a separate letter to multiple congressional health committees in which they urged the committees to 'protect the integrity' of the taskforce. 'The loss of trustworthiness in the rigorous and nonpartisan work of the Task Force would devastate patients, hospital systems, and payers as misinformation creates barriers to accessing lifesaving and cost effective care,' the organizations said. In June, Kennedy removed all 17 members of a US Centers for Disease Control and Prevention panel of vaccine experts. Writing in a Wall Street Journal op-ed, he accused the committee of having too many conflicts of interest. Kennedy's decision to overhaul the immunization panel was met with widespread criticism from health experts, with the American Public Health Association executive director Georges Benjamin calling the ouster 'a coup'. 'It's not how democracies work. It's not good for the health of the nation,' Benjamin said.

Parents, beware the devastating consequences of measles
Parents, beware the devastating consequences of measles

The Guardian

time3 hours ago

  • The Guardian

Parents, beware the devastating consequences of measles

After reading the letters about vaccine misinformation and hesitancy (Measles surge shows why vaccinations are crucial, 20 July), I felt I must write to tell you of one unrecognised cause of the drop in vaccine uptake: when I worked as a community school nursing sister in the 1980s, with 11 state schools and a number of private schools that took up the vaccine service, we had 98% uptake of vaccines in the school setting. This was due to the system of sending letters home to parents requesting their consent and following up by phone, if necessary, by the school office staff. The children came in class batches. Then the local health authority decided that this service should be discontinued and parents were invited to take their child to the local GP surgery for their vaccinations. The uptake plummeted to less than 40% of eligible children due to children not taking the letters home, or parents forgetting or losing the letter – or being unable to take time off to take their child to the surgery. When I asked the GPs at the local health centre what the uptake for the cohort of eligible children was, they looked at their records and were surprised, but reluctant to do anything about it. Health visitors were responsible for, and very successful in, advising new mothers when vaccines were due, where to get them and encouraging uptake. It should be compulsory for all vaccines for preschool children (which includes measles) to be done before a child is admitted to school, as in many other countries. As a midwife, I saw a baby born to a mother who had contact with rubella in early pregnancy. The little girl was born with a body rash, had bilateral cataracts and was totally deaf. She was was very ill. Schools for deaf children may return again for these children if vaccination is not taken up for whatever reason. How StephensLiphook, Hampshire I contracted measles just before the NHS was established. With it came serious ear infections, burst eardrums, etc. There were no vaccines, just ear drops. Over the years the infections and operations continued and now, aged 82, I have no hearing with complications. I beg people to think seriously about vaccination. The consequences of measles can sometimes be devastating. Jean JacksonSeer Green, Buckinghamshire I caught measles aged six in 1953, at a time when parents hoped their children would get it (and chicken pox and mumps) so as to gain immunity. My dad, aged 54, had not had measles as a boy, caught it from me and nearly died. The risk of not vaccinating children is not just to WallLondon

DOWNLOAD THE APP

Get Started Now: Download the App

Ready to dive into a world of global content with local flavor? Download Daily8 app today from your preferred app store and start exploring.
app-storeplay-store