Gary and Sarah Andrews’s daughter Wynter died 23 minutes after she was delivered by Caesarean section at the Queen’s Medical Centre on 15 September 2019 after repeated warning signs of her being in distress had been missed.
Wynter died from a loss of oxygen flow to the brain – which an inquest found could have been prevented had staff delivered her earlier.
Sarah, 41, had been admitted to hospital on 14 September, six days after initially experiencing contractions.
The inquest heard the maternity unit was “busy” when she arrived, with information on the patient’s history not properly handed over to other staff at shift changes.
The inquest found Wynter may have survived if “multiple missed opportunities” had been spotted.
In what would become a recurring theme about warning signs being missed, the coroner cited a 2018 letter from midwives to bosses at the trust, outlining concerns over staffing levels as “the cause of a potential disaster”.
“The grim predictions… were indeed realised some 10 months later when Wynter died as a result of the unsafe practices warned about,” coroner Laurinda Bower said.
The Care Quality Commission (CQC) prosecuted NUH over her death in January 2023, with the trust pleading guilty to care failures.
The criminal prosecution resulted in NUH being fined £800,000.