Preventable Baby Loss

I beg to move,

That this House has considered preventable baby deaths.

It is a pleasure to serve under your chairmanship today, Mr Dowd. This debate is not the type of debate I look forward to because it is filled with sadness and sorrow. I am delighted to be joined by some of the Ashfield families who have been affected by baby loss in the past couple of years or so. According to the Royal College of Midwives, every day in the UK 1,845 babies are born alive and there are between 302 and 428 miscarriages. We have eight stillbirths per day with 145 babies born prematurely and five neonatal deaths.

When a pregnancy is announced in the family, on most occasions it is a joyous, wondrous time in people’s lives. They are happy. Dads make plans for their son to be a footballer—they have picked the football team already. Mums look at princess dresses, even though the baby is about as big as your thumb. Grandparents squabble over who will have rights to look after the new grandchild. There are all sorts of plans such as what schools they will go to. Especially for first-time mothers it is a strange time—a wondrous, joyful time—and once things settle down would-be parents sometimes get a little bit apprehensive and scared, worried about the baby and whether he is going to be well. Will he be born well? Will he develop properly? It turns from being happy to being concerned, but still happy.

There are quite a few risks, as we know, in pregnancy, during birth and in the postnatal period. Every preventable stillbirth, neonatal death or infant death of a child is a tragedy and we must make all efforts to prevent it happening. The families that I have brought here today believe, along with the hospital, that deaths were preventable. Mistakes were made and things were missed. I hope that today the ministerial team can give the families something so that they can go away and know that they have been listened to.

There are factors apart from mistakes, such as diabetes, obesity, drinking too much, smoking and other factors in pregnancy that can affect how a baby develops and ultimately how healthy it is once it is born. But as I say, in these cases mistakes were made. I have spoken to some of the families, and two families are here today. I will read out their stories—not my words, but their words. I asked them to print out their stories so that I could read them out here in Westminster Hall.

The first one is from Rob and Emma Stretton. They tell the story of Olivia. This is from Rob:

“On the 31st of May 2023, Emma and I attended a routine scan at King’s Mill Hospital, Mansfield. During the scan a few issues arose. The sonographer called for assistance from her senior and her recommendation was made to contact a consultant. His decision was that Emma needed admitting immediately for observation. The time was approximately 14:30. We were taken upstairs to the maternity unit where the situation was explained to a midwife at the nurse’s station. Her reply was we should return later as no beds were available and a phone call should have been made to the ward prior to attending. The consultant suggested for us to return in a couple of hours to which the midwife replied this wouldn’t be feasible due to shift change over. She said between 19:30-20:00 would be better.

After this we left for home and returned to the ward around 19:45. Emma was admitted for monitoring and once she was settled, I returned home. Upon entering the house, I received a phone call from a midwife advising me to return as soon as possible as no foetal heartbeat could be obtained. I went straight back to the ward to be informed our baby…had died. Emma was given medication to induce labour and gave birth to our stillborn daughter three days later at 18:13.”

The next story is from Bianca Chapman. This is Imiza’s story:

“My placenta was completely covering my cervix. I was a high risk pregnancy. I had a bleed in the November and wasn’t given much advice on any risks. In the early hours of 3/12/22 I had a big bleed and went into KMH. The registrar raised concerns but was ignored by the consultant. In the space of just over 24 hours I then had several more bleeds. It wasn’t until my daughter’s heartbeat baseline stopped beating I was considered to be allowed surgery.

The consultant in charge had gone missing, which delayed my daughter coming out. The ward was on code red. It took 45 minutes to find him. I was then operated on to find out my placenta had abrupted inside me. They struggled to get my daughter out so they had to make a further cut in my stomach, which now due to that I will never be able to give birth naturally.

My daughter came out at 11.16 am not breathing. It took 7 minutes to resuscitate her. I had clumps of placenta floating around my stomach and had to be put to sleep to have further surgery. We were led to believe she was fine, but we weren’t able to see her. We were told they was just waiting for her to urinate. She was later transferred to LRI, which was when we were finally told the truth: she had a bleed on her brain due to being left inside me too long with no oxygen. Her nappy was filling with blood.

Within the space of a few hours, we were told she would be highly disabled, to get your family here, who you would like to meet her, as it’s in her best interest we turn her life support machine off. After turning her life support machine off I was then told I was going to be put back on the maternity ward around all mothers and babies…There was no way in this world I wanted to be around alive babies.

Once we had our investigation, we were told a lot of things that could have prevented all of this. We was told if she was taken out around 7 am she would be alive right now. Those vital few hours made all the difference yet we was left to suffer a lifetime of pain through a choice of a fully qualified consultant…We were also told he would of known her life expectancy would be short due to the abruption yet he told us she would be home with us for Christmas and not to worry.

We believed in them to be later proved it was all a lie. All that happened to the consultant responsible for our baby girl’s death was he was audited. We are now both changed forever…I was pushed out in a wheelchair holding a memory box as that’s all my daughter then was, a memory.”

Amelia Bradley wants to tell Theo’s story:

“My pregnancy was the typical normal pregnancy. I attended all antenatal appointments and was deemed as low risk. On the 13th September 2023, I attended King’s Mill Hospital in the evening, despite being a booked homebirth, to get some pain relief. On the first admission to the Sherwood Birthing Unit, I was left waiting for 40 minutes, before being told by a supporting midwife that they were really busy, and someone would see me shortly. 30 minutes later, the same midwife returned to complete my original triage assessment, something that should be undertaken within 15 minutes of arrival.

This midwife apologised for the delays and started my assessment immediately when she came back into the room. She told me that I was l to 2 cm dilated and that my cervix still had some changes to make until I was in active labour. She still deemed me as low risk, gave me a codeine tablet and said that I would still be suitable for a homebirth, as the only pain relief I could get with a water birth would be gas and air.

I got home at around about midnight and got into my birthing pool, before leaving it to use the toilet at around 12:30 on the 14th September. I had 2 contractions on the toilet and felt a pop, which was followed by bleeding. I put on a pad to monitor the bleeding and within 2 to 3 minutes, it was full. Luke rang the Birthing Unit and put the phone on speaker so I could consent to them talking to Luke and my mum because of how much pain I was in, and I couldn’t speak for myself.

They asked if I had lost more than a teaspoon of blood, to which my mum said ‘Yes, it’s like a heavy period, but pure blood.’ The midwife didn’t ask any questions about the pain I was in and didn’t try to gather further information on the amount of blood loss. She told me to come back to the hospital.

We returned to the hospital just before 1 am and on getting to the ward at 01:04, I was put into a triage room. 10 minutes later, a support worker came to take my observations, but ignored my mum when she tried to show her the blood-filled pad, and then failed to alert any of the midwives that I was bleeding.

After being in the room for 37 minutes, while 2 triage midwives, a labour ward co-ordinator and several other staff were sat around their nursing station discussing how many Haribos they’d eaten on the shift, and how other midwives who were on bank shifts were getting paid more…a midwife”

never entered the room. When one did enter, she

“took a look at the pad and her face dropped, noting the seriousness of my condition. She couldn’t find Theo’s heart rate, so went to get support and a Doppler to see if this could pick the heart rate up. She found him to be bradycardic and issued a 2222 emergency. The consultant came and ordered for a category 1 C-section to take place.”

The baby died.

This is the story of Hayley Moore:

“My story…Had previous placenta eruption in 2021, was very lucky—was picked up and I was straight down to theatre for an emergency C-section. This time around I was very anxious about it happening again, was questioning the consultant. He said I was only under him because small baby last time. I wanted a planned C-section, but he kept pushing me to go natural and full term.

I went in on the 17th of February with reduced movements and pains, was hooked up to the monitor, was told I can’t be having contractions so was sent home. On the 19th, went for a scan. I felt it was rushed, still said I don’t feel right. They said baby had grown and looked fine. Felt movement early hours.

The next morning by 10 am on the 20th I was at home in agony, rang the birthing unit, they told me to go down so I did. Got there, was sent into assessment unit. Midwife came, checked for heartbeat…had to wait for scan…then moved down to room 11, where the bereavement midwife came up. The doctor was pushing me to go natural again as I was stable.

The midwife at the time, along with my sister, was pushing for my C-section…in the end, I did get rushed down for a C-section, and again my placenta had erupted. The aftercare I received from midwife Holly…was outstanding.”

That is four stories.

Recently, I visited King’s Mill hospital and the maternity unit, where I managed to walk around with the chief nurse, Mr Phil Bolton. It is a brilliant facility at that hospital. The problem that hospitals have, however, is the headlines in the newspapers, which are always bad. We never see the front page of a local paper saying, “Hospital saves a life”, although that is what they do every single day.

Mistakes have been made, and individuals have made mistakes, but I also have to say that I am incredibly proud of King’s Mill hospital, which is where I was born and where my children were born, and it is probably the place where I will leave this earth, when I eventually go—though I have no plans to do that just yet. It is a brilliant hospital, but mistakes have been made. But King’s Mill hospital acknowledged the mistakes; it put measures in place and learnt from some of the heart- breaking stories we have heard today.

I am not here to talk about King’s Mill hospital; I am here to talk about my constituents, who have suffered the most horrendous grief. Baby loss will always happen—we know that—but those were preventable deaths. We must do all we can in this place to ensure that our national health service has the support it needs to make sure that we reduce baby loss.

We know about the Ockenden report in Nottingham. Some of the news coming out of that is quite shocking. I fear that we sometimes treat the birth of babies like a production line—it is not. It is very personal and emotive. Every single family is completely different; mums and dads are different. If we can learn anything from today’s debate, it is that from the families I have spoken to, baby loss touches every single family in this country. Somebody along the line will know or be related to somebody who has had baby loss, whether that be a miscarriage or during childbirth or post-natal.

I ask the ministerial team to have a look at my constituents here in the room today. I know it is not always possible to empathise, because we have not all been through the same thing, but please reassure them that they have been listened to. I cannot go any higher than this. We have the complaints in and the solicitors involved. As a Member of Parliament, all I can do is listen to my constituents and their stories, bring them to this place, let them see the people running this country, and ensure that their stories are listened to and that the facts I have given today are acted upon.

I remind Members that if they wish to speak, they should bob—as some of you have done. Thank you for that.

My hon. Friend the Member for Ashfield (Lee Anderson) has raised a subject that is, for many families and communities, a taboo. It is very, very difficult to talk about. When it comes to prevention, he is quite right to pay tribute to the hospitals where every week, thousands of healthy babies are born. Where there have been errors—we have seen it not just in Nottingham; one of the Kent hospitals had a particular problem with this—everything should be done to make sure these deaths are prevented. Whatever we do, however, naturally some stillbirths will still happen.

I have seen the effect of stillbirth in my own family. It is pretty devastating. It does not go away or get forgotten. Are those that go through this, particularly the women, able to talk about it? Can they share their experiences? A problem shared may not be a problem solved, but it might just make life a little bit more bearable—a little bit easier. I must be honest: when my niece had that stillbirth, I did not feel I could face her and talk about it. I felt too awkward. Would I say something that was wrong? Was it best we just did not discuss the subject? A decade on, even though I am close to her, I have never discussed it. I have just felt too awkward to do it. I suspect that is the case with many men, including husbands and partners. It is just something that is not talked about.

I want to pay tribute to councillor Jeff Bray, the former leader of Tendring district council, who has talked about the stillbirth experience as a father. I am also encouraged by Maria Gormley’s charity in Clacton, where women—and men if they want to—can come together regularly and share their experiences. It is not an easy thing to do. I have admitted my own failings, but I suspect I am far from alone in finding this subject incredibly difficult.

As my hon. Friend the Member for Ashfield said, anything that can be done to prevent avoidable disasters must be, but I want to put it on the record that naturally, these things will happen—hopefully in very low numbers. There needs to be counselling and support for people who have been through that experience. To be honest, I feel that in most parts of the country, it is very sadly lacking.

I thank the hon. Member for Ashfield (Lee Anderson). As a woman who has lost two very much wanted pregnancies, baby and pregnancy loss is very close to my heart. I also represent an area that, in the past, has seen poor maternity care cause the death of babies. I want to speak about the importance of local support for parents and families, and to give those support organisations a voice here in Parliament. I also want to highlight the absolute necessity of rigorous investigations and true candour when babies die. My constituency hosts two excellent support groups for people affected by pregnancy and baby loss: Matilda’s Mission, set up by Chelsie and Matt after the death of their baby Matilda, and the Tigerlily Trust, set up by Val in memory of her daughter Lily.

Matilda’s Mission and the Tigerlily Trust work with local bereaved families. They provide a whole host of support, including remembrance boxes for bereaved parents to make and collect as many memories as possible in the short time they have with their babies, and to give them resources when they return home. There are sibling memory boxes for bereaved living siblings, sibling play sessions, and support groups, which in particular can combat the loneliness and isolation often felt with this sort of grief. They provide a place where people can come and heal together. There are dad drop-ins, one-to-one catch-ups, grandparent events, older sibling events, whole family events at holidays such as Christmas, and of course events around Mother’s and Father’s day. The two groups also work with hospitals and universities on maternity bereavement care and host Baby Loss Awareness Week events.

I asked Chelsie, Matt and Val what they wanted me to say today, and they told me that funding is an issue. For example, the bereavement suite at the Royal Lancaster infirmary, co-designed with bereaved parents, has been closed for some time due to safety concerns. While the trust continues to work on that, maternity bereavement does not seem high on the agenda when it comes to budgets. As Chelsie said in her beautifully blunt way, “Dead babies and their families matter too.” Funding for support groups is also extremely difficult, with some groups struggling to get support for funds to continue. Support for families is currently a postcode lottery, often involving lengthy referral times for NHS services or support from charities. When families are in the depths of grief, 12 weeks’ wait for a referral is tough going. Families need consistent and timely care.

It is a pleasure to follow the hon. Member for Morecambe and Lunesdale (Lizzi Collinge) and to hear her contribution as well. In particular, I thank the hon. Member for Ashfield (Lee Anderson) for setting the scene, as he often does, with a passion and an understanding of his constituents that we all see, and for describing the examples of his constituents who have suffered in this way. He did it with sensitivity, because it is a very sensitive debate. As a father and a grandfather, my thoughts are with those who have faced and are living through baby loss; there are many who have. I say “living through” because I know that it is not something to get over as such.

I could give many examples, but I will give just one. The hon. Member for Ashfield said that every family has been touched, and he was right. My mother has had a number of miscarriages, as has my sister and Naomi in my office, so the issue of baby loss resonates with us all.

There was a lady I greatly admired. Her name was Agnes Thomas. She is dead and gone, but she was 4-foot-nothing. There wasn’t much of her, but she was definitely a whirlwind. I remember her coming to see me. She took care of her 105-year-old mother—and that is the age her mother was when she passed away. Agnes had a very ill husband, and she had minimal help from anyone. Within a few months of her passing away, her mother and her husband died too. She was the centre of that home and one of the strongest women that I have ever known—apart from my own mother, of course, who at 93 is equally strong. However, underneath all that undeniable strength was also a lady that, in her 80s, came to the office to see whether she could find out where her stillborn son—

The hon. Gentleman is making a powerful speech. It is good to hear the story of Agnes, and I hope that he will agree with me that sympathising with our constituents who have suffered such awful circumstances and telling their stories in Parliament is a good way to ensure that they are heard in the future.

I thank the hon. Lady for that. The story of Agnes’s son is this: her stillborn son was born sleeping in the early ’70s and was buried. Agnes came to see me over 50 years later.

The hon. Gentleman is making a very passionate speech, and I think everybody in Westminster Hall can tell how impassioned he is. He tells a very touching story. Does he agree that it does not matter how long ago baby loss occurred—it will always stay with the family?

I am sorry for being emotional. I know that I should not be. I thank the hon. Gentleman for giving me a chance to recover some of my composure.

Agnes came in tears to ask where the Royal Victoria hospital had buried her son. It meant something to her, even though it was 50 years later—that wee small lady, standing in my office telling me her story, which was breaking her heart 50 years later.

The loss of a baby is life-changing, and my thoughts are with those families who have been mentioned in this debate. There will be others. Other hon. Members will speak, and they will tell the same story with the very same emotion, compassion, understanding and that realness that the hon. Member for Ashfield compounded in such a fantastic way in his introduction.

The fact that baby loss can be preventable makes the outcome that bit more difficult to accept. Sands is a phenomenal charity, and it has given the following statistics. I always give a Northern Ireland perspective simply because I feel it adds to the debate, but it also tells us that the things happening here are no different for us back home. The stillbirth rate declined 17.7% in Northern Ireland between 2010 and 2022. However, comparing the rate over a three-year average shows a smaller reduction of 10.1%. My goodness! Though it is decreasing, it is still there with a vengeance. The neonatal mortality rate has been higher in Northern Ireland than in any other UK nation since 2013. It is equally bad wherever it is, but I am just making the point that Northern Ireland has examples of it that are above the rate anywhere else.

I thank my hon. Friend for his powerful speech. This is certainly a debate that resonates with me on a very personal level, but I want to make mention of a little boy called Teddy from my constituency of Upper Bann, who died from sudden infant death syndrome. He will be forever seven weeks old. Does my hon. Friend agree that we need better wraparound services, particularly in our hospitals, with rooms made available for families who find themselves in these most tragic circumstances? There should be support, counselling and help right through their grief journey.

I thank my hon. Friend and colleague for that intervention. What she says is absolutely true.

I tend to be emotional at the best of times, but whenever someone loses someone, particularly at that time, it resonates with everyone. It is a time when people want to wrap their arms around them, because it is the right thing to do. At the same time, there has to be someone outside. The hon. Member for Ashfield gave some examples where—with respect—people were just sent home when they needed someone. That is so sad. I feel that there should be a greater role for churches and ministers to help and, as best they can, to give succour and support physically, emotionally and mentally. Those are things that we have probably all tried to do.

Unlike stillbirths and neonatal deaths, the total number of miscarriages and miscarriage rates are not reported in Northern Ireland. That needs to change. It is a matter for us back home and not the Minister’s responsibility, because health is devolved, but I do feel that we need to do better. I still feel that the aims in the mainland should be replicated. I know that the Minister is sitting in for another Minister who cannot be here, but maybe it could be conveyed to the responsible Minister that we should look at an overall strategy for the whole United Kingdom of Great Britain and Northern Ireland.

Although there is an ambition in England to halve the 2010 rates of stillbirth, neonatal death, pre-term birth, maternal death and brain injury by 2025, there is no equivalent ambition in Northern Ireland. There really needs to be one; that is one thing that I would love to see. Sands states:

“The Northern Ireland Executive must commit to reducing pregnancy loss and baby deaths and eliminating inequalities. Any future targets must have a clear and agreed baseline to measure progress against.”

It is not just about having a goal; it is about having a goal that means something. With respect, we can have words until the cows come home, but they mean nothing unless they turn into action. Sands further states:

It is a pleasure to serve under your chairmanship, Mr Dowd. I thank the hon. Member for Ashfield (Lee Anderson) for securing this important debate and for his moving opening speech. My thanks also go to Bliss for the briefing that it provided.

This is an incredibly important debate for me and, I have no doubt, for all of us here today. As some Members will know, I—like many others here today, sadly—have experienced the devastation of baby loss. Having not spoken about my experience of baby loss until 2016, 11 years after I became an MP, I know how difficult this can be to talk about openly. I want to thank all colleagues for being here, some of whom have personal motivations, as we have heard.

I want to tell you a little bit about my daughter Lucy and about my experience of baby loss. My daughter Lucy was born at 23 and a half weeks, and sadly she was stillborn. Her heart beat throughout my labour until just minutes before she was born. The experience of giving birth to a stillborn child is incredibly traumatic, as we have heard and as I have spoken about previously. It feels weird that the world around you is not responding as it would if you had given birth to a live baby. I felt that I made everyone around me, or anyone I met, feel very uncomfortable: it is one of the last taboos, as the hon. Member for Clacton (Nigel Farage) spoke about. No one knows what to say to you when you have lost a baby or given birth to a stillborn baby—it is everyone’s worst nightmare—so I did not talk about it, and I certainly did not tell anyone new to my life who had not known me before I lost Lucy. When I became an MP in 2005, it took me until 2016 to actually talk about it in this place, or to anyone from my post-baby-loss life.

What compounded this grief was the fact that Lucy did not receive a birth or death certificate. Even more upsettingly, in my records it was not recorded as a stillbirth; it was recorded as a miscarriage. Because she was just days away from being 24 weeks, she was three or four days short of the required legal age to be eligible for a death certificate. Because of that, she does not officially exist in any official records other than our own family records.

I thank the hon. Member for the moving real-life story that she has told. I commend her and her colleagues for their efforts on baby loss certificates. Does she agree that a greater effort needs to be made in the devolved regions—I am thinking of Northern Ireland—to replicate what is happening here in England with baby loss certificates, such is the importance of the issue for families?