Mum Been To 'Hell And Back' After NHS Errors Caused Death Of Newborn Son

Medical Law Experts Secure Admission Of Liability From NHS Trust

25.07.2014

The mother of a baby boy who died shortly after being born because ‘unforgiveable’ errors made by maternity staff caused him to suffer catastrophic brain damage has spoken of the huge gap her son’s death has left in her life.

Reece Noad-Caine was starved of oxygen for over 10 minutes because the midwifery team at Leeds General Infirmary failed to put an appropriate care plan in place for his delivery in November 2011, despite mum Joanne Noad being high-risk due to complications with the birth of her previous child.

Medical law experts at Irwin Mitchell, instructed by Joanne to investigate her loss, found a catalogue of errors were responsible for the tragedy and following the conclusion of a five-day inquest into Reece’s death today (25 July), confirmed for the first time that Leeds Teaching Hospitals NHS Foundation Trust has made an admission of liability.

Expert medical evidence commissioned by the leading law firm found that Joanne’s midwife noted shoulder dystocia (when the shoulder gets stuck behind the pubic bone) had been a factor in the birth of Joanne’s son, Aaron born November 2006 however she was still wrongly categorised as low risk in an appointment about her pregnancy with Reece.

Had this been correctly noted, Joanne, from Leeds, should have been referred for regular growth scans and offered the option of an induction of labour before Reece reached full-term and full-size or caesarean section

The inquest at Wakefield Coroner’s Court recorded a narrative verdict and Assistant Deputy Coroner Melanie Williamson said: “The clinicians failed to evaluate the pregnancy as high risk which meant that there was a poor plan in place for the birth.”

She added that had Reece been delivered on or before 2.47am, instead of 3.09am, he would have survived.

Rachelle Mahapatra is a Partner and medical law expert at Irwin Mitchell’s Leeds office who represents Joanne.

Expert Opinion
Reece’s death has had a devastating effect on Joanne’s life and she has been to hell and back trying to understand why more wasn’t done by midwifery staff to help her son.

“The admission of liability gave Joanne some accountability but she understandably wanted a thorough investigation for Reece’s inquest to ensure no stone was left unturned in getting to the bottom of exactly what went wrong.

“We hope that now the hearing has concluded she can begin the process of rebuilding her life.

“We would also like to see confirmation from the Trust that the root causes identified in its own internal investigation following Reece’s death have been learnt from to ensure no other mother has to go through the same horrendous ordeal.”
Rachelle Mahapatra, Partner
Joanne, 30, added: “The loss of Reece in 2011 is still very raw, not just for me, but also my two children one of whom was nine at the time and the other who in fact had his fifth birthday the very day after Reece died.

“Losing a child is hard enough but in Reece’s case having to wait over two and a half years for the inquest and having to fight for answers has made it even more distressing.

“I have lost a perfectly healthy child which again makes it even harder to come to terms with. Knowing that people who I trusted to care for me and my baby used assumptions and their own judgement calls and did not always follow NHS guidelines of good practice, is very hard to accept.

“Being involved with Irwin Mitchell has helped me gain a better understanding of went wrong and has prepared me better for the inquest. It has meant that independent experts were able to look over my notes and point out where there were flaws in my care.

“I have heard that certain procedures have been introduced and altered as a result of this tragedy and for this I am grateful as I hope they ensure that women are given nothing but the best maternity care. Nothing should be taken for granted during pregnancy or labour and risk needs to be managed appropriately, not dismissed as in my case.

“Women need to be better informed of what problems arise during delivery in a discussion with staff prior to discharge. Until Professor Steer gave his evidence in court this week I had no idea what had happened during labour with the baby I had prior to Reece. All I knew was that it was traumatic. 

“When I visited the consultant Dr Bramara Guruwadayarhalli I was seeking answers about my previous labour, she did not have my notes and made no effort to call me back to an appointment where she would have them. In this situation she simply went from what I told her which was limited as it was indeed not until Professor steers evidence this week that I knew exactly what had happened in labour with my previous baby.

“Communication really is key and all I can hope for the future is that staff are more aware of the need to liaise with one another and manage risk appropriately.”


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