Medical Negligence Lawyers Supporting London Parents

A grieving couple whose premature twins died are calling for lessons to be learned after an investigation report found “lapses in care” resulted in their death. 

Amber Lincoln and her partner Darren, of Woolwich, London, found out they were expecting twins in July last year. Amber was required to be under the care of a specialist clinic at Lewisham and Greenwich NHS Trust.

Two years earlier she had undergone a LLETZ procedure to remove cells from her cervix following a smear test which found abnormal cells. The procedure meant as her cervix was shorter, she was at risk of being unable to carry pregnancies full-term. 

Amber's cervical scan not arranged following IT issue

As part of her care, she should have had undergone a cervical scan by 16 weeks. However, this wasn’t arranged after an IT system allowed a staff member at an earlier pregnancy scan to select the wrong option. This cancelled an entry on the system that a cervical scan still needed to be arranged for Amber, an NHS investigation report seen by the couple’s legal team at Irwin Mitchell said. 

At subsequent appointments she also wasn’t referred to a specialist twin clinic, the report added. 

Amber, who had suffered two previous miscarriages since her LLEZT procedure, was admitted to Queen Elizabeth Hospital at 22 weeks’ pregnant on 22 November, 2022, with a three-hour history of back pain and contractions. 

Daughter Anaya was delivered breech at around 12.20pm the following day and brother, Mael, around 90 minutes later. They were pronounced dead shortly after delivery. 

Woolwich couple asks medical negligence lawyers for help following twins' deaths

Following their deaths, Amber and Darren, aged 34 and 36 respectively, instructed expert medical negligence lawyers at Irwin Mitchell to investigate their care and help them access the specialist support they require to try and come to terms with their ordeal. 

The couple are speaking for the first time about their loss. It comes after the Red Incident Investigation report by Lewisham and Greenwich NHS Trust, which runs Queen Elizabeth Hospital, apologised “for the lapses in care that resulted” in the couple losing their twins. 

It added that “the care pathways and system failures that contributed to their loss fall below our expected standards of care and we are very sorry that this happened.”

Lawyer urges Hospital Trust to learn lessons from tragic case

Expert Opinion

“This is a tragic case which has left Amber and Darren devastated.

“While the Trust’s investigation report has identified worrying issues in the family’s care, understandably Amber and Darren continue to have a number of questions about the events that unfolded.

“While nothing can make up for their loss, we’re now determined to provide them with all of the answers they deserve.

“In the meantime, we urge the Trust to learn lessons from the issues it’s identified to improve maternity safety for others.” Hannah Delahoyde

Baby loss: Amber's and Darren's story

Amber underwent a LLETZ procedure in November 2020. She was told she would have to undergo close monitoring during future pregnancies, as well as needing certain medical interventions, as the procedure meant she was at risk of miscarrying. 

Amber, who has a 13-year-old daughter, Jada, with Darren, miscarried at around six weeks pregnant in September and December 2021. 

Amber found out she was expecting again in July 2022 and self-referred herself to an early pregnancy unit as she felt a stretching feeling. 

A scan at nine weeks on 23 August confirmed she was expecting twins. She should have been referred to a pre-term birth clinic but she wasn’t, the Red Flag report said. 

An IT system allowed a medic to select the wrong option to record the scan findings. This subsequently cancelled an entry on the system that a cervical scan still needed to be arranged.

Amber not referred to specialist twin clinic

At a follow up community midwife appointment three days later, Amber wasn’t referred to the specialist twin clinic. 

Around a month later at a routine scan appointment, Amber also wasn’t referred to the twin clinic nor was it checked whether she had been given an appointment for a cervical scan. 

On 3 October Amber called community midwife team raising concerns that she hadn’t received a cervical scan appointment. Clerks were advised to book a cervical scan for Amber by 16 weeks. However, there were no appointments available by 16 weeks because of capacity. 

On 11 October, Amber attended a routine community ante-natal appointment. A request was made for a consultant review, including a cervical scan as Amber had not yet received an appointment.

Mum Amber's scan not reviewed on the day as they should have been 

Amber underwent the scan at 17 weeks on 20 October. An appointment for a consultant obstetrician review of the results was booked for 2 November. However, the report said Amber should have been urgently reviewed that day. 

The appointment on 2 November was cancelled and rebooked for 30 November because of an obstetric away day. At a subsequent routine appointment on 9 November no cervical scan was performed contrary to guidelines. Amber wasn’t seen by a consultant as she should have been, the report found. 

Amber attended Queen Elizabeth Hospital on 22 November complaining of contractions and lower back pain. She delivered her twins the following day.

Around two weeks after delivering her twins, Amber returned to hospital with abdominal pain and bleeding. She should have been taken to theatre to remove any leftover pregnancy products but was sent home with antibiotics, the report said. Amber returned to hospital two days later where she then underwent surgery.

Amber reveals devastation of losing twins

Amber said: “When we found out I was expecting again we were overjoyed. While Darren and I were nervous given my LLETZ procedure, we thought we were doing everything right by seeking medical advice. 

“We wanted everything in place to make my pregnancy run as smoothly as it could. The baby scans didn’t show any issues, but it felt like my concerns and the concerns doctors had previously raised connected to my LLETZ weren’t fully understood or listened to. 

“I felt that I went out of my way to raise these at the various appointments I had but it still felt like nothing was really happening and I had to always remind the medical staff or chase up for a cervical scan appointment. 

“When I started with back pain and contractions, I didn’t want to admit it but deep down I knew something was badly wrong. 

Family speak out in hope of improving maternity care

“Delivering Anaya and Mael was such a traumatic experience. The doctors in the delivery suite did everything they could to save them but sadly they couldn’t. It’s almost impossible to find the words to describe what it was like knowing Anaya had died before Mael was born. 

“The last few months and trying to come to terms with the events that happened have been awful. Sometimes I wish I had pushed even harder to be heard by the medical staff, but I know that I couldn’t have done or said anything more than I did. 

“We loved our tiny dancers, our hearts are broken that we can’t see them. We’re grieving the future that they would have had if they were with us, they’re terribly missed. 

“We’d give anything to turn back the clock and for things to be different but we know that’s not possible. All we can do now is share what happened to us to make other parents aware. By speaking out we just hope lessons can be learned as we wouldn’t wish what we’re going through on anyone.” 

Find out more about Irwin Mitchell's expertise in supporting families affected by issues in maternity care at our dedicated birth injuries section. Alternatively, to speak to an expert contact us or call 0370 1500 100.