'My baby should be alive'
Ella Harman survived for only one week. Yet her death need never have happened. For her parents, it was a tragedy – and thousands of other families every year face the same agonising loss. Kate Hilpern reports
Tuesday 21 April 2009
There is no good reason why Ella Harman should have survived for less than a week. Her mother, Katie, had a completely smooth, low-risk, full-term pregnancy and apart from Ella's breech position right at the end – hardly uncommon or indeed dangerous, provided it's picked up and dealt with accordingly – everything pointed towards the arrival of a healthy baby girl. "I had the perfect pregnancy – it was straight out of a textbook," says Katie, 29. "I was very relaxed – I had no reason not to be."
A catalogue of errors made by medical staff during labour, however, led to Ella being starved of oxygen at birth and joining the 17 babies born a day in the UK who are either stillborn or die shortly after birth – deaths which a new report by the charity Sands (Stillbirth and Neonatal Death Society) has found could in many cases be avoided. "Even the neonatal staff – who were absolutely brilliant – were blown away by Ella's need to be there," says Katie. "All the other babies in the incubators weighed no more than a bag of sugar, most having been born prematurely. Ella was 7lb 9oz."
Unlike cot death, which now sits firmly on most parents' radar, stillbirth and neonatal death remain taboo. Most of us – even when pregnant – don't think about it, let alone talk about it. And yet the numbers – almost 6,500 a year – are ten times that of cot deaths, a rate that has remained almost unchanged for 10 years. "It certainly wasn't something that crossed my mind," says Katie. "If you get past the 12-week scan, and then the 20-week scan, with no problems, you start to feel pretty confident. You think of things like the baby being born prematurely and of issues like pre-eclampsia, but if you get to near 40 weeks, you can rule those out, too. And even if the thought of your baby dying does enter your thoughts for the very briefest moment, I think most women would assume there'd be a medical reason for it – not something that would happen because of negligence, not in this day and age."
Katie's pregnancy with Ella was her first and while Katie and Ben's plan was a hospital birth, they wanted as little intervention as possible. "So when I was a week overdue and my midwife offered me a membrane sweep to help bring on the baby, I declined. I wanted, if at all possible, to wait for the labour to happen naturally," says Katie.
Sure enough, on the morning of Tuesday 3 October 2006, when Katie was almost two weeks past her due date, she started to feel contractions. "By about 10pm, when they were happening every 20 minutes, I decided to call the hospital. I'd heard that September had been so busy that the labour ward had to be closed a few times and I'd been advised just to check in and say, 'I'm in labour and at some point I'll be coming in'."
By 5am the following day, when the contractions were coming every five to six minutes, Katie called again. "I was told I didn't sound in enough pain to be in advanced labour," recalls Katie. "I was told I should go and have a bath."
An hour later, she could hold on no longer. "Ben phoned a third time, only to hear that the labour ward was full and that they needed an hour to juggle beds. So we finally left the house just after 7am, by which time I was feeling this awful pushing sensation. When we reached the ward, we were taken to a room by a very young midwife who said they might need to send me home again. I just said, 'No way'."
The midwife – who, strangely, the hospital still have not been able to identify – explained that in 20 minutes time, at 8am, she'd be off-duty, so it made sense to wait for her replacement midwife to do a full assessment. "Finally at 8.45am – nearly an hour after I'd arrived – I had my first vaginal examination. The midwife broke my waters and found meconium, which can be sign of foetal distress. So she called in the registrar."
When the registrar did her own examination, Katie remembers her turning white, looking around the room and saying, "Who examined this woman? She's fully dilated and the baby's coming out breech." The panic button was pressed and an obstetrics team was called in. Although Katie had read that a caesarean section was usual practice for a breech birth (and the hospital later said it may have increased Ella's chances of survival), she says the obstetrician warned her off it, pointing out a number of risks, notably that by the time she'd been prepped, the baby would probably be coming out naturally anyway. "We weren't told about any risks of delivering a breech baby naturally, of which we later learned there are many," says Katie.
The delivery was difficult, not helped by the fact that the obstetrician who decided on the natural delivery left the room and that the registrar – who, they later learned, lacked experience in vaginal breech births – used the wrong forceps.
The placenta came out first, compressing the umbilical cord, and by the time Ella was handed to Katie, she was grey. "They put tubes in her and tried to resuscitate her but then they just waited. I screamed out, 'What's happening?' and was told they weren't trained – that they needed to wait for someone who was. I remember thinking, 'Well, just shout out!' But they just waited. When the neo-natal expert arrived, she confirmed Ella was very sick and rushed her down to the neo-natal ward."
It was four hours before Katie and Ben were told anything more, at which point the neonatal team mentioned the very real possibility of death. When Ella made it through the night, Katie and Ben started to regain hope, but as the days went on, Ella's heart rate and ability to breathe decreased dramatically. "I think Ben and I must have said goodbye to Ella on 30 different occasions," recalls Katie. Finally, at 5am on Monday, everyone agreed that Ella should be unhooked from the machines. "We were allowed to go to a private room with her, where we changed her nappy and put on a new item of clothing. At 7.20am, she died peacefully."
Over the course of Ella's short life, Katie and Ben took more than 250 photographs, some of which are in photoframes dotted around their Clapham home, while others are neatly displayed in a pink photo album, which Katie still kisses every night before she goes to bed. "We took handprints and footprints and I still sleep with her babygrow in my bed," says Katie. "I know we have a lot more than some people who lose their babies do. But none of it can bring her back and for months, I couldn't get my head round that. Most days, I couldn't get out of bed, let alone go out of the house. Everyone seemed to have a baby except me and none of my friends knew what to say. It was a very isolating time."
Katie and Ben were offered counselling by the hospital, but it turned out the counsellor had no experience of dealing with parents of deceased babies and even the local bereavement service couldn't seem to help. "I needed to talk to other women who had gone through this and that's how the charity Sands turned out to be a lifeline."
Katie and Ben's grief was not helped by what turned out to be a two-and-a-half-year legal battle with Chelsea and Westminster Hospital which only last month culminated in them accepting full responsibility for Ella's death and paying compensation. "They accepted negligence in a drip-by-drip fashion and that was really hard. It wasn't just that we needed them to admit it – it was also the fact that we wanted them to learn from their failings and to make sure no other family experiences the same lack of care."
Katie and Ben now have another child, Zac, aged 15 months, who was born at home with the aid of an independent midwife, and Katie is due to give birth again. "It's wonderful to be having more children. Zac is fantastic and I'm very excited about the new baby. We are moving on, but that is very different from saying everything is ok," says Katie.
In fact, Katie and Ben's experience is typical of Sands' latest research, which found that 81 per cent of parents suffer depression and reduced confidence, with a third saying the loss of their baby had affected their marriage or relationship. "How can it not?" asks Katie. "Men and women deal with things very differently."
Then there's the financial impact, with 48 per cent of parents saying the death of their baby resulted in them or their partner being less effective at work, which has a negative impact on their careers. "I had to drop down to a three-day week in my advertising job, and Ben, who is freelance, obviously found it almost impossible to work some days."
Katie and Ben want what most parents like them – and indeed Sands – do: a culture of continual risk assessment within antenatal care; better resourced maternity and neonatal services that would lead to things like continuity of midwifery care during pregnancy; more funding for research; and greater awareness among prospective parents and healthcare professionals of the extent and risk of stillbirth and neonatal death.
"If I'd have had a simple routine scan at 36 or 37 weeks, they'd have picked up the breech," says Katie. "If I'd have had the same midwife throughout my antenatal care, she probably would have picked up the shape of the bump changing. If I'd have been more aware about the possibility of neonatal death, I may have demanded more than I did during labour. If the hospital had been more aware, they would no doubt have been more careful. The list goes on, but then again, I can't spend my whole life pressing a rewind and pause button in my mind."
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