Royal Derby Hospital: 'Shortcomings' led to newborn baby's death

Parents Jodie and Ben Blackwell paid tribute to their son at the hearing

A baby boy who died a day after being born would have lived had he received adequate hospital care, an inquest has heard.

Ethan Blackwell was born at Royal Derby Hospital in May 2021 and died 32 hours later after suffering brain damage.

The trust that runs the hospital admitted he should have been delivered by Caesarean section seven hours earlier.

It apologised to Ethan's family at the inquest into his death on Wednesday.

His parents, Ben and Jodie Blackwell, aged 31 and 23, told Derby Coroner's Court how the heartbreak of Ethan's death still haunts them and how it has impacted their career aspirations and confidence, reports the Local Democracy Reporting Service (LDRS).

The court heard how Ethan died in his mother's arms

A statement read out on behalf of Mr Blackwell said, "the poor midwives were running around like headless chickens; it was so busy".

He also said doctors had told them the maternity unit was "understaffed".

Mr Blackwell's statement added: "I feel I am a failure of a father and that I am to blame. I see the same scenes again and again. I just burst into tears and have breakdowns where I cry and scream."

Dr Sophie Stenton, who carried out the post-mortem on the baby, told the hearing that the leading cause of death was a "very severe hypoxic brain injury".

This caused Ethan to be born with almost all of his organs having already failed and major brain damage.

The inquest heard the University Hospitals of Derby and Burton NHS Foundation Trust agree with a report's recommendations that said there were a number of "missed opportunities" in the lead-up to to the baby's death.

'Shortcomings'

The court heard that the emergency buzzer was pulled twice at about 03:00 and 05:00 to alert staff to issues relating to his heart rate.

But, discussions about an emergency Caesarean section were dismissed when the rate reduced back within normal thresholds.

Signs of infection were also present, with Mrs Blackwell looking "very unwell", the LDRS said.

A pessary - a tablet on the end of a ribbon aimed at preparing the cervix for labour - fell out of Mrs Blackwell twice and was readministered.

However, on one occasion, it fell into the toilet bowl onto used toilet paper, but due to a "misunderstanding", was deemed hygienic enough to be readministered

The maternity unit at Royal Derby Hospital was rated inadequate in November

The couple's midwife, for the majority of their labour, said she would not have signed off on the reinsertion of the pessary had she known it had fallen within the toilet bowl.

"I am so sorry that you lost your little boy. Jodie, you were amazing, you too, Ben," she told Ethan's parents.

A spokesperson for the University Hospitals of Derby and Burton NHS Foundation Trust said: "We are profoundly sorry for the shortcomings in care that Ethan and Jodie received in 2021, and our deepest condolences remain with their family.

"We remain absolutely dedicated to making the changes we have committed to so that we continue to improve the safety of care we provide for parents and babies at our hospitals."

The inquest continues.