The Daily Telegraph - Saturday - The Telegraph Magazine
A new hope
The initiative to reduce stillbirths and injuries during labour. Mary Riddell reports
Each year 2,000 babies die needlessly during childbirth in the UK. Jake Canter, above, was one of them. Mary Riddell reports on how his parents, and other bereaved families, are fighting to make giving birth safe. Photographs by Laura Braun
As the ambulance rattled towards its destination, Rachel Canter told herself that she would not survive. ‘I thought I was going to die. The journey was horrific and the pain and the fear surreal.’ It seemed impossible, then as now, to connect what was happening to the tranquil beginning of a long-awaited day.
Rachel, a personal trainer in perfect health, had gone into labour wit h her f irst baby some hours before. She and her husband Andrew had chosen a new, midwife-led birthing centre near their home in Welwyn Garden City. They had asked what would happen should any thing go wrong and received a reassuring response.
‘Staff said we would be only seven minutes away on a blue light from Barnet Hospital,’ Andrew says. Against expectations, the baby’s heartbeat dropped, and t he midwives decided t hat Rachel should be moved as a precaution. It was only when the ambulance crew arrived that the Canters started to worry. Barnet, they were told, was ‘closed’, and they would be taken instead to a more distant hospital.
‘ That s eemed cr az y – a mil l ion mile s away,’ Andrew says. The 27-minute journey transpor ted the Canters from hope to a nightmare from which they have never fully emerged. Jake Canter was born in a side room wit h t he umbilical cord wrapped tightly round his neck.
Even as doctors tried to resuscitate his son, Andrew realised that it was too late. ‘I told Rachel it wasn’t looking good, and she was shouting, “Come on Jake, you can make it.” It was hideous.’ Twelve years have passed since Jake was stillborn, but tears still slide down his mother’s face at the memory of what happened and what might have been.
In the family’s modern Welwyn villa, a photog raph taken just after Jake’s birth hangs on the living-room wall. The hall wallpaper features dragonflies – the motif of the charity founded by the Canters to improve maternity care, and a symbol of the importance of even the briefest life.
Rachel and Andrew’s subsequent children. Ruby, nine, Mia, eight, and Theo, six, know they had an older brother, and the family often visits his grave. But Jake’s story is significant also to all those parents who have suffered at the hands of an unfair and often brutal system.
In modern Britain, thousands of babies still die needlessly or suffer life-changing harm. Many families, denied any explanation, see no option but to turn to the courts. Like Andrew Canter, t hey become accustomed to t he closed faces a nd ra nks of t hose who do not, dare not, acknowledge their mistakes. ‘My way of dealing with what happened was to campaign and get the answers,’ he says. But ca lls went unacknowledged, meet ings were ca ncelled, and it only emerged later that blunders had included mistaking Rachel’s heartbeat for her baby’s. As a result, the caesarean section stipulated in her transfer notes was deemed unnecessary.
The Canters eventually received a ‘five-figure settlement’ for their baby’s death and loss of earnings as t hey st r uggled wit h t he result ing t rauma. ‘But it wasn’t about the money. All we did was put it into the charity we had started,’ Andrew says. That organisation, the National Maternity Support Foundation, or Jake’s Charity, has campaigned ever since to ensure better maternity care. As its founders acknowledge, its work is very far from done.
A report published some weeks ago by the National Ch il d b i r t h Tr u s t a nd t he National Federation of Women’s I nst it ute s cla i med t hat half of women in childbirth in the UK are being put at risk, wit h ma ny cl a i mi ng to b e t reated ‘like catt le’ in understaf fed maternity units. Stories of babies damaged at birth are seemingly commonplace, and t he cost to t he st ate of result ing lawsuits is expected to reach £1 billion a year by 2020.
Change is urgently needed, according to Professor Sir Cyril Chantler, vice chair of the team behind the independent National Maternity Review, which calls for more personalised maternity care and a move – opposed by some lawyers – away from the current litigation culture to a nofault, rapid redress scheme for stillborn babies and fullterm infants damaged during birth. Under the status quo, some parents face years of delay before they win compensation. Others, unable to prove negligence, get nothing.
Not only does this tragic jackpot strike many doctors and lawyers as arbitrary and unfair, but by the time blame is accorded, the team at fault has disbanded and no lessons are learned. While Britain remains a safe country in which to have a baby, stillbir th rates in the UK are among the highest in western Europe. ‘If we had the same system as Sweden, 2,000 babies [who die each year] would be alive,’ says Professor Chantler.
With compensation claims for disastrous blunders in childbirth tripling in a decade, the Health Secretary seized on the Maternity Review’s proposal for a Swedish-style
‘I told Rachel it wasn’t looking good, and she was shouting, “Come on Jake, you can make it”’
Rapid Resolution and Redress (RRR) scheme, which would settle claims without recourse to the courts. In a speech last October, Jeremy Hunt set out plans for fast-track compensation and promised a consultation. That three-month process was launched in March in a step towards cutting legal bills and embedding the standards practised at the best centres in England.
In the skies above Southmead Hospital, air ambulances come and go. The sprawling campus on the fringes of Bristol looks no different from many other reg ional NHS hubs. Nor does the labour ward have an obvious claim to distinction, bar one. This is probably the safest place in the world to give birth.
‘Thank you for saving my family,’ reads a note displayed in the midwives’ room and sent by a father whose first baby was born in the unit a few days previously. The operation had gone smoothly and the new parents were admiring the infant when, without warning, the woman went into cardiac arrest. Where less experienced staff might have panicked, the Southmead team recognised a rare inflammatory response and reacted instantly. ‘If you miss the first opportunity, you miss them all,’ says Tim Draycott, the unit’s senior consultant. ‘That woman could have survived in many other units, but it was good that she was here.’
Fifteen years have passed since Southmead introduced PROMPT (Practical Obstetric Multi-professional Training) – a method of collaborative working and learning from mistakes that is now being implemented across the world. Since t hen, t he unit has achieved reductions of between 50 and 70 per cent in common bir th injuries. Draycott, a former doctor of the year, believes that ‘rapid redress is a good thing. All of us make errors. We all have a legacy of close shaves.’
In Draycott’s office lies the plaster replica of a baby that he developed to teach what to do if an infant’s shoulder gets jammed during childbirth. ‘You can deliver this one yourself,’ he says, passing me the model. ‘See how the top shoulder gets stuck. It’s like a lor r y going under a low bridge. The more you pull downwards, the more likely you are to get an injury. We see people making the same mistake over and over. They pull behind the baby’s elbow even though that might fracture the humerus.’
One of the most common consequences of such accidents is Erb’s Palsy, in which the nerves of a baby’s neck are damaged. Back in 2008, it was reported that the NHS was facing 246 claims for this condition alone for which £93.6 million had been set aside. ‘Most parents start litigation not for money but because they want the truth,’ says Karen Hillyer, who founded the Erb’s Palsy Group to help affected parents.
Halle Johnson-rose is 13, and her parents are still waiting for their court case to be settled. Hal le’ sm other, Louise, was 34 when her first daughter was born. She weighed 9lb 5oz and doctors struggled to deliver her.
‘She had bruising all the way down her arm, and it didn’t move at all. The consultant told me she had Erb’s Palsy. I had never heard of it,’ says Louise. Halle had the first of five operations at 12 weeks old. She has since spent two long stretches in a full-body cast in order to regain some use of a withered right arm and her childhood, though happy, is a chronicle of unfulfilled dreams. She has tried gymnastics, kick-boxing, musical instruments, ballet and break-dancing, and all have proved impossible. Meanwhile, Louise and her husband Darren are still waiting for compensation. Louise has been unwilling to seek to hasten t he process while doubts persist about whether Halle will require more surgery and what her ultimate needs will be. In the absence of a final settlement, the family has received only one small interim payment.
The rising cost sofa sclerotic system have al armed many lawyers. Sir Philip Otton, a former justice of appeal, deplores a ‘slow and costly’ process and endorses Jeremy Hunt’s attempt to introduce a fast-track alternative. Once you have eliminated t he need to prove negligence, Sir Philip believes it is possible in most cases to establish what happened ‘within months’ and to set appropriate redress. ‘The cost to the NHS of proving (or disproving) blame is extremely high and disproportionate.’
Elizabeth Pro ch ask a, a distinguished barrister, is another supporter of change. She believes that a Swedishstyle scheme would ‘unlock justice and help the NHS… One of the main problems [with litigation] is that it’ s totally arbitrary whether you are able to get compensation if a baby is damaged. A lot of families will never be able to prove to a legal standard that anyone was negligent.’
Meanwhile, lawyers continue to earn hefty fees. Sonia Macleod, an Oxford academic currently writing a book on personal injury claims, says that claims of above £1 million cost just 18 per cent of the settlement in legal fees. Where families get less than £10,000, the lawyers’ costs rise to 324 per cent, so a payment of £10,000 would cost £32,400 in legal fees.
Under a redress scheme, parents would retain their common law right to apply to the courts at any stage. As Macleod says, ‘There’s no plan to limit access to litigation. So you have to have a scheme that is attractive – partly by being an awful lot quicker when the delay between the point of injury and settlement is so horrendous. But also compensation payments will have to be sufficient.’
Introducing change will not be easy but many experts deem it essential. In an age of medical marvels, babies still suffer injuries and die, while the cost of legal settlements grows perilously high. It is now for government to decide whether a civilised society can afford the financial and emotional cost of such failure.
‘Rapid redress is a good thing. All of us make errors. We all have a legacy of close shaves’