One Born Every 40 Seconds Panorama

We're in the middle of a baby boom. No. Push, push, push. That's it.

There you go. Last year, there was one born every 40 seconds, the

highest number for nearly 20 years. That's the baby's head out, darling.

All pregnant women are meant to have a choice of safe, high quality

maternity care, but in some parts of the UK the reality is quite

different. Sometimes I think if they'd done it the other way round

There he is, half an hour old. I have been through childbirth twice,

and each time I was lucky enough to have great midwives who gave me

their full attention throughout labour. But in too many hospitals

that's not happening. As the number of births soars they're also

becoming more complicated, there are more older and overweight mums

and with IVF more twins and triplets. Add to that a chronic

shortage of midwives and some maternity units are struggling to

cope. Heather Paterson was 40 when she

became pregnant with her first child. It was a happy surprise for

her and her husband. I remember us taking photographs of the pregnancy

test, we were so excited. Every day was like that, it was excitement

seeing him develop through the scans. The number of women over 40

having children has almost trebled in the last decade. Heather's age

should have meant special care. When she was nearly two weeks

overdue she arrived at the Royal Free Hospital in London to be

induced but she was sent home because it was too busy. Did it

come as a surprise to you that you turned up and were told there

weren't enough beds? Yes, it was a major London teaching hospital and

we turned up when they asked us to come. We were booked in and they're

sending us away and not only send us away, they joked there's no room

at the inn. The unit was still busy when they came back, the first

midwife Heather saw gave her twice the recommended dose of drug to get

induction started. This meant contractions painful. Later a

second midwife kept leaving Heather to attend to another woman. She

asked Ian to keep an eye on the machine monitoring the baby's heart

rate. The midwife said to me I am a little concerned. The heart rate

has dipped a little bit. I need to go out, here's a call button. If

that monitor dips below 100 press it. Were you surprised she didn't

stay to monitor it? To be honest, I was so focused about watching it

and she panicked me because she said I am a bit concerned about

this, will you watch it? It's our first time having a baby. She's the

expert. Iain says he called the midwife when the heart rate dipped

on three occasions but still she didn't stay or get a doctor. It was

three hours later when the baby's heart rate couldn't be heard a

doctor was called. The delay starved baby Riley of oxygen.

no idea until Iain came over and told me that he didn't make it. I

was a healthy woman. I had a healthy baby. And so you expect

that you'll walk out of that hospital the next day with your

child. And to not do that was devastating.

Instead, they had to arrange Riley's funeral. They filmed it for

Heather's family back in Australia. We will feel his presence always.

For me personally, Riley and his existence literally saved my life.

At the inquest a jury ruled that neglect contributed to Riley's

death. The hospital apologised and paid compensation. But Ian and

Heather were unhappy that the two midwives involved were allowed to

continue working with additional training. So they complained to the

midwives' governing body. Today is the first day of the disciplinary

hearing. It's been more than six years since my son was killed and

it's also been about four and a half years since I put in a

complaint against the midwives and I really - I am angry that it's

taken so long. Ed first midwife didn't attend the hearing. She was

suspended for 18 months. The panel heard the critical period when

Heather's baby could have been saved was in the early hours of

Good Friday when the labour ward was understaffed. As the labour

ward co-ordinator the second midwife Beverley Blankson shouldn't

have been caring for Heather while looking after another woman in

labour. It was her duty to call in extra staff if she needed them.

There were eight mothers and five midwives that night. One phone call

she could have had extra midwives. The panel found Beverley Blankson

failed to monitor properly the baby's deteriorating heart rate. It

ruled her fitness to practise was impaired but won't decide until

September whether she should be disciplined. The Royal Free

Hospital Trust told us it has reviewed and fundamentally changed

many aspects of its maternity service and increased staff numbers

since Riley's death. Beverley Blankson wasn't willing to comment.

It may have been a blip. I don't know. But as far as I am concerned

she is partially responsible for the death of my child and I don't

really think that someone who couldn't spot problems or the tell

tale signs is still someone who probably should not be dealing with

women. In its findings the panel said it was concerned that despite

considerable further training, even at the hearing midwife Blankson

still didn't recognise that the baby's heart monitor printout was

abnormal. Beverley Blankson still works as a midwife at the Royal

Free. Failure to monitor or respond to an abnormal foetal heart rate is

a mistake that's being made in other hospitals over and over again.

We've discovered that the number of negligence claims against the NHS

for that reason increased last year alone by nearly 20%.

Electronic monitoring of the foetal heart rate is not new medical

technology. It has been around for 20 plus years. It is worrying that

there are still failures to properly interpret and to respond.

It's terribly depressing when we see the same things happening time

and time again and lessons apparently not being followed

through, not being learnt within the NHS.

The Royal College of Midwives says it's hardly surprising, by its

calculations at least 4,700 more midwives need to be employed across

England and Wales to provide a safe service. Most midwives get up in

the morning wanting to do a really good day's work. They want to give

the care that they've been trained to give, many of them achieve that

and for the vast majority of midwives who don't manage to

achieve that I would very strongly argue it's because the system is

not supporting them to do the work they're meant to do. A recent

survey of NHS maternity staff in England found that only half were

satisfied with the quality of work and patient care they were able to

deliver. More than 90% had reported incidents,er rors or near-misses in

the previous month. Women don't come in tidy numbers when they're

pregnant but the problem for midwives now is that the pressure

is relentless and none of us can really keep our standards as high

as they should be if day after day we're working under extreme

pressure. Are things really that bad? We carried out an exclusive

Panorama survey writing to every maternity unit in the UK. 171 in

total, almost 90% replied. We asked what the midwife vacancy rate was.

In Wales and Northern Ireland it's below 1%. In Scotland, just above

1%. Our survey showed England's vacancy rate is nearly 5%. But in

some London trusts the rate is as high as 19 or 20%, that's one in

five posts lying vacant. Before the last general election David Cameron

pledged 3,000 more midwives for England. So we asked the Department

of Health how many new posts have been created since May 2010. They

don't collect that information. It's not just babies that are being

put at risk when hospitals are overstretched. It's women, too, at

a time when the number of women whose pregnancies are considered

high risk is on the rise. Clever girl, aren't you? Mummy's going to

chase you! Caroline Hardy suffered from a painful pelvic condition and

needed special care throughout her pregnancy. By 38 weeks I was in

hospital because I just couldn't make it from one room to another in

the house without being crippled with pain. She went to Wythenshawe

Hospital in Manchester for an induction but it was delayed

because the unit was so busy. When the labour didn't progress, she was

rushed for a Caesarean. But another woman needed to go to theatre at

the same time. There was a bit of an argument as to who needed to go

to surgery now because there was obviously another lady who needed

to go and I only won because I was halfway to the surgical room and I

was prepped. Sometimes I think well if they'd done it the other way

round would things be different, but... It's OK. It's upsetting to

go through it again. Take your time. It's because, not just the surgeon,

but the team had so much pressure on them to prevent something worse

happening to the lady waiting, that something was missed. Caroline gave

birth to a daughter, Tali but when she was sewn back up a large piece

of placenta was left inside her. Caroline thinks it's because of how

busy the staff were. I think it played a huge part because it was

such a big mistake to have made, it's not something that happens,

it's not a daily occurrence. Three weeks later Caroline collapsed and

had to be rushed to hospital for emergency surgery. I am quite lucky

that I only had another haemorrhage, because I could have had

septicaemia, I could have had infections, I could have died,

could have had a million and one things happen to me. University

Hospital of south Manchester Trust confirmed that the piece of

placenta shouldn't have been left inside Caroline. It apologised for

the error and any distress and worry caused. Milton Keynes

Hospital and Kerry is about to have her first baby with partner Che.

am going to put the bed up... Midwife Rachel has been assigned to

care for Kerry throughout her labour. You are a good 7-8

centimetres which is good, the head is high so I am going to have a

word with the doctor, we don't want the waters going and the cord

coming down. Rachel uses an electronic monitor to hear the

baby's heart rate so make sure it's not in distress. The heart rate can

dip down and that's normal at certain parts. Milton Keynes hasn't

always been able to offer such a high level of care. Three years ago

the unit was understaffed. The local coroner called the situation

scandalous after three baby deaths he felt could have been prevented.

Broadly morale was low. There has been for a while a shortage of

midwives in this country and Milton Keynes was not particularly

successful in attracting midwives that there were. With a shortage of

qualified English midwives the hospital has had to look abroad to

recruit. In four years it's boosted numbers by more than 30. Now the

hospital says it's the only one in England that can show it gives one

to one care to all women once their contractions are regular and

they're in established labour. push, push. Keep going, keep going,

keep going. So you just phoned the doctor. He will come and review,

she's been pushing for an hour now so we get the doctors to review.

she tired? Yeah, exhausted now. Might you do something different?

Don't know, he will say carry on or Keep it coming. That is it, well

done. Yes, we did have a baby. was it? Cor... You forgot to check!

I had better check! A baby boy! boy, thank you. And this is they

been made. You must be so proud. You must be exalted as well. But

was hard going, wasn't it? Yes. Milton Keynes has managed to turn

its maternity servers around. Our Panorama survey shows that they

still had 18 vacant midwife posts and they do not always have enough

beds to cope with demand. It turns out we have arrived on a pretty

busy day. The maternity ward has actually had to close its doors to

new admissions, and that means two women have already been sent to

other hospitals more than 20 minutes away. It is a difficult

balancing act for the head of midwifery -- midwifery. To

guarantee one to one care, she sometimes asked to deny women their

choice of where to give birth. Isn't that disappointing if they

have been hoping to come to this hospital? It is, and it is for us,

too, because we would like to provide that care, but it is

important they get appropriate care, and if it is best for them to go

elsewhere, that is the right thing to do for them. In our survey, we

found that Milton Keynes had to shut its doors on 14 separate

occasions last year, mostly due to under staffing. Rosie Hospital in

Cambridge, though, closed 28 times. In Leicester, both maternity use

its closed more than 50 times. In Nottingham, both units closed at

the same time on five occasions. But the unit that closed its doors

most often was Barnet Hospital in London. Over 100 times last year.

Across the UK, we found that maternity units were forced to

close 1055 times last year, nearly always to do under staffing or

overcapacity. That meant that at least 927 women have to be turned

away. To turn up at the place you were expecting to have your baby

and be told, well, I am sorry, you have got to go down the road to a

different unit, I just think that is not a high standard of care, and

it should not be what we are giving 32 babies were delivered at Milton

Keynes over the two days the unit was closed to new admissions. The

average would normally be nearer 23. Those women who were not turned

away, though, were delighted with their care. How have you found your

care here? What was it like? Excellent from start to finish. We

had a very traumatic time on Sunday evening getting easier. She was in

distress and had to be delivered very quickly. We cannot fault the

care that we have received here. Staff have coped well when so many

babies born over a challenging 48 hours. What has that been like for

all of you? I have delivered four of them. Four in two days. That

sounds like hard work. Yes! It is lovely, though. Milton Keynes may

be operating safely now, but that is not always happening elsewhere.

London has seen a huge rise in births, 16% in five years. Many of

those have been high risk, leaving some maternity units struggling to

cope. The NHS in London became concerned when it notice that the

number of maternal deaths in the first half of 2009 was as high as

the whole of the previous year. A confidential inquiry was launched,

and we have been given exclusive access to its findings. The

conclusion is shocking. 17 deaths over an 18 month period could have

been avoided if the women had been Professor Trish Morris-Thompson is

NHS London's chief nurse. She is also a practising midwife. The MBE

were a number of opportunities to prevent death occurring, and

because of that we have taken enough action across the

organisations in London, and we will continue to do so to put right

those actions. That is pretty damning. These women could still be

alive if they had been given the proper standard of care. And in

some of those cases the report indicates that the less than

optimal care was given and death did occur. However, we need to look

at the context of those 200,000 births occurring in that period of

time. A lot of women in very poorly conditions were cared for, and a

lot of babies were delivered very safely. Of the 42 mothers who died,

half were from deprived backgrounds, two-thirds from ethnic minorities,

and some have not sought maternity care until late in pregnancy. That

was not the case for Suzanne Valentine, though, who had regular

check-ups, a partner in a London law firm, a mother later in life

through IVF. She was one in a million more than anything. She was

just an incredible person. Their good points were probably my weak

points, and vice versa, so it worked really well, really well as

a team. At 47, Cezanne was classed as high risk, but like her first

two pregnancies, this one had gone smoothly. -- Suzanne. To the end,

she was sort of glowing, really looking forward to having a third

child. One week before the due date, though, a scan confirmed the baby

had died. She had to be induced. Afterwards, Stephen got a chance to

hold his daughter, Georgianna. had about 40 minutes were third. --

with her. Yes, I had 40 minutes. When I left, I left the room at 20

past, around about 20 past two in the morning because the crash team

had been caught. As Stephen grieved for his daughter, his wife went

into cardiac arrest. She was losing huge amounts of blood but staff

could not work out why. They did not call a consultant obstetrician

straight away. He arrived an hour later and discovered that her

uterus had ruptured. He stopped what they were doing and tried to

fix the tear. Maybe if the consultant had been there quicker,

do you know, if the consultant had been in the hospital, things might

have turned out different for Suzanne. She died soon afterwards.

The hospital's own investigation was critical that a consultant

obstetrician had not been called earlier but concluded it would not

have saved there. By that stage, the damage was done. At the inquest,

the coroner criticised the high dose of Labour and using drugs she

had been prescribed, 16 times what is recommended. This increased

their risk of a ruptured uterus. How did you feel when you realised

that? I was angry, a bit shocked. Devastated, disbelief. It is still

very raw, and it is still very upsetting, you know, but I have two

other children but still get up, they want their Coco Pops and Ready

Brek in the morning, so they have still got to go to school, so you

have to sort of deal with it, and you have to get on with your day.

St George's Healthcare NHS Trust told us it had used similar doses

of the drug given to Suzanne since 2003 without any serious

complications. It has now revised its guidelines. The trust also says

it has improved training to ensure that staff seek a higher level of

clinical leadership at the correct time. When things do go wrong, it

is crucial that any inquiries carried out afterwards are thorough

and objective to make sure that lessons are learnt. But the review

of maternal deaths in London found that is not always happening. Of 29

serious incident reports scrutinised for the review, a panel

of experts only agreed with the findings in 12. It found that many

reports were defensive in nature and disagreed with six that

included the woman's death was inevitable. The panel said

different management and earlier diagnosis could have changed the

I think the most worrying thing that comes out of this report is

the suggestion that lessons are not being learnt. I would agree, having

read the reports, and prior to the publication of the independent

review, we were working at the organisations to say, this is not

good enough, you need to have a more robust response to the report

and it needs to be more extensive. While some London hospitals are

stretched to crisis point, elsewhere the picture is quite

different. To write a save maternity service, the Royal

College of Midwives says there should be an average ratio of 1 to

28. -- to provide a safe maternity service. We have found that

midwives deliver more babies, with a ratio of one midwife to 33 births.

In Wales, it is one midwife to 30 births. Northern Ireland has one to

just under 28 birds. In Scotland, though, there is an average of one

midwife to just 26 berths. Here in Scotland, there is no midwife

shortage. There are currently only 20 posts lying vacant across the

whole country, which means that in hospitals like this one they can

offer mothers the undivided attention of a midwife throughout

Hannah Fox is expecting her 4th baby. She is being induced, and

midwife Doreen will be with airside every step of the way. I will just

have a listen to the baby again. Just check that she is nice and

happy. There she goes. Do you think it makes a difference to you?

huge difference. I had my two old as children in a different hospital,

and the midwife was hardly ever in the room, and it was really

frightening. Hannah is one of just 19 women giving birth here today.

Thorpe Park Hospital deliver slightly fewer babies than Milton

Keynes every year but employers 35 more midwives. There's only one

vacant post. When you look down south and DEC vacancy rates are 15%,

what do think about the service they can offer? I feel that for my

colleagues working in situations like that, it must be very

difficult to actually provides the One 2 One service and the 1-1 care

that you would want to provide. It must be very hard and challenging

to work in those circumstances. After a long, tiring day in labour,

A new life is about to emerge. There you go. Congratulations. Oh,

she is just beautiful! Maternity care here may be the envy of their

southern colleagues, but for how long? The Scottish government has

pledged to protect frontline services, but public spending cuts

of nearly 8% are expected in the coming years. I just hope our

politicians listen to the women and listen to the staff and the

midwives, obstetrician as he will advise them about safe levels and

staffing levels required for their units. Ian and Heather Havard two

more children, but they will never forget their first son. -- have had.

It is a very poignant message that you chose to have carved on the

bench, lived for 35 minutes. Is that hard for you, even today?

is hard to know that you have what should be a perfectly healthy baby

and then everything goes wrong. But you know, you never stop loving

that baby, and every single day I With one baby born every 40 seconds,

there will always be times when things go wrong, but the care of

women receive should not depend on where they live or what time they