Stillbirths: the deaths that don't count

Stillbirths / Film 1

All Siobhan Desmond wanted was to be a mum.

Her son Axel should be nine-years-old, just about to finish primary 5 and looking forward to a long summer break from school.

Instead, baby Axel never took a breath. He was stillborn in October 2001 – one of the 112 stillbirths in Northern Ireland that year.

Siobhan has battled ever since for answers and official recognition that her son should not have died.

Her case highlights the Catch 22 situation faced by parents of a stillborn child: that the system fundamentally does not recognise the need for these deaths to be investigated and for lessons to be learned when mistakes are made.

Siobhan’s only avenue for accountability was to sue the hospital whose care she came under. That took 10 years and the process concluded a few weeks ago without her even getting her day in court.

As is the case in most civil actions, an out-of-court settlement was agreed with the Western Health and Social Care Trust. There was no admission of liability on behalf of the trust.

What’s more: the payment only acknowledged injuries suffered by Siobhan in her labour and Caesarean section operation.

It took no account of the life or death of Axel; because he was stillborn, legally he didn’t count – even though he was alive, moving and had a heart rate up to the moment his mother was anaesthetised for the caesarean.

The financial deal was settled four days before long awaited court proceedings were due to begin.

Siobhan, who had been receiving legal aid, was warned that if she turned down the offer against the advice of her legal team she could face a massive legal bill if she went ahead and lost the case.

The trust will now pay £20,000 for Siobhan’s personal injuries and also her legal costs which still have to be calculated but are understood to be around £30,000. The settlement also includes repaying money to the government equivalent to the benefits Siobhan received because of her injures – approximately £60,000. Her injuries include Post Traumatic Stress Disorder (PTSD).

Axel couldn’t feature in the settlement. In order to be awarded damages for a death caused by alleged negligence, there has to be someone alive who subsequently dies. Siobhan’s son was stillborn and therefore never legally “alive” so there were no personal injuries to him and, as a result, no compensation for his death.

The outcome doesn’t feel like a victory to Siobhan. Her long legal fight was never about the money.

Instead she wanted to raise the issues surrounding Axel’s death in a public forum and is very disappointed that this will now never happen.

In an interview with The Detail, she said: “It was about having a day in court and challenging what some people had said about Axel’s death; some even blamed me.

“I wanted the facts to be set straight because over the years things got blurred around the edges. I wanted my reputation back as a person and not to be known as someone who was responsible for the death of her child.”

At the age of 37, Siobhan, from Derry, had been delighted to discover she was pregnant.

“I had a very strong, supportive family around me so whatever was going to happen it was going to be good,” she said.

“I really enjoyed my pregnancy. I was as healthy as a trout.”

She felt that the safest way for Axel to be delivered was to have a home birth, which would ensure she would have the attention of at least two midwives during her labour. However, when she went over her due date, the midwives put pressure on Siobhan to be induced.

“I was worried that I would be induced just for the sake of fitting in with a particular date but I was completely prepared to do whatever anybody needed to do to protect my baby,” she said.

Siobhan ended up going into labour naturally two weeks after her due date at home in Derry. She was supported through her early labour by midwives at home but Axel then became wedged against her public bone and it became clear that it would not be possible to deliver him naturally.

An ambulance was dispatched to take Siobhan to Altnagelvin Hospital.

“At this point Axel’s heart rate had been consistent and steady. It was monitored, it was fine,” she said.

“On the way to the hospital at the bottom of the Dungiven Road the ambulance paused and suddenly on the wee monitor his heart rate dipped to 67 beats per minute. My mum was sitting just opposite me, so she saw what was going on too and I knew this wasn’t good.

“The ambulance man went straight up to the guy at the front and with that the lights came on, the horns came on and within two minutes I was in Altnagelvin.

“In your head you’re thinking: ‘I’m going to have a baby, I’m going to be holding my baby in an hour, it’ll be fabulous.’ But they didn’t take me into the emergency room.”

Twenty minutes passed before the hospital staff began to monitor Axel’s heart rate and an hour and a half after arrival, he was born by an emergency caesarean section.

“From arriving as a blue light emergency, I sort of expected that doctors would run towards us but there seemed to be almost like a slow motion apathy thing going on,” Siobhan said.

“I kept saying: ‘Please, get him out, he’s in trouble’.”

Siobhan had to be put to sleep for the birth after a spinal epidural failed.

“My mum said when Axel came out there was no cry. She kept waiting for the cry. And suddenly one of the nurses went over to one of the phones and then it was just pandemonium. There were doctors running from all directions.”

Staff tried to resuscitate Axel for 20 minutes but this was unsuccessful.

Siobhan’s mother brought Axel to her.

“She put his wee cheek to my face. He was still warm at the time but I was feverish, I was really hot, so I couldn’t feel that,” the devastated mum said.

“Then my dad brought in a priest and he said what are you going to call him? What’s his name? And I said Axel Alexander. They baptised his wee body.

“He had the most beautiful wee face and I was allowed to hold him and be with him. I was looking at this incredible little person but he wouldn’t open his eyes. He never opened his eyes.

“Then I had four days of very bad times. I was put back onto the maternity ward but it was the room beside the monitor that monitored the heart beats of the new babies. So through the wall I was hearing babies’ heart beats. I thought I was losing my mind.”

Siobhan suffers from PTSD and has also since battled breast cancer.

She said: “The worst thing with the PTSD was the flashbacks. I thought I’d lost my mind. It’s like reliving all of the things that happened in slow motion but feeling it and seeing it and anything could trigger it off.

“It is a testament to my psychologist, my family and to all the support that I have had that I can talk about it now. PTSD is just four little letters but it’s hell.”

The final result of the post-mortem examination didn’t come back until 2003, because of a delay created by the UK-wide baby organ scandal.

Pathologist Dr Claire Thornton said that Axel died during labour as a consequence of “intrauterine infection”.

Other medical experts clashed over whether the delay in performing the caesarean played any part in Axel’s death.

An independent medical report commissioned by Siobhan was carried out by expert Roger Clements from Harley Street in London. He concluded: “In my opinion, there was wholly unnecessary delay in transferring Miss Desmond to hospital and, once in hospital, responding properly to the evidence of fetal distress. Because of that delay Axel was stillborn.”

Dr Anthony Barson , a paediatric pathology specialist, also looked at the case. He said: “Axel died from an intrauterine infection… This infection, combined with the effects of postmaturity, led to him being unable to survive the stress of labour and delivery.”

Taking a completely different view, Mr Roy Davies – a consultant obstetrician and gynaecologist – said that if Siobhan had agreed to being induced earlier “there is a strong possibility that her child would have survived”.

No inquest is held into stillbirths unless there is the possibility that the baby was alive at birth so there was no way for Siobhan to get answers from this forum.

Paddy Mullarkey

Paddy Mullarkey

Siobhan’s solicitor Paddy Mullarkey explains: “The coroner does not have jurisdiction in relation to a stillbirth, he only has jurisdiction where the child survives independently of the mother.

“He can sometimes become involved if there’s a debate as to whether or not the child survived for any period of time, but there’s no doubt whatsoever that in this case regrettably Axel was born dead.”

Siobhan says she wouldn’t now recommend to other parents who find themselves in a similar tragic situation to go down the legal route.

“I had this mistaken impression about things like truth and justice but it just comes down to a balance of probabilities,” she said.

“For every expert that you have who documents what happens to you, the other side will have someone who will say the exact opposite and perhaps worse. That’s how it works.

“Eventually I’m given to understand that it comes to a 50:50 ‘he says, she says’.”

She doesn’t believe that Axel’s case was ever going to see the inside of a courtroom.

“All of the investigations and assessments I had which set back the treatments I was having were for nothing because it was never about the money.

“I thought the whole point was that when you’re broken, when you’re damaged, there’s a system in place which looks at what happened and hopefully the truth comes out, but that’s not what happened. I can now totally understand why people do not go down the legal route.

“I don’t know what else I can do but I just have to move forward.

“I don’t have a nine-year-old wee one torturing me for the latest trainers. The only thing I can do right by Axel is to try and make sure that some change takes place. If they don’t learn from the mistakes, they are going to make them again and again.”

We asked the Western Health Trust for a comment on Siobhan’s case. A spokesman said: “The Trust will not be commenting on an individual case.”

The Department of Health was more forthcoming.

A spokeswoman said: “The Department would wish to offer its condolences to the family.

“The death of a baby in any circumstances is a very tragic and traumatic event for everyone involved.

“While maternity services in Northern Ireland are of a high quality the Department is committed to continuously improving services for pregnant women.”