Midwives' actions before baby's death scrutinised

A fitness to practise hearing has begun for two midwives involved in the care of a mother whose baby died 27 minutes after she was born.

Fiona Winser-Ramm and Dan Ramm's daughter, Aliona, died at Leeds General Infirmary in the early hours of 1 January 2020.

A 2023 inquest previously found there were "a number of gross failures of the most basic nature that directly contributed to Aliona's death".

Giving evidence at the start of the Nursing and Midwifery Council hearing into Ruksana Bibi and Yasmin Karolia on Wednesday, Winser-Ramm said: "There isn't an inch of my life that hasn't been destroyed or seriously damaged since the death of my daughter."

Winser-Ramm and her husband were among a group of bereaved and harmed families who successfully campaigned for an independent inquiry into "repeated failures" at Leeds Teaching Hospitals NHS Trust's maternity units.

The Trust previously said it was already "taking significant steps to address improvements".

At the beginning of her evidence, Winser-Ramm held up a photo of her daughter and said: "I want people to remember she is not a case number, she is not a poor outcome, she is not a piece of paper sitting on your desk, but she is our perfect daughter."

She added: "All that I wanted, expected or had the right to receive was good quality care, treatment and to take my daughter home.

"We didn't even receive the absolute basics of care."

Winser-Ramm told the hearing she had phoned Bibi after noticing a discharge which concerned her.

She said: "Something didn't feel right about the situation. However, I was met with no concern [and] no suggestion about what it could be.

"When you are a woman in labour for the first time you believe in everything, and have trust in everything, by the people you believe are the experts."

A call record said Winser-Ramm had not reported spontaneous rupture of membranes (SROM) - a sign she was going into labour - which the witness said was "absolutely not true".

Having initially been told to stay at home, Winser-Ramm was later told to come into hospital for an assessment after speaking to another healthcare professional.

While in hospital, her baby's heart rate was categorised as pathological or abnormal using a cardiotocograph (CTG).

Karolia was then assigned as the family's midwife and tasked with carrying out CTG scans every 30 minutes.

Winser-Ramm told the hearing she and her husband were "fed this narrative that everything was absolutely fine and the CTG had especially improved".

"We believed everything was normal again because we weren't told anything to the contrary," she said.

Karolia has been accused of failing to communicate the outcome of the CTG reviews despite claiming she shared the results with Aliona's parents.

She is also accused of failing to request additional support when there were difficulties interpreting the CTG trace and failing to recognise the result of three reviews as "pathological".

Winser-Ramm said records had been falsified and that made her feel "ike being told Aliona had died all over again".

The family were "totally denied any opportunity to even safeguard our daughter", she told the hearing.

"These concerns were happening right under our nose. They knew about the concerns and not only did they not act on the concerns, they lied and held that information from us."

Winser-Ramm said the family could have asked for a Caesarean section had they known about the difficulties, adding: "My daughter was knowingly left in pain for five-and-a-half hours."

She said Aliona would still be alive had she been born 10 minutes earlier.

Tope Adeyemi, representing Karolia, was "keen to extend her condolences once again" and was "extremely sorry for her actions".

She told Winser-Ramm: "There are aspects of the care that she provided to you that she does accept could have been better."

Adeyemi said Karolia accepted she had "incorrectly documented" that she had communicated the outcome of the CTG reviews.

She also accepted that she had failed to categorise some results of the reviews as pathological, Adeyemi said.

Adeyemi said her client denied "any negative intention" in not relaying the results of the CTG reviews.

She also disputed the allegation that she failed to ask for help when there were difficulties interpreting the CTG result.

The hearing, which is scheduled to last 34 days, is yet to hear from Bibi about the allegations of neglect in her care to Winser-Ramm.

They include failing to provide a time frame on when she should have called back after reporting concerns over the discharge, as well as failing to document that she should have called back within an hour.

It is understood she has admitted to this, but disputes other allegations made against her.

Those include failing to record details of the report of concern and recognising that it was SROM, in addition to failing to invite Winser-Ramm into hospital for an assessment and advising her on the induction of labour.

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