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Last Updated: Friday, 25 May 2007, 13:06 GMT 14:06 UK
Midwives Undercover: Transcript
NB: THIS TRANSCRIPT WAS TYPED FROM A TRANSCRIPTION UNIT RECORDING AND NOT COPIED FROM AN ORIGINAL SCRIPT: BECAUSE OF THE POSSIBILITY OF MIS-HEARING AND THE DIFFICULTY, IN SOME CASES OF IDENTIFYING INDIVIDUAL SPEAKERS, THE BBC CANNOT VOUCH FOR ITS ACCURACY.


PANORAMA
Midwives Undercover

RECORDED FROM TRANSMISSION: BBC ONE
DATE: 03:05:07


JEREMY VINE: Tonight, undercover in NHS material wards.

HAYLEY: Are you okay?

MIDWIFE: She's been crying again. She's labouring on our corridor, seriously.

MAVIS KIRKHAM: This is Third World conditions.

VINE: Having a baby can be the most stressful time in a woman's life, but too often the support they need just isn't there.

MOTHER: Three times I'm calling, nobody coming.

MOTHER 2; I asked for help. No one came. Nobody came.

VINE: We meet the parents who are fighting to uncover the truth about what happened to their baby.

MAN 1: You can't give up. You must keep going and you must demand the answer that you're looking for.

VINE: And we meet the midwives who fear it will take a disaster before anything is changed.

MIDWIFE: We've killed off babies before now, and deaths you can push under the carpet. But to kill the mother will actually give us results.

JEREMY VINE For the past six months Panorama has been speaking to women across the UK about their experiences of NHS maternity units, and many of them have told us the care they received simply wasn't good enough. Despite record government spending on the Health Service there aren't enough midwives, staff are overworked and in some cases mothers and their newborn babies are being neglected.

WOMAN: I was frightened that I was in danger and my baby was in danger. The whole experience was, I think, shocking, and if my experience is the same as many other women, then I think women are being short-changed, I really do.

I couldn't hold my child. I couldn't hold my child after because I was so angry about the whole situation and I feel really gutted about that because I wont have that with her now.

VINE: After hearing stories like these, we decided to go undercover to find out first hand what was going wrong. Hayley Cutts, a BBC journalist, volunteered for unpaid work experience at hospitals where we had heard there were problems. First stop was St Mary's Hospital and the largest maternity unit in Greater Manchester. While Hayley helped out on the maternity ward she used a hidden camera. Within days it became clear that staff felt they were overstretched.

MIDWIFE: Too much workload with the high risk women. Too many patients, not enough support staff.

MIDWIFE: I don't get a chance to look after my patients, sorry... when there's no support staff on.

HAYLEY: Oh gosh.

MIDWIFE: There's no support worker on this morning.

HAYLEY: Oh, how come?

MIDWIFE: Because if I'm on they think I can do both.

VINE: During the investigation Hayley kept a diary and recorded her thoughts about life on the maternity unit.

HAYLEY'S VIDEO DIARY: Feels really stressful on the ward and I've spoken to a number of midwives who're saying that they don't feel they're giving the right amount of care to the patients because they've got so much to do. I've also spoken to a number of women who say that they don't feel that they're getting the care that they should be doing because midwives just don't have enough time to be with them.

MIDWIFE: It's just a bit frustrating sometimes when you're like.. you're busy and you can't give proper care, it's not very nice when it's like that and you've got people at the door saying "My wife's in more pain now" and trying to get them upstairs and there's no beds for them, and they're delivering on the table... examination table.

VINE: Most mothers are happy with their treatment at St Mary's but Hayley was about to discover just how often things went wrong. She was working on a maternity ward where women are cared for in the early stages of labour, and again once their babies have been born.

HAYLEY: (meets Lilly) I'm Hayley, I'm a volunteer.....

VINE: But this mother found it doesn't always work like that. Lilly's baby was late arriving. Because St Mary's was so busy she had already waited four days longer than usual for the birth to be induced. She was 16 days overdue when she was sent to the delivery unit to give birth. But after being induced she was turfed out and sent back down to the ward.

LILLY: They induced me then they sent us back down here because they needed that room for somebody else.

HAYLEY: Right. Gosh, but by then you were already coming on.

LILLY: Yes.

VINE: Because Lilly wasn't in the delivery unit she could only have the most basic pain relief.

LILLY: I just couldn't get any pain relief or anything apart from gas and air.

HAYLEY: Why not?

LILLY: Because you have to be upstairs to get either pethidine or an epidural but they had no beds free for me.

VINE: In a statement St Mary's told us they had no record of pain relief being unavailable that day, but Lilly was labouring in pain. Lilly says she begged to be examined and eventually she was. In turned out she was in the very late stages of labour and she was rushed back upstairs.

FATHER: I don't blame them, I blame the system. I just felt that nothing was done until they realised it which.. s*** this needed to be done, or this should have been done.

VINE: We asked an expert to view our undercover footage. Mavis Kirkham is a professor of midwifery with many years under her belt working as a midwife. We asked her to analyse what had happened to Lilly.

What's happened here?

MAVIS KIRKHAM: This is a woman who's been induced when there's no bed for her to labour in.

VINE: What do you think of that?

Prof MAVIS KIRKAM I think it's so sad, but I think a woman in labour should have rights to labour with reasonable facilities, privacy and security, and certainly not be moved when she's in labour.

VINE: So we're missing a bed or a midwife or what?

KIRKHAM: Well both, I mean there wasn't a bed. If there wasn't a bed there certainly wont be a midwife, so they left her on a post natal ward because there was no room in the labour ward. And yet they'd induced her knowing that.

VINE: We spoke to Lilly later. She told us she'd been traumatised by her experience at St Mary's. Happily mother and baby are now doing well. The outcome is not always as good. We were told about another case at St Mary's in Manchester which happened when the unit was very busy. I went to meet Iran and Farouk Ahmed and their children. Eighteen months ago Iran went into hospital. Hers was a high risk pregnancy. Identical twins were on the way. The doctors decided she needed a caesarean section. But during that day the maternity unit and operating theatre were extremely busy and the caesarean was postponed. The next morning midwives came to monitor Iran's babies and found serious problems.

IRAN: They rushed me upstairs into a wheelchair... carried me upstairs and took me into the scan room, and my consultant came in with me and she told me that one baby's stillborn and the other one is poorly, it's going to die. (emotional) And after that she said we have to rush into theatre to get these babies out. And after that... I didn't know...

VINE: One baby had died. The second, Hafsa, was seriously brain damaged through lack of oxygen.

They're good at dealing with her, aren't they. (reference to Hafsa's siblings)

IRAN: Yes, very good. It's like now she's going into spasm and she's going stiff. Her legs have gone very stiff and you can't bend them. You know, you have to slowly, slowly, like massage her feet underneath and then she'll open up and let you bend it in.

VINE: St Mary's told us what happened was a matter of enormous regret. But they said although there were some lessons to be learnt, the outcome could not have been foreseen. After her caesarean Iran's blood pressure soared. She had a dangerous blood clot and had to have another operation and a transfusion. Despite everything she'd been through Iran says she was not given the aftercare she needed, and the staff seemed not to have time to look after her properly.

IRAN: Basically they were too busy on the ward. You know, they said we've got important things to see to. And when they say things like that I thought right, am I not important? You know. I've had three operations, been opened up three times. Lost a baby, one's poorly downstairs. I mean why do you treat me like that.? It was like.. I was just so... traumatised after what had happened, and the worst thing was losing a baby which was never going to come back to me.

VINE: Back at St Mary's our reporter Hayley met several women who felt like Iran they weren't getting the level of care and attention a mother needs after giving birth.

HAYLEY: Hello, how are you?

ROSINA: I'm so tired.

HAYLEY: Are you?

ROSINA: Yes.

VINE: Rosina has a painful pelvic condition which makes it very difficult to walk. When Hayley meets her she is struggling to cope physically with looking after her new baby.

HAYLEY: Are you getting much help from people?

ROSINA: Not really, no. It's happened so many times, I keep calling anyone. No one listens.

HAYLEY: Do they answer?

ROSENA: I just said to the one who's supposed to be dealing with me, give me a hand with the nappy but she never came back. Yesterday I was saying three times, they're saying she wanted to go to bed, and nobody came.

KIRKHAM: This is a woman who's got a pelvic condition which gives her considerable pain and difficulty in movement. This is a woman who surely needs tremendous cherishing postnatally.

VINE: Cherishing is a good word because there's not a lot of evidence there in that moment.

KIRKHAM: No, there isn't.

VINE: In a statement St Mary's in Manchester admitted: "in some instances it did not meet the expectations of all women and their babies within the post natal environment." It claims this was due to: "increased activity and the complexity of medical conditions that women have." Hayley was about to uncover further problems in her spell as a volunteer in Manchester. But we heard of poor standards in other hospitals too. A survey shows one in five women comes away from a maternity unit dissatisfied with the care she's received. Women we spoke to round the country agreed.

MOTHER 1: It's just kind of a baby making factory really, that's how it made me feel.

MOTHER 2: People were there and they could see that I was buzzing, but they were just ignoring it, and they could see me upset and anxious but they were just ignoring the fact that that was there.

MOTHER 3: I felt like I was putting the midwives out a lot of the time because they just didn't have the time. They were quite stroppy sometimes. When you asked them questions it was like: "Oh you'll have to wait" or "we've got to do this, we've got to do that first" and I obviously wasn't their priority when I just wanted a little bit of support.

VINE: And it's not just mothers who are unhappy. Panorama spoke to midwives across the UK. Many said they were struggling to provide adequate care with the resources they had. Most felt frightened they'd lose their jobs if they spoke on camera. But Deborah Killick from Kent was about to move to Australia with her family, so she felt able to speak out.

DEBORAH: I believe that because of the way that the NHS is at the moment and the lack of resources in maternity services in particular, that women are receiving substandard care. Distress and pressure on you on a day to day basis is enormous. Every day, or.. you know, you're put under extreme tension. You've got the life of a mother and baby that you're looking after. And sometimes because of that, because you're under-resourced, you can see that things might or could go wrong.

VINE: What Deborah told us echoed what Hayley was seeing undercover, working in overstretched and under-resourced units, many midwives feel utterly demoralised.

What I wanted was to become the best midwife I possibly could, and deliver the care that I believe women deserve, and I know I haven't achieved that. And I know that some of my colleagues, my dear colleagues who work extremely hard, feel the same way. None of us signed up for this.

VINE: So what has the government promised us? Well in 2004 it pledged that every woman in established labour should have access to a designated midwife 100% of the time, and yet the Royal College of Midwives is saying that the system is currently 3000 midwives short. It carried out a survey in January which found that more than a third of maternity units had their budgets cut last year, and all of this while Britain's birth rate goes up. Back in Manchester at St Mary's our undercover reporter was discovering another fundamental problem staff said they battle with - a lack of equipment.

MIDWIFE: It's just ridiculous you know, the amount of stuff that's broken and it goes off for repair and then we never get it back.

HAYLEY: So is the ward often down on equipment then?

MIDWIFE: Yes, we have a list of everything that we should have and when you try to find it, it's all over St Mary's but everywhere but the units.

HAYLEY: Does it ever stop things like being done or prevent patient care of something?

MIDWIFE: Because how can wards that have three antenatal units and they're all waiting on the same monitor? So, it's bound to.

VINE: Hayley was about to find out at first hand about this lack of equipment. An electronic foetal heart monitor, also known as a CTG machine, is an important piece of kit that midwives and doctors use to check on the heartbeat of the baby in the womb if there is any reason to be worried.

HAYLEY'S VIDEO DIARY: I found out that we only actually have one on the ward at the moment, only one that's working. Someone else was using the CTG monitor. So one of the midwives asked me to go and see if I could find the CTG monitor in the other ward in SM6.

Hi, I'm a volunteer on SM5 and can we borrow a monitor please?

MIDWIFE: You can't at the moment I'm afraid, we've only got one and it's still in use.

HAYLEY: That's alright. Do you know when it will be free?

MIDWIFE: No. Probably later on because we've got seven antenatal women that all need it I'm afraid.

HAYLEY: Okay.

I reported this back to the midwife. She then told me to go and try the central delivery unit. So I went upstairs to the CDU and I asked if they have a monitor there.

I'm just a volunteer from SM5 - hiya - I was wondering whether we can borrow a CTG monitor?

WARD CLERK: It'll be a matter of finding one. I doubt it. The place is full.

HAYLEY: The ward clerk looked everywhere in the ward, looked in every room for me. Came back and said "I'm sorry, I can't find a monitor for you."

WARD CLERK: I can't find one anywhere love.

HAYLEY: Really. Alright. Do you know when one will be available or not?

WARD CLERK: I couldn't say, no. Unless they might have one over there. Have you tried over there, have you tried over there? On MDU, maybe, yeah.

HAYLEY: Okay, I'll go and ask. Well thanks.

WARD CLERK: Alright.

HAYLEY: Hiya, I'm a volunteer from SM5 and we need a CTG monitor. I don't know whether you've got a spare on, have you?

MDU: We haven't. They're all in use I'm afraid.

HAYLEY: Are they?

HAYLEY'S VIDEO DIARY: So basically I had to go back and tell the midwife that there were no monitors in the rest of the hospital that we could use.

Sorry, CTG monitors, there's none on CDU, there's none on the Assessment one across the road. Oh yeah, there is this one there but they're all being used. Is there anywhere else I can go?

DIARY: So we had to survive on one monitor for that day - 25 women.

VINE: The great CTG monitor hunt. You sort of know she's not going to find it, don't you, somehow.

KIRKHAM: You do, yes, you do. And she is a volunteer. She's an addition to the situation. If she wasn't there, it would be a midwife hunting.

VINE: Or no one.

KIRKHAM: Or no one hunting. But whilst the midwife is hunting for the CTG, what a waste of time when midwives are so thin on the ground.

VINE; If you are without monitors in your job, is that bad news?

KIRKHAM: It is in this situation because these are women who've come into hospital in order to be monitored.

VINE: Monitoring a baby's heart electronically can be a very effective way of telling that everything is okay and is crucial if there is cause for concern. The machine produces a graph of the baby's heart rate. If the heart speeds up or slows down too much, something could be very wrong. Controlling the monitor is an important job.

HAYLEY'S VIDEO DIARY: Today a midwife asked me to hold a baby's heart monitor.

VINE: A mother had come to the hospital concerned about her pregnancy and staff decided her baby's heart should be monitored.

MIDWIFE: [to Hayley] Do you want a job?

HAYLEY: Yeah.

MIDWIFE: You can hold this if you want to...

HAYLEY: Yeah, go on.

HAYLEY VIDEO DIARY: Now the midwife asked me if I could hold it on the mother's stomach for about 20 minutes.

MIDWIFE: Sit down, you'll be there for 20 minutes.

HAYLEY: Oh right, okay. Do I have to look for anything?

MIDWIFE: No, can you just see how I've got it angled?

HAYLEY: Yeah.

MIDWIFE: In like that. That's it. You need a green light.

HAYLEY: Yeah, I'm making sure that...

MIDWIFE: That's fine, that's it. I'd just like you to press a bit here. It's like on an angle a little bit so we get a continuous line. About twenty minutes if you can manage it.

HAYLEY: Am I looking for anything?

MIDWIFE: No, just keep the heartbeat there, and the green light. If you go into red you've lost it, it'll go blank, anyway. You might have to dig deep a bit. If you lose it, come again.

HAYLEY: Alright.

VIDEO DIARY: So she left. I think everything was fine but I don't know. I'm untrained, I don't know what I was looking for. I really wouldn't know if everything wasn't fine really.

VINE: Hayley is a volunteer helper. She has no training and has never worked a monitor before. Now, thinking she's lost the baby's heartbeat, she rings the buzzer for help.

HAYLEY: [to mother] Hold on, I'll have to buzz.

VINE: But nobody responds. Hayley rings again. Again - nobody. Then she finds the heartbeat once more. After Hayley's been left for more than ten minutes the midwife comes back to see if she's okay but she's not staying.

MIWIFE: I need another ten minutes. Are you alright there? You're doing a good job. I've asked the student to come down. and tack it off and file it.

HAYLEY: Okay.

VINE: After another 7 minutes a student midwife comes to take the reading from the heart monitor. Concerned the trace she's taken may not be good, Hayley warns her she is untrained.

HAYLEY: Can I take my hand off?

STUDENT: Yeah.

HAYLEY: Am I alrioght to do that? Do you need any training?

STUDENT: Oh no, that's fine.

HAYLEY: That's alright then, just checking.

STUDENT: I don't think so, anyway.

VINE: And I suppose in defence of that, you can, as a lay person, hear a heart beating.

KIRKHAM: Yes, but the trace is lost several times in this clip. At one point you can hear the foetal heart beating and then you cease to be able to hear it. It may just be because the baby's moved. It may be a healthy baby that squirms and moves away from the machine. The volunteer didn't have the knowledge to explain to the woman something which is potentially really frightening.

VINE: In a statement St Mary's Hospital told us it has a: "well established equipment replacement programme and has now secured six additional foetal heart monitors." It added it would "not be normal practice for a volunteer to operate a foetal heart monitor." That is totally outside their operational guidelines. Hardly surprising when you consider the sums the Health Service has to pay out in medical negligence cases when things go wrong.

Last year the NHS had to pay out nearly 260 million pounds in maternity cases alone, and that was nearly half the total. In fact, if you look at the 100 biggest payouts you find that nearly half of them relate to one thing which is failure to respond to an abnormal foetal heart rate. Astonishing then, isn't it, that our untrained volunteer was asked to take those readings?

The parents of this baby, Abby Everitt, believe mistakes surrounding a foetal heart monitor caused her brain to be damaged while she was delivered at another hospital.

KERRY EVERITT: I'm just doing her medication now. I'll just put that into there so I can use it again. Just draw the medicine off. This is a sedation so she'll be asleep for a while now.

VINE: When we met Abby at her home in Telford she was 18 months old. She had to be fed through tubes. Her parents have been warned she may not live beyond the age of 3.

KERRY: We need to wind her before we give her medication because she'd have a lot of stomach ache. Sometimes she'll have griping pain in the stomach and then I tend to do it then really. Then I ?? ?? just give her the ?? hydrate. At the moment she's on 364 mils and then I'll just put it back onto 1 and then I'll start at 60 mils an hour again.

VINE: There were already worries about Kerry's labour when she arrived at the Royal Shrewsbury Hospital in December 2005. Abby's heartbeat was monitored and the readings gave cause for concern. Her parents believe that prompt action could have been taken then, but it was only later that staff discovered the baby was in serious distress.

Reconstruction

MIKE EVERITT They tried to scan Kerry again which they said the baby's not moving. The baby's still in the same position, the heart beat's gone. Then a consultant came in the room and said: "What's going on? This girl should be in theatre." And then me and Kerry's mum actually had to help him take all the jewellery off, take all the nail polish off her nails before they actually put her into theatre, and the last thing that happened then was they just wheeled her off and we could hear Kerry screaming as they put her under.

KERRY: I actually feel really let down by them because she's not going to have quality of life what she should have had.

MIKE: Abby's literally a shell of a daughter that I should have. Kerry's been traumatised for life with it because of what's happened to her.

VINE: In a letter to Mike and Kerry, Shrewsbury Hospital admitted that a foetal blood test should have been carried out at an earlier stage in the labour. Abby's parents have launched legal action trying to prove that the error led to Abby's brain damage. Today Mike and Kerry are taking Abby from Telford to a consultation at Alderhey hospital in Liverpool.

MIKE: Just packing to take Abby to Alderhey. I've got all the medications that she needs to take in with us. I've got her syringes that she's going to need, if she needs anything during the travelling up there, her glasses, a jug for winding her. Abby's suction machine and spare catheters in case we have any accidents - and that's it.

VINE: They're concerned Abby's health is fading and are hoping that tests at the hospital will find out if anything is wrong. We'll come back to find out how Abby gets on later. The World Health Organisation says Britain has more babies that die around childbirth than most other countries in Western Europe, and in the UK the worst area for stillbirths is greater London. Our research also suggested that some London maternity units are struggling to cope with financial constraints and an increasing birth rate. So, earlier this year, Hayley went undercover again to investigate, this time at Barnet Hospital, North of London. Within days it became clear that staff felt under pressure. Early evening, Tuesday 23rd January, and the maternity wards are choc-a- block. One of the midwives is called away leaving two qualified and one student midwife to look after 24 women on the joint ante and postnatal Victoria Ward. Staff are not happy.

MIDWIFE 1: So I'll just hand these ladies over to you because I have to go.

MIDWIFE 2: I've now got 14 patients.

MIDWIFE 1: Who else will I hand them over to?

MIDWIFE 2: There's no one to hand them over to. This is the issue.

MIDWIFE 1: This is a daily occurrence, that's why no one wants to be a midwife.

VINE: The team is struggling to cope. As a volunteer, Hayley is there to help out where she can. She's been told her job includes manning the phones.

HAYLEY: Hello, Victoria Ward, can I help you?

VINE: With a qualified midwife by her side, Hayley takes a call from the delivery unit which is full. She's told they're sending a woman over because they're too busy.

HAYLEY: There's a woman coming over in two minutes.

MIDWIFE: There's a woman what?

HAYLEY: There's a woman on her way over. She'll be here in two minutes.

MIDWIFE: For what?

HAYLEY: She's from Delivery Suite.

MIDWIFE: There's no... I don't think there's any beds because I just put that antenatal lady up there. There's no antenatal beds.

HAYLEY: [on telephone] Oh she's contracting one in four. We have no beds at the moment I'm afraid.

MIDWIFE: Have they sent her already?

HAYLEY: [phone] She's on her way.

MIDWIFE: She's here, and there's no beds.

HAYLEY: [phone] No, she's here.

MIDWIFE: We haven't got no beds at the moment.

HAYLEY: [phone] We need a bed for normal delivery.

MIDWIFE: She just need to take a seat there and as soon as we get one, we'll move her.

HAYLEY: [phone] Okay, when will that be?

VINE: The lady is in labour but is left by qualified staff members to go through all that in the corridor. Hayley tries to reassure her.

HAYLEY: Are you okay?

MOTHER: I'm feeling strong pain, yes.

HAYLEY: Strong pain. We haven't got a bed for you yet but I'm moving people round so soon we should have a bed.

MOTHER: Okay, it's not your fault. Alright, fine.

VINE: Concerned about what is happening Hayley informs the midwife in charge of the ward that day.

HAYLEY: She's crying out there.

MIDWIFE: Sorry?

HAYLEY: She's crying.

MIDWIFE: Who's crying?

HAYLEY: The woman who's waiting for the bed.

MIDWIFE: Go tell her to get a life.

VINE: Twenty minutes later the same midwife speaks to the delivery unit and explains the situation.

MIWIFE: We have a woman here expecting on the corridor, there's nowhere to put her. No, we've no singles, there's nowhere to put anybody at the minute. She's labouring on our corridor, seriously. She's in multiple contractions. Even though she's smiling at me at the minute, I know she's in agony.

Prof MAVIS KIRKHAM Sheffield Hallam University I think that's really tragic. That poor woman in strong labour in a public corridor. This is.. this is Third World conditions, and in fact no farmer would let an animal they valued labour with that degree of stress and anxiety in a tense public place like that.

HAYLEY: Okay, we have a bed ready for you now. Are you okay? Stand here. Are you okay/

MIDWIFE: Who's crying?

HAYLEY: The woman who's waiting for the bed.

MIDWIFE: Go tell her to get a life.

VINE: Twenty minutes later the same midwife speaks to the delivery unit and explains the situation.

MIWIFE: We have a woman here expecting on the corridor, there's nowhere to put her. No, we've no singles, there's nowhere to put anybody at the minute. She's labouring on our corridor, seriously. She's in multiple contractions. Even though she's smiling at me at the minute, I know she's in agony.

Prof MAVIS KIRKHAM Sheffield Hallam University I think that's really tragic. That poor woman in strong labour in a public corridor. This is.. this is Third World conditions, and in fact no farmer would let an animal they valued labour with that degree of stress and anxiety in a tense public place like that.

HAYLEY: Okay, we have a bed ready for you now. Are you okay? Stand here. Are you okay/

VINE: Eventually they find her a bay on a shared ward and it's left to Hayley, 4 days into a work experience placement, to take her there.

HAYLEY: Oh! There's no bed there yet. Sit down, I'll get you the bed. Hold on.

VINE: It turns out there isn't actually a bed ready for the woman so she has to wait for Hayley to find one and make the bed up. No qualified member of staff has taken control of this situation for over 50 minutes.

KIRKHAM: As far as the system was concerned she didn't exist. No one is caring for her, no one's supporting her, nobody is monitoring her condition or the baby's. It's an impossible position to labour in.

VINE: We explained what we'd seen to the Chief Executive of Barnet and Chase Farm Hospital Trust.

We watched one woman labouring in a corridor for 50 minutes without even a basic examination. What is the explanation for that?

AVERIL DONGWORTH Barnet and Chase Farm Hospital NHS Trust VINE: Eventually they find her a bay on a shared ward and it's left to Hayley, 4 days into a work experience placement, to take her there.

HAYLEY: Oh! There's no bed there yet. Sit down, I'll get you the bed. Hold on.

VINE: It turns out there isn't actually a bed ready for the woman so she has to wait for Hayley to find one and make the bed up. No qualified member of staff has taken control of this situation for over 50 minutes.

KIRKHAM: As far as the system was concerned she didn't exist. No one is caring for her, no one's supporting her, nobody is monitoring her condition or the baby's. It's an impossible position to labour in.

VINE: We explained what we'd seen to the Chief Executive of Barnet and Chase Farm Hospital Trust.

We watched one woman labouring in a corridor for 50 minutes without even a basic examination. What is the explanation for that?

AVERIL DONGWORTH Barnet and Chase Farm Hospital NHS Trust If there is a mother labouring in a corridor I think that's absolutely unacceptable and I will investigate that and take that issue up with the staff concerned and make sure categorically that everybody in this trust understands that that is not an acceptable way to treat any mother.

VINE: But there was nowhere for her to go, that's the point about it. They were doing their best. They only had a chair.

DONGWORTH: Well if there was nowhere for her to go, then it would have been clear that they hadn't escalated their policy quickly enough for treat and transfer the area.

VINE: Move her to another hospital.

DONGWORTH: And move her to another hospital or move somebody else less um... forward in their labour to another hospital and make sure that that woman got the appropriate care that she was entitled to.

VINE: Later on, the midwife in charge recognised the potential danger of the situation and filled in a clinical incident form. It's known as "a near miss". The unit closed to admissions that day as staff couldn't cope with anymore women coming in. In the period of time Hayley helped out at Barnet, on at least 8 occasions the unit closed to new admissions. Hayley was told by staff that one of those closures was for over 24 hours. Each time staff appeared to be stretched to the limit.

HAYLEY: So are they closing the ward?

STAFF: It's closed at the minute. It's closed. It has to be closed because there's no room anywhere.

HAYLEY: Why do they.. I don't understand why they close hospitals, is it because they don't have any beds or they don't have any midwives?

STAFF: We're dangerous at that stage. It gets to the point that when you've got so many women because they don't have any beds over there. It gets to the point where so many women and not enough staff to look after them that we could miss things.

VINE: Now are you closing the wards to stop them becoming dangerous or because they already are?

DONGWORTH: To stop them becoming dangerous.

VINE: Are you sure about that?

DONGWORTH: I'm absolutely sure. The midwives on site have to make a judgement about their workload, the cases that they have in place, the cases that they're expecting. This is a very important time for a mother giving birth to a beloved child and we want to make sure that that is a good experience.

VINE: When Barnet Hospital closes to admissions, women are sent 6 miles away to another hospital. Overstretched maternity wards are not just uncomfortable and inconvenient for women, they can be dangerous. Katie McKay was past her due date when she finally went into labour 8 months ago. She phoned the Chelsea and Westminster Hospital in London where she was due to give birth. She was told by a midwife that the maternity unit was too busy.

KATIE McKAY: She said, you know: "Call back." She said: "Go and have another bath" and she said: "The unit's actually closed for admissions as well." At which point I obviously freaked out and said you need to get on to another hospital. They said: "Go away and have another bath" which I did and 6 o'clock the contractions coming every 5... every 4 minutes. I phoned the hospital again and was told that other hospitals weren't available to take me so they'd need an hour to juggle beds, but they would see me at the Chelsea and Westminster.

VINE: When Katie did finally arrive at the hospital 2 hours later, it was chaotic. And like the woman we saw earlier, labouring in the corridor at Barnet Hospital, Katie wasn't examined for more than an hour. A midwife said they were busy, so she'd have to wait until the changeover of shift.

KATIE: Twenty past eight I was then seen by another midwife. My waters then broke at quarter to nine and it was only after my waters had broken one hour and ten minutes after I'd actually been on the ward that I was given my first internal examination, and by that point I was almost fully dilated.

VINE: The staff then realised the baby was lying the wrong way round, in the breach position. Readings on the foetal heart monitor also showed that the baby was in distress but staff didn't respond to this and instead of an emergency caesarean they tried to deliver baby Ella normally. Ella was starved of oxygen and died five days later.

KATIE: From our point of view it was just far too many red lights... we went through too many red lights. If you go through one red light, you might get away with it. If you go through five, you're going to end up having an accident and the first red light that we went through was the baby wasn't... the position of the baby wasn't picked up. The second red light was that the hospital was closed to admissions. The third red light, not examined for an hour and a half, in our case these were all crucial red lights that we shouldn't have gone through, should have been picked up and.. you know, unfortunately for us it resulted in the death of our baby.

VINE: The pain is still very raw for Katie and Ben. They lost Ella last autumn. Since her death they've had meetings with the hospital to find out what went wrong.

BEN: Whenever we're in this area, you drive past and you see the Chelsea and Westminster and it just.. it's that impact of that memory of that night and what happened.

VINE: And what have they said to you at the hospital ?

KATIE: They've admitted.. obviously they say mistakes were made and we've been badly let down, and I'm hoping that obviously what's happened to us that the hospital will.. you know, change procedures. I believe that some procedures have been changed but for us it's too little, too late. But I hope that for other people, us speaking out is going to help actually make a difference.

VINE: Chelsea and Westminster Hospital has apologised unreservedly to Katie and Ben, and carried out a thorough review of the case. It told us that as a direct result of Ella's death a series of recommendations is now being implemented. They'll affect the way women are dealt with when they first arrive in the hospital. Across the country women have complained to us about the care they receive when in labour they reach the maternity unit.

MOTHER 1: When I arrived on the ward in the evening there were very few staff and the next morning the midwife came and apologised to me and she said she was sorry there was nobody there to really speak to me and settle me in, but they'd had an emergency situation.

MOTHER 2: They had no idea that I was expected. The message hadn't been passed on and they didn't have a room ready for me, they didn't have any midwives ready for me, and so it felt like I was an inconvenience.

MOTHER 3: Certainly I did actually feel the baby's head coming out. There was no midwives, not one person apart from my husband in the room.

VINE: Back undercover in Barnet Hayley is finding that there's also plenty wrong with the way women are treated after they have given birth.

HAYLEY'S VIDEO DIARY: The ward here at Barnet seems to be almost always full. There's always women that need beds. I've also noticed that they're putting women in another area called the transitional care unit which is quite a walk away, it's sort of down three corridors that you have to walk to. It's about one and a half minutes for a midwife, but for a woman who has just given birth and who is in pain, that must be quite difficult.

VINE: Transitional care or TC is not really a ward at all. It's the equivalent of hotel beds. Women use them when their babies are being cared for nearby. Despite this, and despite the distance from the maternity wards, Hayley discovered TC was being used as a dumping ground for women who did need care.

HAYLEY: I couldn't quite believe that women were being left there. This was a place that was supposed to be for women who were discharged and didn't need any care. But instead it was being used for women who were still under medical treatment. I spoke to quite a few women there who just felt forgotten about.

VINE: One woman, Mrs Taqur, had to walk all the way over from TC with her baby because she wanted to see a doctor. When she arrived she was asked to wait in a room normally used for storing equipment. She waited an hour for the doctor to come. In the meantime, she spoke to Hayley.

HAYLEY: So when did you go over to TC?

MRS T: Yesterday 3 o'clock.

HAYLEY: So you were here for a day, were you? Or did you go straight from delivery ward onto that ward?

MRS T: No, from the delivery ward here I'm coming.

HAYLEY: Oh, and then you got sent over there.

MRS T: Yeah.

HAYLEY: Why?

MRS T: Because here is a very busy.

HAYLEY: Okay. And were you getting any care over there? Was there any midwives or that coming to see you?

MRS T: No, nobody coming, no. Wait, wait, wait here. Yeah, three times I am calling, nobody coming.

VINE: One of the junior midwives looks to Hayley, an unqualified volunteer remember, to take responsibility for Mrs T.

MIDWIFE: Is this one of your ladies in here?

HAYLEY: She's at Department TC, she's waiting to see the doctor.

MIDWIFE: Oh you're from... okay, no, wait here then. Can I leave her under your care because I'm doing something.

HAYLEY: Okay, well I can watch her but I don't know what to do.

MIDWIFE: I don't know what that thing is.

VINE: At that moment, another lady from the distant TC ward rings on the tannoy and Hayley answers it.

HAYLEY: Hello?

MOTHER: I'm in the transitional care unit.

HAYLEY: Okay.

MOTHER: And I was supposed to have gotten discharged today but nobody's came to see me since last night.

HAYLEY: Nobody's been to see you since last night.

MOTHER: And the doctor said somebody would come to take my blood pressure last night and this morning.

HAYLEY: Okay. I think you're in the same situation as someone else actually. I'll find out for you. Hold on.

VINE: This woman told Hayley she'd been forgotten about for well over 12 hours. She was finally discharged that afternoon. A few days later and Hayley discovers a third woman who was having trouble in TC.

CLERK: Hello?

ANNA OSMAN: Yes, my name is Anna Osman

CLERK: Yeah.

ANNA: Very painful. Can you get my midwife.

CLERK: Okay. I'll ask somebody to come and see you then. Okay?

ANNA: Okay.

MIDWIFE 1: Okay, bye. Can somebody go and see Mrs Osman.

MIDWIFE 2: Where is she?

MIDWIFE 1: (laughing) TC. She's feeling very painful.

MIDWIFE 2: Very pain.

MIDWIFE 1: I've give her very pain. (laughing)

VINE: Twenty-three minutes later a midwife remembers about the call.

MIDWIFE 2: Oh and there's a woman in TC that I haven't seen yet and she's shouting about "a big pain" isn't she?

HAYLEY: Oh yeah.

VINE: But nothing is done. Another three quarters of an hour pass and Hayley reminds staff that Mrs Osmond still has not been seen.

HAYLEY: That TC woman rang at 2 didn't she.

MIDWIFE 1: You'd never do me a big favour and go over to transitional care and there's a woman over there with a big pain. Probably a huge pain now.

MIDWIFE 2: A huge pain? She needs...

MIDWIFE 1: I don't know what she needs. Analgesics of some description.

VINE: In the end a student midwife goes to see Mrs Osman but there's a mystery as to why she's there.

MIDWIFE 1: Why is she in transitional care I wonder? Are her notes at the end of her bed?

MIDWIFE 2: Yeah, I tried that one.

MIDWIFE 1: She's multip normal delivery. Why is her baby in.... you don't know?

HAYLEY: I don't know. I think because there were no beds.

MIDWIFE: Is that all?

HAYLEY: Well she's forgotten.

MIDWIFE: Okay.

VINE: What do you think of this?

KIRKHAM: I think this is a unit working at over capacity and these are women who really need care who are being dumped somewhere where they don't get the care. It's not designed for that. And I think it's really neglectful of these mothers, and damaging for them.

VINE: Barnet Hospital told us it hadn't been aware women who needed care were being left in TC and said it would look into this. It wasn't only in Transitional Care that women in Barnet Hospital were feeling neglected. Hayley was about to meet another woman with a nightmare tale to tell. Jack Deep had a 24 hour labour followed by a traumatic emergency caesarean section. She's in pain and finding it hard to walk. She's been given a room on her own but found there were no staff around to help her.

JACK DEEP: You know when you have stitches and you can't move around much, then you expect more help. I think I would have been better if I was at home. Last night I was sick, really badly sick.

HAYLEY: Were you?

JACK: Yeah, when they moved me here, they told me to come here on my own, so I woke up...

HAYLEY: What, and no one's brought you here?

JACK: No, and my mother-in-law she brought the staff here and I came here and I started vomiting straight away. And in the same... I asked for help, but no one came.

VINE: I spoke to Jack Deep and her husband Suki several weeks later at their home in North London. I found out she'd been putting a brave face on things when she spoke to Hayley in hospital. The reality, she says, was that she was terribly unhappy with her care.

But what's your abiding thought when you look back? What do you remember?

JACK: Oh a terrible time in hospital.

VINE: What, from emotional distress.

JACK: Yeah, distress, yeah. I'm not having my other.. like next child in this country, anyhow.

VINE: What are you going to do?

JACK: I'm going to go to India or somewhere else, or America, but not here. If I have to pay, I will pay, but not here, no.

SUKI: We wanted a second child but this has made us think twice.

VINE: That's a serious thing to say.

SUKI: It is, isn't it. It's the level of service provided so we are seriously contemplating shall we have another one or not?

VINE: How do you feel now, how has it affected you?

JACK: I had a bad time in hospital but I'm happy I'm at home now. I can't... I don't want to remember anything, just him (baby).

VINE: It's that bad.

JACK: Yeah.

VINE: There will always be mistakes in hospitals but staff shortages and over work make them much more likely. In Barnet our undercover reporter witnessed what appeared to be a disturbing example of this. The midwives need a blood sample taking. The staff member who comes to do this says she's in a rush because her own department is, yes, short-staffed.

MIDWIFE: I'm not even supposed to be on this ward. I'm supposed to phone and say that we're short-staffed. I've only just come to help.

VINE: In her rush to finish the round she makes a mistake. It dawns on the midwife that blood has been taken from the wrong patient.

MIDWIFE: This is really important, she's taken the wrong one! She's taken her blood instead! This is a very serious mistake.

MIDWIFE: That is a serious mistake.

MIDWIFE: We need to call her.

VINE: The consequences could have been serious because she'd wrongly taken the blood of a different patient, one who is HIV positive.

MIDWIFE: The blood you have taken from the wrong patient. Because that lady is HIV positive. You've put in the wrong name.

DONGWORTH: I would not defend it. What I would say is that that mistake - and I'm not going to say that mistakes never happen - but that mistake was picked up by the staff on the ward and rectified at source by themselves. It didn't have to be picked up later in the unit or, thank goodness, before anything happened to the patient.

VINE: Some mistakes though cannot be rectified and when that happens, finding out what exactly went wrong can be difficult. One couple in Cornwall have been fighting for more than three years to discover how their baby Katlyn lost her life on the day she was born.

WAYNE: This is Katlyn's birth certificate. I had to register Katlyn's birth and Katlyn's death both at the same time. Hardest thing I've ever had to do in my life, to sit there and actually say this is my child, she was born on Christmas day and as soon as that paperwork was done then had to register her death at the same time.

VINE: In December 2003 Karen Coyne was admitted to the Royal Cornwall Hospital. It was Karen's fourth baby and she felt something was wrong. The foetal heart trace caused concern. Their midwife called for a registrar. It was over an hour before he arrived. By the time Katlyn was delivered by emergency caesarean she'd been seriously starved of oxygen.

WAYNE: Your baby is delivered, there's no cry and she's on a table, a little... they're rubbing her and got stuff down her throat and giving her injections and Karen's screaming: "What's the matter, what's going on, what's going on?" (chokes sobbing) You can't tell her what's going on because you don't know.

KAREN: I think it would have been easier if she did have a problem, if we knew that there was something wrong with her that couldn't be fixed - but there wasn't. It was just the time frame involved, she couldn't hang on until these people did their job properly.

VINE: Katlyn was resuscitated but died hours after being born. The couple say they were under the impression they'd been hit by one of life's unavoidable tragedies. It was only a month later when their GP decided to pass on a letter he'd received from the hospital that they realised her death might have been avoided. It was the start of a long quest to discover precisely what had happened and who was at fault.

KAREN: Even if your questions come to nothing, anyone in that situation if you are in the slightest big of doubt at all as to the care you received or something had or hadn't been done that you think should have been, you should ask questions because the information will not be volunteered, you have to ask.

WAYNE: Yes, exactly.

KAREN: Because they certainly will not come to you and say we made a mistake.

WAYNE: Yeah, they wont do it.

KAREN: You have to prove that they made that mistake and you have to keep on proving it right up to the very end.

VINE: The Cohens decided to complain and fought for an independent review into their baby's death. That review revealed a number of serious failings but the couple were still not satisfied. They sued the hospital and at the same time pressed the coroner to open an inquest into Katlyn's death. They wanted a public hearing to make sure the lessons were learnt. Shortly before the inquest the hospital admitted full liability and has paid the Cohens compensation. The inquest itself was to be an emotional experience for the couple. Today is the day of the verdict and Karen and Wayne are anxious to hear what the coroner will decide.

KAREN: It's been a long time coming and we still might not see the end of it today.

VINE: After hearing the evidence the coroner concluded that Katlyn died due to a serious failure to provide medical care. It had taken the medical team too long to help Karen when her labour became problematic.

WAYNE: It just worries me that it's taken us this long when really it was an open and shut case. The hurdles that are put in front of you are so high that it's so easy to give up. And what I would say to people, you can't give up. You must keep going and you must demand the answers that you're looking for.

VINE: The Royal Cornwall Hospital Trust told us it offered its sincere condolences and said there had been no deliberate attempt to avoid answering questions that the Cohens have had. The hospital told us it had implemented changes to policies and procedures following Katlyn's death. At a national level there are supposed to be changes coming too. The government has only just announced the new maternity strategy which it's calling: "Maternity matters" and it promises one to one care in labour, a better choice of birthing place and method, and just overall easier access to better services. But, there's no specific commitment to more midwives. The government leaves it up to local NHS Trusts to decide how they meet these commitments, how much money they spend on maternity and how many midwives they employ. Barnet Hospital Trust says it currently has enough midwives. That would be news to some of the staff working there. It's Friday, 2nd February and there's only one fully qualified midwife looking after 23 ante and postnatal women. Tempers are beginning to fray.

MIDWIFE: I just came on my shift this morning and there was just me. I think you need to be a bit more patient because at the end of the day it's not our fault.

HAYLEY: Are you the only midwife here Sophie?

SOPHIE: Yeah.

VINE: Half an hour later, the maternity day unit closes to allow the midwife from there to come and help out. But they are still struggling.

HAYLEY: Can I help with anything?

MIDWIFE: I don't even know what I'm doing myself.

HAYLEY: Okay, well just shout when you think of anything.

MIDWIFE: (laugh)

VINE: So it's not dangerous to have one midwife looking after 23 women as we saw on February 2nd?

AVERIL DONGWORTH Barnet and Chase Farm Hospital NHS Trust Well I refute that. We have had the staffing levels, we had three midwives and two midwives always in charge with support workers. We never leave a unit with one midwife. If that did come to be true, then I would have to investigate that and would have to go through the whole disciplinary investigation because that is not our policy.

VINE: It may not be policy but it did happen. However, by 10.30 another midwife is brought in from a neighbouring hospital to help. But she isn't familiar with the ward.

MIDWIFE: Because I don't know where anything is, you shove the staff together for me in the thing and I'll do her.

VINE: Six days later and the midwife in charge is complaining to Hayley that understaffing is affecting care. This time in front of a patient.

MIDWIFE: The care and everything else that we give the women is like S*** because how can I be expected to be in every room of this bloody ward?

VINE: When the midwives are concerned about issues on the ward, they fill out incident forms. But they don't seem to think this makes much difference.

HAYLEY: Do you fill those incident forms in a lot?

MIDWIFE: Oh yeah, every day.

HAYLEY: Really?

MIDWIFE: Nearly every day, yeah.

HAYLEY: And what happens to them?

MIDWIFE: They're meant to analyse them and then do something about it. But I presume they have hundreds, loads, where they just sit on them and send them to management. I don't know if... they don't get back to us anyway, so...

DONGWORTH: The forms that they're referring to are called IR1s, they're incident forms, and they are encouraged to report incidents and both real incidences and like you will hear from pilots 'near misses', so that anything that has worried the staff in their work they fill out a form.

VINE: We saw it happening but they told us: "We filled out a hundred of these forms and they sit on them."

DONGWORTH: Well nobody sits on them. What happens is they come in to the system, then the division, the actual clinical division, the division of women's and children's, considers and re-looks at those reports and they take the appropriate action locally.

VINE: Caring for a baby who's been damaged in childbirth can be a full time job. Kerry and Mike have just arrived at Alderhey hospital for tests to be carried out on their baby Abby who suffered brain damage when she was born in Shrewsbury.

Okay Abby, we're now going in now.

VINE: Abby is having a barium meal to find out what's happening with her digestion. Her parents are concerned the previous operation to help her keep her food down isn't working.

Okay, that's brilliant, we're all done. Abby you're a little star, well done.

We can't see reflux so that's quite reassuring. Alright?

Okay. Thank you.

VINE: They're constantly worried, not knowing how long Abby has to live.

MIKE: It's been a good relief because she'd have to have more surgery. It's a weight off our mind for the time being.

VINE: But two weeks later Kerry and Mike woke up to find baby Abby had died in her cot. She couldn't hold on anymore.

KERRY: He said: "She's not awake" and I said: "She's okay" and he brought her in the front room here, got the ambulance and they took her off and they were working on her in the hospital for half an hour, and I said to them to stop because I didn't want her to be any worse than what she was anyway.

VINE: The couple are completely devastated and Mike is too upset to talk about it.

KERRY: When I see my friends with their children and I would have been there as well and... it's just.. things like that really. You could go to the shop and you'd see.. you know, a little girl maybe the same age and you think well that could have been. You know, that's never ever going to go away.

VINE: Kerry and Mike are taking legal action against the Royal Shrewsbury Trust. They say it's the only way they'll find out exactly why their daughter died. The Royal Shrewsbury Hospital told us it had fully investigated all the issues raised by Abby's parents. It said the Health Care Commission also investigated and decided not to proceed to a full review. The Trust expressed its "deepest sympathies for Abby's family" but said that because of the ongoing legal claim it could not comment further on the specific circumstances relating to Abby's birth. While the vast majority of deliveries are successful, giving birth is one of the most dangerous times in a woman's life, not to mention the baby. Filmed undercover staff at Barnet Hospital were only too aware of the potential for disaster. A midwife from another hospital tells the Barnet staff about a recent case they've had there.

MIDWIFE 1: We had a baby die.. cord prolapse... did you not hear?

MIDWIFE 2: No.

HAYLEY: What's a cord prolapse?

MIDWIFE 1: Mother was in labour.. waters went and the cord prolapsed into the vagina so as the uterus contracts and the head is pressing down, the cord is just completely squashed, baby gets the oxygen supply cut off. The baby died. This woman was on the monitor and big deceleration ... big, big deceleration of the heart rate.

MIDWIFE 2: You'd wonder what the hell is happening here!

MIDWIFE 1: And they were arranging a crash section, didn't examine though but were talking about a crash section, and then it picked up and when she went to theatre the heart rate was normal and.. - dead!

VINE: Some incidents are so serious they do lead to action. It emerged that over three years ten women had died during or after childbirth at Northwick Park Hospital in North London. An investigation led to more staff being brought in there. But despite fears that the problems were more widespread other hospitals have seen few changes. The midwives Hayley met at Barnet knew all about the Northwick Park story. They felt it might take a similar tragedy for them to see any improvements.

MIDWIFE 1: I'll tell you what it's going to take, a baby dying.

MIDWIFE 2: No, no, no, babies die but babies are not the mother....

MIDWIFE 1: Yeah, yeah, yeah, we need the Northwick Park thing happening, isn't it, and then suddenly it'll all be all... well not 'we need' but...

MIDWIFE 2: We've killed off babies before now deaths we can push under the carpet. Killing a baby is cheap, to damage a baby is more expensive but kill the mother and that'll actually give us results...

MIDWIFE 1: Yeah.

MIDWIFE 2: but God love the poor midwife involved in that.

If you've been affected by any of the issues in tonight's programme and would like to talk to someone in confidence call the BBC Action Line free on 0800 077 077.


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