A baby girl passed away after midwives failed to give her the medical care she needed as she struggled to breathe after birth, a coroner has found.
Ida Lock suffered a serious brain injury due to a lack of oxygen during her delivery at Royal Lancaster Infirmary in November 2019.
She was later transferred to the neonatal intensive care unit at Royal Preston Hospital, but she passed away a week later. The Lancaster coroner, Dr. James Adeley, stated that a major failure by midwives to provide basic medical care led to Ida’s death.
One of the key issues identified was the inadequate resuscitation efforts by the lead midwife in the first three-and-a-half minutes of Ida’s life. This failure contributed to the infant’s brain injury.
“Ida was a healthy child, and her death was caused by a lack of oxygen during delivery. This happened because the three attending midwives failed to provide essential care and did not act quickly when it was clear she was in distress,” Dr. Adeley said.
Midwives also missed signs of an unusually slow fetal heart rate when Ida’s mother, Sarah Robinson, arrived at the hospital in early labor.
An independent Healthcare Safety Investigation Branch report from April 2020 highlighted several mistakes in Ida’s care that contributed to her passing. A hearing at County Hall, Preston, was told that these failures could have been prevented.
Dr. Adeley also emphasized the importance of clinical governance, a system designed to ensure medical professionals follow high standards of care and improve patient safety. He criticized the hospital trust for not responding to a letter from Ida’s parents, who were seeking answers about her passing.
He described the situation as “a failure of a system that lacked both compassion and honesty” and said the investigation revealed serious issues within the healthcare process.
Ida’s father, Mr. Lock, expressed hope that the findings would prevent other families from experiencing the same loss.
“These answers won’t bring our daughter back, but we hope they will stop this from happening to another family,” he said. “No parent should have to struggle just to understand what happened to their child.”