A tragic incident during a home birth resulted in the untimely deaths of a mother and her newborn baby due to what a coroner described as “neglect,” “catastrophic error,” and “gross failures in providing basic care.”
Jennifer Cahill, 34, passed away in the hospital on June 3, 2024, a day after delivering her second child, Agnes, at their residence in Prestwich, Bury, Greater Manchester. Sadly, baby Agnes also succumbed in the hospital four days later.
Following a two-week inquiry into the tragic events, the coroner concluded that the family had experienced a scenario akin to a “Victorian-aged tragedy” unfolding in the present day.
Both mother and baby were rushed to the hospital individually due to various complications. Agnes was born without breath, with the umbilical cord wrapped around her neck. Meanwhile, Mrs. Cahill began losing an estimated two liters of blood shortly after delivery.
According to the pathologist’s report on October 17, Mrs. Cahill’s cause of death was attributed to multi-organ failure resulting from cardiac arrest due to postpartum hemorrhage, while Agnes died from multi-organ failure due to hypoxia following umbilical cord compression.
During the proceedings at Rochdale Coroners’ Court, Coroner Joanne Kearsley highlighted “gross failures” in providing basic care during Mrs. Cahill’s antenatal care and the delivery care received by both mother and baby Agnes.
Ms. Kearsley emphasized a “catastrophic error and gross failure” in medical care due to the absence of an out-of-guidance birth plan, a crucial document that was never completed after Mrs. Cahill opted for a home birth. This plan could have assessed the risks, identified potential hazards, and explored Mrs. Cahill’s decision to choose a home birth more thoroughly.
The coroner criticized Mrs. Cahill’s antenatal care as lacking in inquiry, being assumption-based, and perfunctory. Additionally, it was noted as a “gross failure in providing basic medical care” that heart rate checks on Agnes were not conducted every five minutes as Mrs. Cahill went through labor. Had these checks been performed correctly, midwives could have detected Agnes’ distress earlier, given the umbilical cord had been wrapped around her neck for approximately an hour before birth.
Neglect was identified as a contributing factor in the tragic deaths of both Agnes and Mrs. Cahill.