Ethan Blackwell inquest: If baby had been delivered seven hours earlier he would have survived
Phil Brewster spoke to Ben and Jodie Blackwell about their agonising three-year wait for answers. They shared precious photos with us of Ethan when he was born and after he died.
A coroner has ruled that a baby who lived for just 32 hours would have survived if he was delivered by caesarian seven hours earlier.
Ethan Blackwell's parents Ben and Jodie Blackwell from Littleover waited three years for the inquest, after their son was born at Royal Derby Hospital in May 2021.
He had significant brain damage and failed organs, which left him gasping for air and unable to open his eyes.
The University Hospitals of Derby and Burton NHS Foundation Trust marked the opening of the inquest by saying they agreed with recommendations from an independent report that there were a number of “missed opportunities” in the lead up to Ethan’s death.
The Trust also acknowledged that Ethan should have been born seven hours earlier, at 5.30am instead of 12.30pm, in which case he would likely have been a fully healthy baby boy – and now be aged nearly three-years-old.
Ethan's parents Ben and Jodie Blackwell speak outside court following the conclusion of the inquest into their son's death.
Dr Sophie Stenton, who carried out the post mortem examination on Ethan, determined that the leading cause of death was a “very severe hypoxic brain injury”, which is the deprivation of oxygen running to the brain for “several minutes.”
This caused Ethan to be born with almost all of his organs having already failed and major brain damage due to a “significant period of stress.”
The Coroner said there were failures in the medical care given to Ethan and his mother Jodie, but that this did not amount to gross neglect.
Following the conclusion of the inquest, Garry Marsh, the Executive Chief Nurse at the University Hospitals of Derby and Burton NHS Foundation Trust said: "We are profoundly and deeply sorry for the tragic loss of Ethan and for the continued heartbreak that we know the shortcomings in his care have caused.
"We fully accept that we missed opportunities to deliver Ethan sooner, and we have been determined to make changes in the years since his tragic death in 2021 to make our care safer, particularly around measuring a baby's heartbeat during labour and how we involve families in decisions about their care.
"We have new heart rate monitoring equipment which tracks oxygen levels and is checked daily, and our staff training rates in this specialist area are now above the national standard with support from dedicated midwifery and doctor leads.
"Our clinical guidelines are up-to-date with national best-practice, and we have changed our escalation, handover and documentation practices so that they support safer and more coordinated care and better involve families in decisions.
"Whilst we know these changes cannot possibly impact on the grief caused to Ethan's family, we remain absolutely committed to continuing these improvements so that we provide safer care for every parent and baby at our hospitals."
Want a quick and expert briefing on the biggest news stories? Listen to our latest podcasts to find out What You Need To Know…