Mums blamed for deaths of their babies in NHS maternity scandal

A review into baby deaths at a scandal-hit NHS trust said maternity staff had caused distress to patients by using "inappropriate language" and blaming grieving mothers for their loss.  The inquiry into deaths and allegations of poor care at Shrewsbury and Telford Hospital NHS Trust (SaTH), set up in 2017, identified seven "immediate and essential actions" needed to improve maternity services in England.  The report said that when completed, the review of 1,862 families "will be the largest number of clinical reviews undertaken relating to a single service, as part of an inquiry, in the history of the NHS".  Former senior midwife Donna Ockenden's report said "one of the most disappointing and deeply worrying themes" was the "reported lack of kindness and compassion from some members of the maternity team at the trust".  The chief executive of the trust apologised for the "pain and distress" caused to mothers and families due to poor maternity care - after the review found staff had been "flippant", "abrupt" and "dismissive".  The review also said the deaths of Kate Stanton Davies in 2009 and Pippa Griffiths in 2016, whose families had campaigned for an independent review into maternity care at the trust, "were avoidable".  Responding to the report, patient safety and maternity minister Nadine Dorries said she expects the SaTH to act on the recommendations immediately following the "shocking" failings.  The "emerging findings" report was published on Thursday, based on a review of a selection of 250 cases of concern, which include the original 23 cases which initiated the inquiry.  Ms Ockenden, chair of the independent maternity review, described the initial recommendations - including a call for risk assessments throughout pregnancy - as "must dos" which should be implemented immediately.  Speaking of the lack of compassion and kindness shown by staff, the report said: "Many of the cases reviewed have tragic outcomes where kindness and compassion is even more essential. The fact that this has (been) found to be lacking on many occasions is unacceptable and deeply concerning.  "Evidence for this theme was found in the women's medical records, in documentation provided by the trust and families, in letters sent to families by the trust and from through the families' voices heard through the interviews with the review team.  "Inappropriate language had been used at times causing distress. There have been cases where women were blamed for their loss and this further compounded their grief.  "There have also been cases where women and their families raised concerns about their care and were dismissed or not listened to at all."  In the review, seven "immediate and essential actions" were recommended for across England, which included risk assessments throughout pregnancy and monitoring foetal wellbeing.  The other recommendations included enhanced safety, listening to women and families, managing complex pregnancy, and staff training and working