Inquest Highlights Maternity Care Failures at Queen’s Hospital, Sparking Calls for Change in Havering

The tragic death of baby Zachariah Orefuwa Millin at Queen’s Hospital has highlighted serious concerns about maternity care after an inquest found that multiple missed opportunities contributed to his death at just six days old.

Zachariah suffered a brain injury during his birth on 26 October 2024 following complications during labour. An inquest heard that there was a delay in performing an emergency caesarean section after concerns arose about his mother’s condition.

East London Area Coroner Nadia Persaud concluded that Zachariah died from natural causes, with neglect recorded as a contributing factor.

The coroner found that when Zachariah’s mother contacted the hospital with concerning symptoms, the urgency of her situation was not adequately communicated, resulting in a delay before she arrived at hospital.

The inquest also heard that despite her high Modified Early Warning Score (MEWS), there were several missed opportunities to escalate her care to senior medical staff.

The coroner concluded that these failings contributed to the circumstances surrounding Zachariah’s death.

The family have spoken of their devastation at losing their son and the pain of knowing that different actions may have led to a different outcome.

Zachariah’s mother said she hopes lessons can be learned from the tragedy and that improvements in care will help prevent other families experiencing similar heartbreak.

The inquest also heard concerns relating to inequalities in maternity care.

A report examining maternity and newborn safety noted that Zachariah’s mother felt her ethnicity had influenced aspects of the care she received, citing experiences of microaggressions and concerns that her pain was not fully recognised as a potential risk factor.

The report referenced wider national evidence highlighting disparities in maternity outcomes and pain management experienced by some women from ethnic minority backgrounds.

Barking, Havering and Redbridge University Hospitals NHS Trust (BHRUT), which runs Queen’s Hospital and King George Hospital, has acknowledged that the care provided fell below the standards expected and has apologised to the family.

The trust has stated that it is committed to learning from the circumstances surrounding Zachariah’s death and implementing improvements to reduce the risk of similar incidents occurring in the future.

The inquest findings come amid continued scrutiny of maternity services nationally and locally.

Separately, the Havering Daily reported last week, the concerns of a Rainham mother who said she was repeatedly told she was experiencing a suspected miscarriage before later being informed that her unborn baby had a strong heartbeat.

The mother described the emotional impact of being told on multiple occasions that she may have lost her baby and questioned aspects of the care she received.

While the circumstances of the two cases are entirely different and should not be directly compared, both have prompted discussion about maternity services and communication with expectant mothers.

Maternity services across England have been the subject of increased attention in recent years following a number of high-profile investigations and reviews into patient safety.

The Care Quality Commission (CQC) has previously inspected maternity services at Barking, Havering and Redbridge University Hospitals NHS Trust. Inspectors recognised the commitment and professionalism of staff while also identifying areas where improvements were required, particularly around safety, leadership and the management of risk.

For many families, these reports and statistics are not simply numbers on a page.

For Zachariah’s family, they represent the loss of a much-loved baby boy whose life was cut tragically short.

The family hope that by sharing their experiences and by highlighting the findings of the inquest, lessons can be learned and improvements made that may help protect other mothers and babies in the future.

BHRUT has said it remains committed to improving maternity services and ensuring families receive safe, compassionate and high-quality care.

As the trust reviews the findings of the inquest, many will be hoping that meaningful changes follow, both for the memory of Zachariah and for the families who will rely on these services in the years ahead.

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