A coroner has ruled that a 'gross failure' in medical care led to the deaths of Jennifer Cahill and her newborn daughter, Agnes Lily, during a home birth in Prestwich last year. The 34-year-old international export manager died after suffering a haemorrhage following the birth, while her daughter was delivered not breathing and died four days later.
The inquest at Rochdale coroner's court heard that Cahill's pregnancy was considered high-risk due to a previous postpartum haemorrhage, but she was not properly advised on the dangers of a home birth. Expert midwife Abigail Holmes criticised the lack of 'meaningful conversations' about risks, stating that phrases like 'out of guidance' were used instead of 'against medical advice', and the risk of death was not explicitly raised.
The court also heard that community midwives Julie Turner and Andrea Walmsley had worked 12-hour shifts before the delivery and had been awake for over 30 hours. Vital notes, including blood pressure readings and the baby's heart rate, were not properly recorded, with one reading scrawled on an incontinence pad that was later discarded.
Manchester University NHS Foundation Trust has accepted that Cahill should have been referred to a senior midwife to discuss the risks. The coroner described the events as 'a Victorian-age nightmare', and the trust has apologised for the failings in care.
