Baby girl dies due to ”unacceptable” Caesarean section delay – inquest


A baby girl who died after her Caesarean section was delayed for three-and-a-half hours was the victim of ”unacceptable” neglect by NHS doctors, an inquest heard.

Tragic Natasha Knowles suffered severe brain damage as a result of the unnecessary delay and fell into a coma before dying aged just four days old.

The inquest heard that on the day she was born a decision was made with her parents Mark and Snezana to carry out a Caesarean section.

However, doctors failed to recategorise the operation from ”urgent” to ”emergency” and the three-and-a-half hour delay left Natasha’s brain starved of oxygen.

Recording a narrative verdict at an inquest held in Flax Bourton, Somerset, on Friday, deputy coroner Brian Whitehouse said there was a ”gross failure” by the NHS.

He said: ”The delay in performing the Caesarean section amounted to a gross failure to provide basic medical attention which significantly contributed to her death four days later.

”There’s overwhelming evidence that I’ve heard that this delay shouldn’t have occurred and that it was unacceptable.

”From the evidence I’m, somewhat reluctantly, persuaded that neglect did occur and that neglect significantly contributed to this little baby’s death.”

Natasha slipped into a coma and died at Southmead Hospital, Bristol, on February 11 2005 just four days after she was born.

A decision to carry out a Caesarean section was made at 11am on February 8 but the operation was not carried out until 2.23pm.

She was born not breathing and with no heartbeat because of the delay and fell into a coma.

Natasha’s parents made the difficult decision to turn off her life-support four days later.

Dr Chris Burton, medical director at North Bristol NHS Trust, offered his condolences and claimed ”lessons have been learned” from the tragedy.

He said: ”A full and thorough investigation was undertaken and as a result we made immediate and significant changes.

”Since Natasha’s death in 2005 the Trust has been continually improving practices and the lessons learnt from this tragic case have been incorporated in our training.”

Mark and Snezana declined to comment following the inquest.


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