Monthly Archives: February 2010

Nothing’s gonna harm you

Music has immense power. As the saying goes, it can soothe a savage beast, and it can also reach into your soul.

I’ve always been surrounded by music. My Welsh father had the stereotypical tenor voice and my mother played the piano. I annoyed my parents from a very early age until they were finally able to find someone willing to teach a, by then, 6-year-old the piano.

I don’t remember at what age I started going with my parents to see local productions of musicals, but my childhood is filled with memories of seeing all the standards, from Pirates of Penzance to The Sound of Music and, as I became a teenager, the ones which would become classics, like Cats and Phantom of the Opera.

My favourite musical will always be Les Miserables. I’d never had such an emotional response to a piece of musical theatre before. I had been excited and entertained, but never been so moved before.

I came to Sondheim quite late, relatively. But he immediately became my favourite musical  composer. Again it was due to a strong emotional response to both the notes and the words. Sometimes my emotional response is so strong that listening is no longer an entertainment or even easy.

During our few days with Sofia, Roberto sang to her and the song I remember him singing was ‘Not While I’m Around’ from Sondheim’s Sweeney Todd.

Nothing’s gonna harm you, not while I’m around…
No one’s gonna hurt you,
No one’s gonna dare…

Hearing him sing this was difficult. Inside I was screaming, ‘But we weren’t able to protect you.’

It continues to be a very difficult song to hear, but will always remind me of the time we did have with Sofia.


Our child

You are our love, our life, our soul
You will always have our love, our hearts, our souls
Our guardian angel, keeping watch over us

We will never be alone
Enfolded by your love, feeling your love, remembering your love

By remembering your strength
You keep giving us strength
Strength and courage to keep living without you

Memories remain with us
Your sweet smell, your softness, the happiness you brought
Happiness and love that will never fade

In the news

Our local paper’s write up of the inquest into Sofia’s death:

As it was on the front page of the paper

Text-only version

It was difficult to read what had happened and think at the same time that it was about us. I wasn’t reading about some tragedy that had happened to someone else; I was reading about me and about my daughter.

Fighting an uphill battle

We had to fight a year and a half to have an inquest into Sofia’s death. It was difficult at times to keep our strength up. Friends questioned if it was in our best interests to keep appealing with the coroner and I’m positive it affected our psychological recovery, not being able to at least close this door. In the end, I didn’t want Sofia to only be a piece of paper for the coroner to move from his ‘in’ to his ‘out’ tray as quickly as possible.

We entered the Coroner’s Court not knowing what to expect from the coroner – would he just go through the motions as quickly as possible to finally get us out of his hair or actually do his job properly? Thankfully he did his job even more than properly, giving us a verdict that was so harsh for the hospital that our barrister had previously warned us there was no hope of getting it. Our uphill battle was worth it.

I hope this verdict makes it easier for others in the future who also have to fight to be heard.

Verdict of Coroner Dr Andrew Scott-Reid at the Poplar Coroner’s Court.

Coroner sitting at the Inquest on 9 December 2009 in which he has assumed jurisdiction.

Sofia was born on 11 February 2008 on the Labour Suite in Homerton.   She was born alive, she was not stillborn. Following her birth she was cared for by the Paediatricians where she survived for three days before dying on 14 February 2008. The cause of death is Hypoxic Ischemic Encephalopathy Grade 3 and on balance this was due to intrapartum hypoxia in the second stage of labour.  It is not for the Coroner to consider criminal or civil liability as this is a fact finding mission into the cause and circumstances of death.

In relation to the circumstances, he notes that Mrs Willicombe was admitted to hospital in labour with Sofia being 12 days overdue namely at 40 weeks plus 12.  A sweep was performed which failed to induce labour and therefore Mrs Willicombe was admitted for the induction of labour.

Mrs Willicombe was assessed by the Specialist Trainee on the ward round and in accordance with the protocols 50 micrograms  of Misoprostol was given and there was a prompt response.  A review was to take place four hours later, at approximately 1400 hours.  A further dose of Misoprostol was given at about 1400 hours and there is no criticism of this second dose.  This is a matter of clinical judgment and in accordance with the hospital’s protocols.  At this time Mrs Willicombe was monitored and there is no cause for concern and there was some reassuring features on the CTG.

The coroner noted an absence of monitoring between 1600 and 1830 hours.  Mrs Willicombe was to be reviewed again but approximately half an hour before that review she was seen at 1830 hours and it was clear, following a vaginal examination, that the labour was progressing and that the cervix had dilated and therefore the decision was made to transfer Mrs Willicombe to the labour suite.

The labour suite rooms were occupied and the only room available was the mother’s suite and the midwife was asked to bring Mrs Willicombe to this at about 1835/1845 on 11 February. There was a handover to the midwife who was assigned to manage the second stage of the labour.

The midwife from Turpin ward was asked to perform a vaginal examination while the room was being prepared.  The midwife confirmed that the cervix was nearly fully dilated and effaced with Mrs Willicombe well on the way.  From experience it was expected that delivery would be within an hour and if not there would then be a further escalation in treatment. Thereafter between 1845 hours and 2015 hours Mrs Willicombe was under the care of the midwife in the mother’s suite.

He heard conflicting evidence and accounts of the factual situation in the second stage between 1845 and 2015.  There are retrospective notes and he has heard direct oral evidence from the sister, the midwife from Turpin ward and the midwife from the mother’s suite. He preferred the evidence of the other witnesses and records which are contemporaneous.  He did not find the witness evidence of the midwife from the mother’s suite to be reliable and therefore he has treated her evidence with a degree of caution.

Accepting the other evidence, he is satisfied, on the balance of probability, that during the second stage of labour there was an unacceptable level of monitoring  of the fetal wellbeing.  From the evidence that we can reliably obtain it satisfies him that the Trust’s own guidelines were not followed or complied with and this was sufficiently deficient. Whilst there is always risk, the monitoring is geared to identify the risk and allow the obstetricians to act to prevent adverse outcomes.  Although there are technical issues and differing bodies of opinion, both in relation to obstetric and midwifery care, he finds that on the balance of probabilities the intrapartum care on the second stage of labour was particularly ineffective and lacking basic midwifery care, and putting all the evidence together at the key time this monitoring was grossly lacking.  It also follows this grossly lacking care was causative of Sofia’s death.  This was on the basis that at the time she was not properly monitored.

His primary conclusion is therefore she died of natural causes but he has said the test of neglect is made out in that there is a gross lack of basic care and therefore he concludes that Sofia died of natural causes to which neglect in the intrapartum care contributed.

The Coroner thereafter thanked all the witnesses concluded the Inquest and passed on his sincere condolences to the family and confirmed his sympathy was with them and hoping that this Public Enquiry would assist them.


There are many expressions in the English language that use the word ‘time’.

play for time,
pass the time,
it’s high time,
move with the times,
not before time,
time on your hands,
time after time,
time flies…

Time is subjective and how we each experience it can be impossible to explain to someone else. We can share our experiences which involve our senses; we can both hear the same song or taste the same freshly baked cake. But it’s impossible to share another person’s perception of time.

The first year after Sofia died was as if time stood still. Looking back, I feel as if that year never actually existed for me, in a sense ‘the year that never was’ for me. I was able to spend nine months on leave (it was still considered maternity leave) and during those nine months I went from my bed to the couch and back to bed, and that was pretty much all I did.

People say time heals all wounds. It’s logical the deeper the wound the more time is needed to heal it. I felt wounded to my very core, as if someone had ripped open my chest and pounded my heart as much as it could be without destroying it completely. It would take a lot of time to heal my wound and heal my heart.

Not long after Sofia died, I received a letter from a distant cousin I’d never met. She had also lost a newborn and wanted to reach out to me. I only managed to skim her letter. The pain which wasn’t so evident in her actual words was written everywhere else, and the pain was immense. She had since had another two children and her loss was now many years ago, but I felt her pain was still almost unbearable for her. I knew then that losing Sofia wasn’t something I would ever get over, but seeing how another mother’s pain was so raw even after so much time had passed, was a terrifying confirmation for me.

Getting through the first anniversary of Sofia’s birth and death felt like an achievement. Like other grieving people I’ve talked to, the first year was definitely the hardest. Thankfully, with time, the pain has softened. I don’t think it will ever go away, but as time passes the pain becomes more bearable.

Time heals what reason cannot – Seneca

The day my daughter died

With my angel

Sofia came into the world at 8.30pm on 11th February 2008. I have sometimes wondered if her lateness in entering the world was because she knew her life in the outside world was going to be very short.

She spent her first night in the Special Baby Care Unit of Homerton Hospital, hooked up to various machines and monitors. She was surrounded by other babies, all of whom had been born prematurely. They were all tiny, fragile bundles, fighting to stay alive. I’d never seen babies so small in real life before. Sofia was 3.5kgs; she looked like a healthy, chubby newborn baby ready to begin life. Yet, of all the babies in the room, it was she who had no hope of living.

The next morning we talked to the doctor who was taking care of Sofia. All the previous night I searched for any scrap of hope while, at the same time, being unable to take in what had happened (normal shock and denial, I guess). As the doctor talked us through the results of the tests and monitoring they’d carried out, my brain was really only listening for positive things, waiting to hear some tiny message of hope I could cling on to. But I wasn’t hearing any. The one phrase the doctor said that’s still engraved in my memory is, “When she dies…”. Not ‘if’, but ‘WHEN’.

We decided to take Sofia off life support that afternoon. There was no way of knowing how long she’d live… minutes, hours or days. We started taking photos, lots of photos, most of which I still haven’t looked at.

After it became evident that Sofia wasn’t going to stop breathing immediately, we were able to all move into a private area just off the ward which had a bedroom, small kitchenette and sitting area. This is where the three of us lived for the next three days, with the wonderful nurses and doctors coming to check on all of us there. In the bedroom we were able to take care of Sofia. We changed her nappy, we changed her clothes, we did some of the things all parents have to do. As her heart beat slower and slower, and her breathing became more shallow, we talked to her, sang to her and played her music.

Sofia died at 4.30pm on 14th February 2008.

The shoes I wear…

I am wearing a pair of shoes

They are ugly shoes, uncomfortable shoes.

Each day I wear them, and each day I wish I had another pair.

Some days my shoes hurt so bad that I do not think that I can take another step.

Yet, I continue to wear them.

I get funny looks wearing these shoes.

There are looks of sympathy…

I can tell from other’s eyes that they are glad that they are my shoes and not theirs.

They never talk about my shoes.

To learn how uncomfortable my shoes are might make them uncomfortable.

To truly understand these shoes, you must walk in them.

But, once you put them on,

You can never take them off…

I now realise that I am not the only one who wears these shoes.

There are many pairs in the world.

Some people are like me and ache daily

As they try and walk in them so they don’t hurt so much.

Some have worn the shoes so long

That days will go by before they think of how much they hurt.

No one deserves to wear these shoes.

Yet because of these shoes I am a stronger person.

These shoes have given me the strength to face anything.

They have made me who I am.

I will walk forever in the shoes of a parent who has lost a child.

(Author unknown)