The incident is among dozens of alleged failings at the Oxford University Hospitals NHS Foundation Trust, which is being reviewed as part of a nationwide inquiry into maternity care standards across the NHS.
An investigation by the New Statesman and Channel 4 News spoke to 24 mothers who said they were traumatised by their care, or whose babies died or were harmed, due to alleged failures at the hospital since 2009.
One mother, Emma Cox, gave birth prematurely to twin girls, Hope and Lilly, in May 2011.
“At 24 weeks I went into spontaneous labour. They were born. I was told that one of them was stillborn and the other one was taken and resuscitated and taken to the neonatal unit,” she said.
“A short time later Lilly was brought back to me and they said the mortuary was unable to take her because she was actually alive.”
Cox described her baby as “pink and moving her little hands and her little toes.” She pleaded for Lilly to be placed in the neonatal unit alongside her sister, but the hospital refused, saying she had been without oxygen for too long and nothing could be done.
Lilly survived for 24 hours without medical intervention, while her sister Hope died 12 hours after birth.
The New Statesman investigation also uncovered cases of women being denied caesarean sections and reports of poor care over many years. In 2023, Oxford University Hospitals recorded the highest stillbirth rate in the UK.
Health Secretary Wes Streeting said the Oxford Trust had “serious questions to answer” and described the findings as “deeply troubling.”
He added: “There is a cultural problem in this country. We have accepted as normal levels of birth injury, trauma, and baby loss that other advanced health systems would never accept as normal.”
Recent inquiries into maternity care at East Kent, Morecambe Bay, and Shrewsbury and Telford have revealed widespread systemic failures across NHS maternity units, where dozens of babies died due to poor standards of care.
Data from the Care Quality Commission shows that half of NHS maternity services still fail to meet basic safety standards. Streeting has ordered a new national investigation into maternity services, led by Lady Amos, which is expected to publish its findings next year. The Oxford trust is among the 12 NHS trusts being examined.
Simon Crowther, interim chief executive of the Oxford University Hospitals NHS Foundation Trust, said:
“We recognise the profound responsibility entrusted to us in caring for women, babies and families during some of the most significant and vulnerable moments of their lives.
“We extend our heartfelt apologies to any family who has not received the standard of care they deserve and our condolences to those who have experienced loss.”
He said the trust was cooperating fully with the inquiry and had “taken meaningful steps” to improve maternity care, including recruiting 54 additional midwives, investing in clinical training and leadership, and upgrading facilities.
Crowther added that the trust had also strengthened bereavement services to provide compassionate, specialist support to grieving families.
“However, we recognise there is much more to do and we remain determined to go further,” he said.
