As minister holds maternity summit, a mother's angry open letter By Jane Feinmann Junior health minister Dr Dan Poulter has organised a seminar today to consider maternity policy in the NHS. As well as representatives from midwifery and obstetrics, patients have been invited. Here, one of those asked to attend, Beatrix Campbell, who lost her baby a few days after birth, pleads for an end to 'conveyor belt' maternity care. My daughter Alexandra suffered a barbaric death at just three days old as a result of appallingly substandard care in 2009. Beatrix Campbell and her husband's baby died aged 3 days old after negligence at the Royal Infirmary So I hope today's seminar will be a soul-searching event. Top of the agenda should be last month's horrifying finding by the National Audit Office that the number of lawsuits involving 'obstetric damage' is rising - as well as 'significant and unexplained variations in rates of obstetric complications and interventions'. Behind the jargon there are the stories of babies left with a lifetime of brain damage or, worse, stillborn or dying soon after birth. Stories of babies like Alexandra. What is going wrong? One of the major problems is the conveyor belt mentality that pervades some maternity units. This is based on the extraordinary idea that there's a right and wrong way to give birth - natural childbirth is 'good', while women who have problems during labour are failing or are even making trouble. I was 14 days past my due date when I was admitted for an induction. Alexandra was my first child and I remember how reassured I was by the bright, modern, well-equipped and well-staffed Simpson Centre for Reproductive Health at Edinburgh Royal Infirmary. The midwives were calm and reassuring - though at that point, I now believe, there should have been concern. Beatrix was reassured by the bright and modern Simpson Centre for Reproductive Health Slim and just 5â€‰ft 2â€‰in, I was carrying a large baby, her body a tight fit in my belly and lying sideways - a known risk factor for stillbirth and one of the most common reasons for a planned Caesarean. So, 30 hours after the induction had started, with the birth canal still barely dilated, I begged the midwife to organise a Caesarean. I was shocked that the request was brusquely refused as unnecessary. From then on, I was a silly girl making a fuss. When I requested a second opinion and asked to see the consultant obstetrician, with my husband Craig repeating the request, we were ignored. If the team had followed national guidance, based on the evidence on what makes for safe obstetric care, I would have had surgery at that point. Indeed, in its internal inquiry into the death of Alexandra, the hospital acknowledged that our daughter could have, and most likely would have, lived had she been delivered by Caesarean at that point. 'I was told by a senior midwife that I must keep quiet about Alexandra's death because the incident might frighten future patients' But she wasn't. Instead, the team decided - I believe on a point of principle - to leave me to continue the labour for a further ten hours. At that point they made a decision without consulting me to carry out a risky forceps delivery. This is not just the view of one set of bereaved parents. A survey by the website Mumsnet, and reported at a conference organised by the Birthrights charity two months ago, found a two-tier system of care. Low-risk women, it found, were 'treated with respect and given great care', while high-risk women, especially those who questioned their lack of choice, 'set off a process of coercive and disrespectful communication from maternity staff'. The campaigning group, Choosing Caesarean, told the conference they hear from women who have lost their babies or seen them injured as a result of being forced to have a vaginal birth. They say midwives can be under pressure to lower their hospital's Caesarean rates by refusing maternal requests. Craig and I have had plenty of time in the four years since Alexandra died to understand how apparently caring staff in a modern hospital could allow such things to happen. What we discovered beggars belief. At the time of her birth, the World Health Organisation had quotas in place to decide how babies should be born: a hospital should allow no more than 15 per cent of all births to be Caesarean - Britain's current rate is 25 per cent. That was being ignored as unscientific in many units. After all, how could a decision on safe birth be decided by quota? She begged for a Caesarean 30 hours after the induction had started, with the birth canal still barely dilated Indeed, the quota was withdrawn in 2010 amid a scientific scandal over evidence that it had been drawn up virtually at random. Today, the National Institute of Health and Care Excellence insists 'the woman's decision (as to whether to have a planned or emergency Caesarean) should be respected'. Yet the idea that it's right to ration Caesareans persists and I'm convinced this is partly to blame for the 'significant and unexplained variations' in complication rates, as identified by the National Audit Office. Last year, the NHS spent Â£482â€‰â€‰million - that's one fifth of the obstetric budget, the equivalent of Â£700 per live birth - on compensating mothers and babies for obstetric damage. In the publicity for today's seminar, the National Audit Office report's recommendation on the need for more midwives and obstetricians is highlighted. That need may exist - though I have to say the unit where Alexandra was born was well staffed. But please, Dr Poulter, make today an opportunity to confront the problem of conveyor belt obstetrics. We must record the outcome of all methods of delivery, notably those that are risky - and, in particular, the controversial Kielland's forceps. 'An untrained and unsupervised junior doctor turned Alexandra's head without moving her body, injuring her brain and spinal cord' Invented in 1915, this instrument, clamped to the head of a baby that has become stuck in a sideways position in the birth passage, is designed to rotate the baby before it is extracted. But rotating an infant's head is risk-taking that doesn't belong in maternity care - particularly since the advent of the increasingly safe Caesarean. Today, many U.S., European and, indeed, British hospitals ban its use. Yet after Alexandra's death, Craig and I were astonished to discover through Freedom of Information questions that the NHS does not keep documentation for injury to mothers or babies as a result of any forceps delivery, including Kielland's. And at the Edinburgh Royal, Kielland's forceps deliveries are twice the national average. My experience of this procedure was traumatic. Without explanation, I was transferred to an operating theatre where an untrained and unsupervised junior doctor turned Alexandra's head without moving her body, injuring her brain and spinal cord so badly she was unable to breathe on her own. She was left so severely brain damaged she was on a ventilator for three days before she died in my arms. Since then, I've made contact with several other women with horribly similar experiences. Tina (not her real name), 33, has a three-month-old son who is severely brain damaged after being delivered by Kielland's forceps at the John Radcliffe Hospital in Oxford, where one in five deliveries uses forceps. She has no doubt that had a Caesarean been performed, her baby would be thriving. What worries me so much, Dr Poulter, is that a woman checking out the safest possible place to have her baby will have no inkling these tragedies have occurred. When such terrible things happen, only an independent investigation can ensure it is never repeated. Accountability in maternity service is just as important as in the rest of healthcare. Yet four years after Alexandra died we have not received a proper apology from the hospital and we know there has been no disciplinary action against the junior doctor who effectively killed our daughter or the senior doctors who failed in their responsibility to do no harm. Edinburgh Royal Infirmary carried out an inquiry of sorts conducted by the senior doctor and midwife most closely implicated in Alexandra's death. At a meeting with us, they added insult to the terrible injury we've suffered by informing us we were 'just unlucky, very unlucky'. I was told by a senior midwife that I must keep quiet about Alexandra's death because the incident might frighten future patients. Certainly the last thing I want to do is frighten women. Craig and I have weathered this storm in many ways. I have a second daughter, Oriane, who is nearly two. We're a happy family. But in memory of our first child, we are committed to fighting for changes in obstetric care so no one suffers as we have done. If all that comes out of today's meeting is a plan to recruit more staff, Dr Poulter, you will have failed in this chance to end conveyor belt obstetrics, and the dangerous dogma and lack of accountability and record keeping that's responsible for so much suffering. Alexandra must not have lived so briefly in vain.