Winter 2018 have called the birth and told me that the work was in progress. The woman was then 42 weeks pregnant and because it was the couple's first child they wanted proper guidance. But in the phone call, the staff replied that there was a long time left for childbirth and that they would stay home.

According to the report, two more calls were made during the same day when no fetal movements were experienced. But when the couple had a scheduled time in the specialist maternity care the same day, the woman was advised to take painkillers and go on the scheduled time for assessment.

Found the child dead

According to the report, however, the midwife must have failed to inform the specialist maternal care that there will soon be a patient who does not know any fetal movements. The couple had to wait an extra 40 minutes to get in and well inside the midwife it is stated that the child is dead. However, the IVO's decision contains contradictory information regarding the fact that the patient did not feel fetal movements.

IVO criticizes the delivery department at Norrland University Hospital in Umeå for lack of record keeping. This is when the first documented telephone call occurs only at the third contact with the birth.

- IVO is right in its criticism that journal documentation was incomplete. We have lifted this in the business. But our assessment remains that this had not prevented the tragic event and that is why a lex Maria notification was not made by us, says Eva Innala.