The obstetric gap
At least eleven of the seventeen indicted babies were twins or multiples. Multiple pregnancies are managed, in the UK, by specialist obstetric and fetal-medicine teams — not by general neonatologists. The complications the mothers of the indicted babies were managed for include TTTS (twin-to-twin transfusion syndrome) in monochorionic twin pregnancies, selective growth restriction, APS (antiphospholipid syndrome), and the specific high-risk profile of triplet pregnancies sharing a single placenta.
These antenatal histories are, in obstetric terms, as relevant to any retrospective causation question as the neonatal records. Twin-pregnancy complications produce specific, well-documented patterns in how the babies then present, deteriorate, and respond to routine neonatal care.
Hawkins’s core observation is simple: the medical experts who reviewed the evidence at trial were, by and large, general paediatric specialists. The obstetric and fetal-medicine context that would normally frame how these babies were understood was largely absent from the evidence the jury saw.
What an obstetric-informed review would include
- Antenatal booking records. Where the mother was booked; under which specialist team; what specific complications were identified during pregnancy.
- Referral patterns. How the mothers came to deliver at the Countess of Chester (a Level 2 unit) rather than at a regional tertiary centre equipped for high-risk multiples.
- Fetal-medicine interventions. In monochorionic twin pregnancies with TTTS, laser surgery is sometimes performed antenatally; the babies’ postnatal trajectory depends substantially on that intervention’s success.
- Placental pathology. Systematic review of placental histology in twin pregnancies is a routine part of obstetric casework. It was largely not adduced at the Letby trial.
Why the CCRC is the right body to look at this
The CCRC’s role is to identify whether evidence not before the jury, which a reasonable Court of Appeal might treat as significant, now exists. The specialist obstetric evidence that would contextualise the indicted babies’ antenatal histories is exactly that class of material. See our CCRC explainer.
Meeting Prof. Richard Gill
Hawkins’s letter grew out of months of correspondence and eventual in-person discussion with Prof. Richard Gill, the Leiden statistician who was instrumental in the Dutch Supreme Court’s exoneration of Lucia de Berk. Gill’s position is that the Letby case is a structural copy of the de Berk case at the level of statistical methodology. Hawkins’s position is that, additionally, the medical-specialist methodology was wrong: you cannot adequately review a cohort of twin-pregnancy babies without calling the specialists who actually manage twin pregnancies.