The parents of a child were left alone when their baby son was born in Royal Bolton Hospital (RBH), an inquest has heard.

Emmanuel Allen Ohizu was born on June 21 at 2.55pm, but tragically passed away just one hour and 28 minutes later.

He was four months premature.

His mother, Adrienne Allen, told the court: “My husband did ask if anyone was going to clean me and no one did.

“So my husband took me to the shower to clean me himself.

“There was no communication about how quickly he would come, or how that would happen.

“There were 10 to a dozen people in the room, but everyone had left the room after my water had broken.

“So we delivered our baby ourselves in the room alone.”

According to Ms Allen’s statement her husband, Jude Ohizu, was told by staff that he was being “intimidating”.

Coroner Michael James Pemberton oversaw the inquest in Bolton Coroner's Court on Thursday.

He said: “This added further stress because you felt Jude may be removed from the delivery room and he was your sole supporter at the time.

“This was your first child, you were only half-term and had not taken any birthing classes, this was an entirely unknown situation for you.”

Ms Allen went to the maternity triage on June 18, complaining of “considerable” abdominal pain, where she was diagnosed with a urinary tract infection (UTI) and prescribed antibiotics and painkillers.

After the pain didn’t improve she returned where it was discovered that she was three centimetres dilated.

A speculum exam could have been performed after the UTI diagnosis, which could show whether or not she was actively in labour.

Dr Kirsten Lee, who made the diagnosis, told the inquest: “In hindsight, reviewing the decision made and what has happened subsequently, I probably should have performed a speculum exam at the time.

“That’s something that I have reflected on since, but at the time I was satisfied with the diagnosis.”

A UTI test after Emmanuel’s birth came back negative.

The coroner agreed that a speculum exam should have been performed but emphasised that he couldn’t be sure what it would have shown.

Ms Allen’s pregnancy was 21 weeks and six days when she gave birth.

However, hospital staff had incorrectly thought that the pregnancy was 22 weeks and six days.

The inquest heard from multiple obstetricians and gynaecologists that there is a firm line of 22 weeks for premature births, before which doctors will not attempt to save the baby.

At the time of Emmanuel’s birth, Ms Allen was just hours away from being 22 weeks pregnant.

Mr Ohizu told the inquest that hospital staff had asked “if [they] could hold on for another nine hours” for a “chance of intervention”.

The coroner said that this mistake: “gave the expectation that something would be done when it wasn’t going to be.”

Mr Chattopadhay, the consultant obstetrician and gynecologist at RBH at the time of the birth, attended the inquest.

He had suggested that a cervical stitch might be an option to delay the pregnancy for five to six weeks.

However, this was a risky procedure to perform, especially on someone having contractions.

Within an hour and a half of him suggesting the procedure, Ms Allen was in labour.

Mr Chattopadhay said: “When we discussed the option we didn’t think she would become fully dilated and deliver in 90 minutes.

“I would say a very quick progression. It’s an absolutely impossible thing to predict.”

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By the time Ms Allen’s water broke, the only midwife present was Antoinette Holton.

Ms Holton had taken over from another midwife, Chloe James, who said she could not handle the stress of the situation.

Ms Holton said: “[She] said she didn’t feel able to cope with the emotions shown in the room so I offered to take over.

“It was not beyond her technical ability but she didn’t feel able to provide care.

“You don’t know what’s going to happen with premature labour. Because she had dilated so quickly the assumption was that it was going to happen quite quickly.”

The coroner said: “Unless you have been in a delivery suite in a moment of crisis, I think it’s impossible to understand – it’s a difficult situation.

“I also do recognise, not just the effect on the parents, but the effect on professionals – this is not something that would have been an easy day at work.”

After the doctors in the room left, Mr Ohizu’s sister arrived with a Subway for the parents, so Ms Holton left to show her to the family unit and to bring clean sheets for Ms Allen.

Ms Holton said: “Obviously they were quite upset and trying to wrap their heads around this – all of this had happened when she was lying down.

“Mr Ohizu was upset – quite rightfully so.

“She had told me that she felt better standing up than lying down – so I felt alright leaving the room to show Mr Ohizu’s sister to the family room and get clean sheets.”

When Ms Holton returned, she found that Emmanuel had a heartbeat, so she gave him to Ms Allen to hold.

The coroner concluded that the death was due to extreme prematurity and that it was unlikely there was anything that could have done to save Emmanuel’s life.

He said: “A baby who lived for one hour and 28 minutes, and yet, within that period I am certain he received an infinite amount of love from his parents who appear to be very devoted.

“On the basis of the evidence I have heard today, I haven’t identified any lack of basic medical care that would lead me to consider neglect.

“I will record a short form conclusion in this very sad case of natural causes.”