A female prisoner who did not know she was pregnant gave birth to a stillborn baby in a prison toilet after a nurse mistook labour for a painful period.
Louise Powell, now 31, was locked up in HMP Styal, Cheshire, for a 35-week sentence for assault and criminal damage.
A watchdog's investigation found staff at the jail made a "serious error of judgment by not assessing Ms Powell properly after she started bleeding and reported being in pain.
The former inmate, who named the baby Brooke, lost the tragic tot in June 2020.
She told BBC's Newsnight: "The pain of Brooke's death will never leave me. I cannot forgive the prison for leaving me when I was calling for help and I felt like I was dying.
"I was having a medical emergency and should have been urgently helped instead I was left. I want justice for Brooke so no other woman has to go through this horror in prison."
When Ms Powell started having gurgling in her stomach, heartburn, bloating and wind, she blamed it on prison food. When she occasionally saw movement in her belly she and her cellmate would jokingly refer to this as her “baby”.
One afternoon she began bleeding and called for help, and told prison staff she could not be pregnant.
By the evening she was doubled up in pain and staff called the prison nurse three times in two hours about her condition.
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However, the nurse said Ms Powell was just having her period and she would book her an appointment over the next few days.
Ms Powell then went into labour in the toilets, and despite assistance from staff, the baby girl, who was born prematurely between 27 and 31 weeks, was stillborn.
It is not known if proper medical attention had been given if the baby might have survived.
A report by the Prisons and Probation Ombudsman (PPO) has slammed the lack of medical care she received.
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It said: "Regardless of the cause, it is not acceptable that anyone should be in unexplained acute pain for several hours without proper assessment or consideration of pain relief.
"Had proper triage taken place, Ms P might have given birth in hospital with proper clinical support and medication instead of in a prison toilet with untrained staff."
The report also said while prison staff – who were praised for the help they gave her during labour – did not miss any obvious signs she was pregnant, more should be done to check if women are pregnant when they enter prison.
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The NHS is now ensuring pregnancy tests are readily available in prisons and is running courses for staff on how to recognise the early stages of pregnancy.
Spectrum Community Health CIC, which runs healthcare services at the prison, has accepted the findings of the report.
Ms Powell says she believes she became pregnant after a night out when she woke up in a strange bed the following morning.
A spokesman said it is "fully committed to ensure that lessons are learnt and that recommendations in the report are acknowledged and actioned following this tragic incident".
Prisons Minister Victoria Atkins said: 'The tragic events detailed in this report should quite simply never happen to any woman or child, and my deepest sympathies remain with the mother.
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