A baby died of massive brain damage after midwives advised his mum to stay home despite falling desperately ill during labour, an inquest heard.
Lewis Booton-White died in mother Vicki's arms shortly after being born at the Serenity Unit in Birmingham's City Hospital last May.
She had been vomiting and had unknowingly been bleeding heavily during labour, but was told to stay home by midwives.
The 24-year-old, from Smethwick, had been checked out earlier in the day at City Hospital, but was told everything was fine and sent home.
Vicki's worried mum later called midwives as her daughter was in so much pain that she could not get to the phone - but she was still instructed not to return to hospital.
Eventually her worried family called an ambulance and she was rushed back to the Serenity Birthing Unit, where doctors discovered the baby's heart rate was dropping.
Lewis was born not breathing and with no heart rate and after being briefly revived he was placed on life support. Medics warned customer service assistant Vicki that if her son did survive, he would be left seriously brain damaged.
After having Lewis baptised, the devastated mum took the decision to stop his life support and he later died in her arms.
At an inquest into the death, HM Coroner Louise Hunt recorded a narrative verdict and said: "Lewis died from acute hypoxia which occurred during labour because he had a small placenta."
The hospital has denied any alleged staff failings had contributed to the death.
The hearing was told Lewis was a small baby and there had been a small placenta but previous scans suggested he was growing within the normal parameters.
Lawyers acting for Vicki claimed a Serious Incident Report carried out by Sandwell and West Birmingham Hospital Trust following the death had highlighted some staff failures.
These allegedly included that the midwife team had poor record keeping and the instructions given to the expectant mum about when to return to the unit were not clear. A telephone log should have also been used, it was claimed.
Victoria Blankstone, from Irwin Mitchell lawyers, who represented Vicki at the inquest, said: "Vicki has been left devastated by the death of her baby boy and for the last 15 months has struggled to come to terms with her loss.
"This is a very difficult time for the family and the inquest has gone some way in providing answers to the questions they had about why Lewis died."
Sandwell and West Birmingham Hospital Trust offered condolences to Vicki and her family and said an internal investigation had been undertaken with findings provided to the coroner.
"Through this investigation we found that whilst there were some areas that could have been improved, there were no failings that could have caused or contributed to baby Lewis' death," a spokeswoman said.
"We accept the Coroner's finding that baby Lewis died of acute hypoxia which occurred during labour because of an insufficient placenta."