A mother who died hours after giving birth to her second child by Caesarean section was emotionally distressed and in pain, a landmark court case heard.
Frances Cappuccini lost more than two litres of blood when her son Giacomo was born at Tunbridge Wells hospital in Pembury, Kent, in October 2012. She was operated on but never woke up and died the same day her baby was born.
Two anaesthetists who cared for Mrs Cappuccini after the operation had completed failed, the prosecution alleges, in what it said was their "elementary task" to ensure she safely came round from the surgery.
Consultant anaesthetist Errol Cornish, of Holmbury Park in Bromley, south-east London, has pleaded not guilty to manslaughter by gross negligence.
Dr Nadeem Azeez, who, the prosecution said, was primarily responsible for the care of Mrs Cappuccini, is not on trial, having left the country.
Maidstone and Tunbridge Wells NHS Trust, which runs Tunbridge Wells hospital, has pleaded not guilty to a charge of corporate manslaughter.
It is the first time an NHS trust has been charged with the offence since its introduction in 2008.
In a written statement, read before jurors at Inner London Crown Court, midwife Julie Michaud described how Mrs Cappuccini appeared as she arrived at hospital in labour.
She said: "She was in great distress both in pain and emotionally.
"She appeared to be extremely frightened."
The case heard her son was delivered at around 8.40am, some 12 hours after going into labour.
But she lost 2.3 litres of blood (around four pints) and was taken into theatre.
The court heard that the tube helping Mrs Cappuccini to breathe after the operation had been removed by 12.30pm but, despite apparent difficulties with her breathing after that point, there were delays in re-intubating her.
Just five minutes after the tube had been removed it became clear there was an issue but Azeez failed to ask for help in time, the court heard.
Prosecutor John Price QC said: "At this stage it is clear that all was not well. The patient was very obviously not breathing properly.
"The prosecution submit that Dr Azeez should at this stage have asked for assistance and was very seriously at fault for not doing so."
By 1pm Cornish had been called to help with the situation, and he spent around 50 minutes in the room, the court heard.
But, Mr Price said, he failed to immediately make sure Mrs Cappuccini was re-intubated, therefore contributing to the cause of her death.
He said: "Dr Cornish had contributed to its cause by failing to do what he himself later was to acknowledge should have been done. He should immediately have ensured that she was re-intubated and in failing to do so was, the Crown allege, he too was grossly negligent."
Azeez, who was appointed by the trust in 2007, did not, the prosecution alleges, have the qualification certifying his basic level of competence in anaesthetics.
He was not appraised until almost three years after first being employed by the trust, and when he was, it was noted that his minimal training in dealing with seriously ill patients meant he lacked both confidence and skills in that area.
The prosecution alleges the trust had failed to make sure Azeez was properly supervised. South African-born Cornish, Mr Price said, had never gained a post-graduate qualification in anaesthesia recognised in the UK and has "never met the criteria for substantive appointment as a consultant anaesthetist".
The death of Mrs Cappuccini, a "healthy young woman", was "wholly unexpected" and "wholly avoidable", Mr Price said.
He said Cornish and Azeez had failed in the "elementary task of protecting her airway in order to ensure that as she recovered from the operation she remained adequately ventilated, that sufficient air was getting into her lungs".
The prosecution alleges that if one or both doctors are found to be grossly negligent, causing the death of Mrs Cappuccini on October 9 2012, the trust can be said to have employed someone they knew or should have known was not suitably qualified or trained for their role.
The trial, which is due to last for four weeks, was adjourned until 10.30am on Friday.