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A plaster cast of Elyce Forshaw-Prowse's feet and another of her fist sit in a pink memory box. So does her white and red blood-pressure cuff, which seems too small for a doll, let alone a newborn.

On the living-room shelf in this suburban Toronto home, Elyce's ashes rest in a small golden urn. Her mother won't bury them until she knows how and why her daughter died in hospital - an answer Ontario's Office of the Chief Coroner is to obtain by late spring.

"If she had passed away in normal circumstances, that would be bad enough," said Sandra Forshaw of her five-day-old daughter who died almost a year ago. "Knowing she was supposed to be here and it could have been avoided makes it all the harder to move on and have closure."

Ms. Forshaw's case shows how difficult it can be to get answers when a loved one dies in hospital. Despite a patient-safety movement calling for greater openness, no one, the 36-year-old mother said, has provided her with an explanation.

She can't help but wonder if things would have turned out differently had she been able to stay in a hospital that provided the highest level of care to mothers and babies - instead of being transferred to a community hospital.

David Evans, acting regional supervising coroner for Toronto West, has ordered Ontario's Maternal and Perinatal Death Review Committee to probe Elyce's death. Answers are expected in late May or June.

"There are concerns raised by the family which I think are, so far, quite legitimate," said Dr. Evans, who is acting chairman of the committee.

Each year, the Ontario committee reviews about a dozen newborn deaths. As part of that review, the regional coroner can, among other things, ask bodies that regulate doctors and nurses to consider reviewing the case and request hospitals to perform a quality-assurance care review.

According to the Canadian Institute for Health Information, 962 babies died from various causes in Canadian acute-care hospitals in 2007-2008, excluding Quebec.

In this case, Elyce, a five-pound baby born at 33 weeks gestation, suffered such severe brain damage that a decision was made to disconnect her from life support on March 20, 2008. Her parents took turns holding her until she drew her last breath, an agonizing four hours later.

"We didn't expect anything to go wrong," said father Corey Prowse, 36.

Hopes dashed

Elyce was to complete the blended family that Ms. Forshaw, with her daughters Emily, 10, and Sarah, 8, and Mr. Prowse, with his 10-year-old son Conor, had created in their home in Pickering, Ont.

Since Ms. Forshaw's previous pregnancies were routine, she decided to have a midwife.

But things did not go as planned: Seven months into her pregnancy, her membranes ruptured. She was eventually transferred to the downtown site of Toronto's Sunnybrook Health Sciences Centre, which is capable of providing care to the highest-risk babies and mothers.

For five weeks, Ms. Forshaw stayed at Sunnybrook, where she says she received excellent care. At 32 weeks gestation, she was transferred to a community hospital, Rouge Valley Centenary in Scarborough, which typically cares for mothers and babies at moderate risk.

"Routinely once they reach 32 weeks, we allow them to be born at a Level 2 centre," said Shoo Lee, pediatrician-in-chief at Toronto's Mount Sinai Hospital. That's because studies show babies at that gestation do as well in Level 2 as they do in a higher-level nursery.

However, Dr. Lee, director of the Canadian Neonatal Network, said that in some cases mothers at 32 weeks gestation who have other complications can stay in a Level 3 hospital, which is capable of providing care to the highest-risk babies and mothers.

The cause of ruptured membranes is unknown, but when it occurs there is a higher risk of acquiring an infection. Yet detecting that infection can be difficult to do in a non-invasive way, according to Gerry Marquette, a perinatologist at B.C. Women's Hospital & Health Centre.

"By the time we have clinical evidence of chorioamnionitis, there has been smouldering infection for some time," Dr. Marquette said.

Chorioamnionitis, which is suspected in Elyce's case, is a bacterial infection of the amniotic fluid and the membranes that surround the fetus.

Dr. Marquette is involved in a study that is trying to determine if it is best to deliver babies of mothers with ruptured membranes at 32 weeks gestation, rather than to wait. The results of the study could affect an estimated 10,000 Canadian women each year.

As for Ms. Forshaw, she wishes she had been allowed to stay at Sunnybrook. That hospital's spokesman, Craig DuHamel, declined comment, due to the ongoing coroner's review.

Two obstetricians who cared for Ms. Forshaw at Centenary, Joanne Ma and Colette Rutherford, declined comment, citing patient confidentiality and the coroner's review.

Rik Ganderton, chief executive officer of the Rouge Valley Health System, which oversees Centenary, also declined comment, and referred an interview request to David Brazeau, its director of public affairs and community relations. Mr. Brazeau said he couldn't comment on Ms. Forshaw's case due to patient confidentiality.

Mr. Brazeau said 2,166 babies were born at Centenary in the 2007-2008 fiscal year, and the hospital's Level 2 nursery cared for 700 infants. Fetal monitoring, he said, is tailored to the needs of the patient, and there is a pediatrician on call at all times.

Ms. Forshaw said she had worrisome signs - abdominal tightening and green discharge - on March 14, 2008.

The next day, she had a 39.5-degree temperature; Dr. Ma was concerned as it suggested chorioamnionitis, according to her operative note.

"I explained that I needed to perform a cesarean section immediately," says the report dictated by Dr. Ma on March 15.

Elyce had a fairly normal heart rate when she was born, but was not making much effort to move or breathe. A Code Pink - when a newborn requires resuscitation- was called, according to Dr. Ma's operative report.

Hours after her birth, Elyce was transferred to the Hospital for Sick Children in Toronto, where she was cared for until her death.

Today, her parents are left with those few things Elyce used in her short life: pink knit booties, the shell the priest used to baptize her, a pink cap.

"I would hate for anyone to ever have to go through this again," Mr. Prowse said.

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Knowing the cause of death doesn't relieve the pain

With a baby's death comes a crushing form of grief, as it violates the natural order: Old people are supposed to die, not infants.

"You should never be burying your child," said Sandy Costa, executive director for the Perinatal Bereavement Services Ontario, a non-profit support group for parents.

When Ms. Costa had to bury her firstborn, Seth, in August, 2005, he was 22 days old. He died after coming into contact with someone who had oral (cold sore) herpes. Many carry the virus that is seen as a nuisance for its ability to make small, fluid-filled skin blisters, but it can be lethal to newborns whose immune systems are not fully developed.

How he contracted it was a mystery: Neither she nor her husband, Daniel Mackie, tested positive for the virus.

Ms. Costa replayed every scenario in her head: Did he contract the virus from a hospital nurse? Was the virus harbouring in a diaper change pad she used?

"Everybody looks for a reason as to why this has happened," said Ms. Costa, who today has two sons, Ronin, 2½ and Gavin, nine months. "I knew why my son had died and there was nothing I could do about it. There was nothing in my control to stop him from getting sick."

Finding the cause of a baby's death does not provide a balm for grief or necessarily the closure bereaved parents crave.

"Babies do die in hospital," she said. "Some will never know [why]. It doesn't make a difference to your grief whether you know or you don't."

Sandra Forshaw, 36, found it especially difficult being separated from her baby, Elyce, who was sent to a children's hospital in Toronto, shortly after her birth on March 15, 2008. Ms. Forshaw was still at Rouge Valley Centenary in Scarborough, recovering from a cesarean section in the maternity ward, leaving on day passes to visit her daughter at the downtown hospital. Afterward, she would return to her Scarborough hospital bed, where "I listened to excited visitors and babies crying all night long," Ms. Forshaw said.

Ms. Costa said moms should be placed in a different area

of the hospital so as not to highlight what the grieving mother has lost, or in Ms.

Forshaw's case, was about to lose with the March 20, 2008, death of her daughter, five days after her birth.

"It's very difficult to go home empty handed," Ms. Costa said, "when you are not supposed to."