Only three nurses were on hand to look after 31 patients when a new mum was found dead with her newborn son fatally injured underneath her.
For years nurses at Cork University Maternity Hospital in Ireland were complaining about under-staffing before this week's heartbreaking events.
One permanent, one agency and one newly qualified nurse were working the ward where 36-year-old Marie Downey was found with her son Daragh crushed beneath her.
The mum, who is survived by her two other children, was found on the floor of her private room on Monday morning along with her newborn, the Irish Mirror reported.
It is believed she suffered an epileptic fit while breastfeeding her son and fell out of the bed.
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Baby Daragh lost his battle for life on Tuesday.
Yesterday Minster for Health Simon Harris announced there would be an independent review into Ms Downey’s and her baby's death along with the hospital review.
The Fine Gael politician described the death as "an extraordinary tragedy".
He added: "It is so upsetting and devastating to have a mother and her son pass away in one of our hospitals."
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Marie and Darragh are due to be buried together on Saturday in St Michael's Church, Ballyagran, Limerick.
A source close to Marie's parents Jim and Helen Cullinane said: "Her family are fantastic people, farming people, good people.
"This is disastrous for them, our thoughts and prayers are with them. She was a lovely person.
"Her family are steeped in hurling and are well known in the local farming community."
Kildorrery Parish Priest Father Eamonn Kelleher added: "The Downey family are good, honest, decent Christian people and an awful tragedy has come upon them.
"The hearts of all the parish, and indeed beyond the parish, go out to them."
