Government report: UK midwives put the lives of mothers and babies at risk

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I’ve been writing about this topic for years, from Promoting normal birth is killing mothers and babies to, only a few days ago, In the UK babies continue to die on the altar of vaginal birth,

Along the way I’ve written about the preventable death of baby Joshua Titcombe and his father’s heroic efforts to make sure no one else endure the grief he and his wife were forced to endure. And I’ve reported on the strenuous efforts of UK midwives to avoid accountability, In the face of staggering death toll head midwife relentlessly promotes normal birth, and the staggering increase in obstetric liability costs as a result of bad outcomes.

The government of the UK has finally taken notice, producing a report that is scathing in its assessment of midwives

The Health Service Ombudsman examined the supervision of midwives after a series of reports into a scandal at University Hospitals of Morecambe Bay Foundation trust involving the deaths of 14 babies and two mothers.

It accuses the midwives in failing to carry out even basic monitoring and then attempting to avoid reponsibility for maternal and infant deaths:

The damning report is fiercely critical of subsequent investigations into the deaths by the trust and the local health authority – which it found guilty of “maladministration” for failing to properly probe the deaths.

Under the current NHS system of regulation, local midwives in were asked to investigate their peers following a series of deaths at Furness General Hospital.

Despite clear evidence of serious mistakes made, they found their colleagues did nothing wrong.

There were long delays investigating the deaths, and failures to highlight obvious lapses in care – such as babies not having their heart rates monitored and not being given antibiotics despite being very poorly, the report found.

The report entitled Midwifery supervision and regulation: recommendations for change is restricted to strengthening the weak oversight of UK midwives that allows them to ignore mistakes, fail to learn from them, and avoid accountability.

As if on cue, the Royal College of Midwives promptly moved to avoid accountability and maintain supervision of a system that could not prevent, and has not learned from, multiple maternal and infant death:

RCM chief executive Cathy Warwick said: “Midwifery supervision is a statutory function, is highly-valued by the midwifery profession and, indeed, has been the envy of other professional groups. It is impartial, in that it does not represent the interests of any service provider.”

“In many maternity services, the supervision of midwives can and should make a significant contribution to the protection of women and their babies,” she said. “It is very important that the long-term consequences for high-quality maternity care of further changes are very carefully considered.”

She added: “We must be extremely careful not to lose sight of the benefits of midwifery supervision; we could be in danger of throwing the baby out with the bath water.”

Bravo, Cathy Warwick! Thanks for demonstrating the point of the report: midwife regulation and supervision must be changed because midwives are interested in protecting each other and avoiding responsibility and give woefully short shrift to their legal and ethical obligations to mothers and babies. QED.

The purview of the report did not extend to investigating underlying causes that led to the mistakes themselves. I suspect that the underlying causes are an unholy marriage between the midwifery philosophy and the government’s desire to save money by hiring midwives instead of obstetricians. These midwives are well educated and well trained, but they subscribed to a thoroughly unethical (not to mention scientifically unsupported) elevation of process above outcome. No doubt they’ve decreased the rate of interventions and C-sections. As a result, they have inevitably increased the rate of senseless, easily preventable maternal and infant deaths.

The “Campaign for Normal Birth” benefits midwives, and kills innocent women and children. It must stop immediately or more lives will be lost in UK midwives’ relentless attempts to promote and protect themselves.

  • EmmaJ

    I had a very positive experience with a hospital birth under private consultant care in the UK. I wouldn’t have had it any other way and felt a lot safer considering I was left with a trainee midwife for a time who couldn’t even get a line in. My husband had to do it. Thankfully he is medically trained.

  • sdsures

    This makes me afraid to have a baby in the UK. Luckily, my medical conditions will mandate a CS, but if I heard any “natural birth” crap from my NHS midwife, I’d be the first person to ask in exactly which prehistoric frog swamp did she attain her credentials.

  • Lizzie Dee

    On one of the many television programmes focusing on midwives, I heard yet again an experienced midwife pontificating about the CS rate. It used to be so low…now it isn’t…how could that be? Women haven’t changed…. etc, etc, etc. Women haven’t changed – but the mortality rates have. What is so difficult to understand about that? The NHS has enough problems without woo infested midwives going on about the wonders of natural – and making damn sure you have it whether you want it or not.

    • The Bofa on the Sofa

      Women haven’t changed, but our medical methods have!!!!! Nowadays, with modern technique and anesthesia, that makes c-sections a lot better in comparison.

      It’s pretty obvious. In fact, there are a lot of things that we do in medicine now that we didn’t do before, because the techniques get better.

      • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

        I think its a reasonable fear though, there have been many protocols that were terrible and had horrendous results in the past. A good discussion of why the rates have gone up is a fine thing to have. I don’t think dismissing the concern is helpful. Most people try to avoid surgery if possible, right?

        • Young CC Prof

          Definitely, people should discuss it! Most mothers don’t want a c-section, and I think prior to term, they should understand more about the issues involved and why c-sections happen.

          What we don’t need is medical professionals who should understand the issues better going on about why the increase in c-section rate is inherently A Bad Thing.

          • The Bofa on the Sofa

            What we don’t need is medical professionals who should understand the issues better going on about why the increase in c-section rate is inherently A Bad Thing.

            And, apparently, they don’t have the first clue about how medicine works.

            Processes and techniques improve, and therefore get adopted to a greater extent compared to those methods that don’t improve. This is pretty much how it all works.
            I

          • fiftyfifty1

            Yep, that’s pretty much how all human culture works actually. Raw meat has not changed much, still has all the same drawbacks. Cooking, on the other hand, got better and better. Cooked meat percentage went up, raw meat percentage went down. Humans haven’t changed and yet the cooked meat percentage is so much higher than it was back in the cave man days. Hand wringing!!!

        • The Bofa on the Sofa

          We ARE having the “discussion.”

          Do you deny that c-section methods have improved?

          When my sister had her first two, at least, it was complete anesthesia. Now, we do them with spinal blocks.

          That alone makes it a hell of a lot better. Spinal blocks are far less risky than knocking someone out.

        • DaisyGrrl

          “Most people try to avoid surgery if possible, right?”
          I don’t know about most people, but I’m not interested in avoiding surgery. I’m interested in understanding why a particular procedure is recommended for me and what the relative risks of treatment vs wait-and-see are.
          When I was told I had appendicitis and should have an appendectomy, my imediate response was “get that sucker out.” This was before I knew what the surgery would entail. I assumed I’d have an awesome scar like my roommate who had hers out the year before. Instead I had a laparoscopy which was like magic to me. Avoiding the surgery didn’t even enter my mind.
          So no, not everyone is interested in avoiding surgery. I think it’s fair to say people are interested acheiving the best outcomes. Unfortunately, NCB has done a good job of hijacking the narrative and making people believe that a c-section is a bad outcome that should be avoided at all costs. It’s an intervention, not an outcome.

          • sdsures

            Exactly. If I need my cerebral shunt revised, I’m not out to avoid surgery.

  • toni

    Has anyone seen ‘Midwives’ on BBC2? I think most of the episodes are on YouTube. I’ve seen three of them and they’re well done. Seeing the faces of parents when the first lay eyes on their babies never gets old! The attitudes of some of the midwives towards the patients are a bit irksome though. It’s filmed at a very busy maternity ward up north and the narrator and the midwives themselves are constantly reminding the viewer how over worked they are and how they barely have enough beds for all the women that need them. Seems this has been a problem for at least a decade, why no improvement? In the first episode one woman having her fourth or fifth baby insisted she would deliver very soon while her midwife insisted she wasn’t in labour and told her to go home and fretted that they couldn’t accommodate all these women not in actual labour. Fortunately she refused to leave and the baby was born soon after. I do like that midwives go to the patients’ homes several times after the babies are born although they aren’t made very welcome a lot of the time. I would have loved that.

    • Hannah

      I’m glad that you posted this, as I was going to bring up one of the episodes as a rider to my point below on the risk level of patients that midwives deal with, and I hadn’t realised they were now available in an internationally accessible format. Here’s the first episode:

      http://www.youtube.com/watch?v=hPtn5-An-rs

      I remember thinking at the time that that midwife (the one with the short blond hair and glasses) was an idiot. The fact that the mother was on her fifth(?) baby might have clued her in that she a) might progress quickly and b) might know what she was talking about when she said that she was in labour and didn’t have the same level of pain at an early stage in her previous labours. The woman dilated to 9 cms while being “not in real labour.” She also seemed to react slowly later in the programme when a baby took a while to start breathing properly, and seemed (I may be misinterpreting) to need to be prompted by another midwife to have a paediatrician called.

      IMO the whole first series (available from the sidebar) is a good overview of the scope of midwifery in the UK.

      Episode 2 shows the training. Episode 4 (this was the one I had wanted to bring up) shows “specialist midwives” providing antenatal care to women with various high risk conditions. This is a role I’m much more sceptical of. It was clear that doctors were directing things behind the scenes but the midwives’ role seemed to me to be (besides saving money for the government) to shield them from the more mundane parts of the job such as explaining to the woman with previous pregnancy losses that she probably hadn’t harmed the baby by dropping a spoon on her bump and persuading the pregnant diabetic teenager to comply with medical advice. Episode 6, I suspect will be interesting to American viewers as it shows midwives in the community performing functions that I understand don’t exist over there.

      • toni

        Do British obstetricians ever attend spontaneous, uncomplicated deliveries? I definitely prefer to have a doctor right there with me waiting for a problem to having an optimistic midwife decide when we’re in trouble and taking who knows how long to get a doctor in the room. I do really like the idea of the community midwives coming to your house to check on you. Not really feasible in a lot of places in the US because houses are much more spaced out but even me with my easy peasy delivery, no stitches and feeling pretty good didn’t like driving to the paediatrician three days post partum. A lot of women feel like complete s**t for a long time.

        They really were tiptoeing around the diabetic girl. I think they said they were worried they’d scare her away if they got on her case too much? Silliness. Needed a good stern talking to IMO. The really anxious lady with the previous 30week stillborn was heartbreaking. I must have not finished the episode because I didn’t see her with her new baby.

        • Hilary

          Toni, no they don’t as a rule. The only time I’ve seen a doctor deliver a baby at a spontaneous birth is when she was there (I think considering prepping for a vacuum lift out) and then the baby just zoomed forward and kind of fell into her hands. Also as a student I “gave” a young, newly qualified doctor one of my deliveries because his overseeing consultant wanted him to get a couple in as he had never delivered a baby as a med student. Really sweet guy, and we talked him through it, but he didn’t have a clue what he was doing. If there is a problem suspected the senior midwife in charge will normally be called into the room to assist with the delivery, so you will have someone extremely experienced there overseeing things.

    • Rachel L

      I’ve also watched this show. I’m in Australia and have watched many episodes of One Born Every Minute UK and the US version as well. While I gave birth in a public hospital, with a midwife, under Medicare in Australia, it is quite different from the UK system.

      The appalling thing about these shows is the high number of inductions that are not explained. I’ll not judge whether they are medically necessary or not, but they are certainly not presented in the shows as medically necessary.

      In the UK version of OBEM and The Midwives, it seems like about half of all women have inductions, and about 90% of women give birth lying on their backs. There is a lot of ARM to speed up the process. Again, I don’t know the actual circumstances, but without explaining these interventions, it appears they are just “the way things are done” there.

      In the US version of OBEM, it looks like about 75% of women have an induction and planned epidural! They also have heaps of extended family in the room in many cases, which I really can’t understand at all. Can’t imagine anything worse, but to each their own!

      The approach to giving birth is clearly affected by culture and the medical system where one lives. Having watched countless episodes of these shows I am SO grateful to live in Australia. The system is far from perfect, and my own antenatal care and birth were far from perfect, but from what I can gather, it was far better than it would have been had I given birth in the UK or US where (it seems) the norm is to speed up the process with unnecessary interventions.

      • Young CC Prof

        You know, the births they choose to show on TV are not necessarily representative of the country as a whole. In fact, the induction rate in the US is 20%.

        And didn’t you explain elsewhere on this thread how your Australia OB ignored obvious signs of intrauterine growth restriction for 8 weeks? You probably should have been induced at 38 weeks, maybe earlier, because your baby had stopped growing.

        I’m dealing with possible IUGR right now in the USA. I go to the hospital every week to check his heartbeat, analyze blood flow through the placenta, check fluid levels, and see how much he’s grown. So far, he’s undersized but holding percentile rank.

        Now that I’m 36 weeks, if his growth stops or they see the placental function failing, they’ll just deliver immediately. I know he’ll grow fast once he’s out, which reassures me a lot.

        • Rachel L

          Hi Young CC Prof,

          That’s true, what’s on TV is not necessarily representative. But it does give an indication of the practice and norms. Eg. Giving birth lying on the bed as pretty much the only option.

          I’m not sure what the medical term was for what happened to me. All I know is that the obstetrician said my placenta had stopped functioning properly and I didn’t have enough amniotic fluid. Without earlier ultrasounds, it’s hard to know whether my baby’s growth slowed down at all. The obstetrician estimated on my due date that my son’s weight was 2.9kg. She said he was safer out than in now that he was full term.

          However when he was born he was 3.3kg, which is 36th percentile on the CDC Chart or 49th on the WHO Chart (which is the chart used here). I didn’t have any fluids in labour so I doubt his weight was artificially increased. His head circumference was very small though, only 32cm (4th percentile CDC, 3rd WHO).

          I don’t think the obstetricians did their job well in my case at all. (As I said, “far from perfect”.) They ignored obvious signs and we are just very blessed to have a healthy, huge (95th percentile for weight!) 2.5 year old, despite their failings. Having said that, my bub was very active in the womb and certainly seemed healthy throughout pregnancy, during labour and immediately after birth. He was very alert, despite pethidine and gas, and there never seemed to be anything wrong with him at all. So I’m happy with how it all turned out.

          What I was saying I like is not so much the ante-natal care (though it was entirely free, public hospital care) but the approach to normal birth. I had a competent midwife, was able to move around as I wished and give birth in a position I was comfortable in. I had the option of medical pain relief, water, and was still able to move around despite fetal monitoring. I had my own room with my husband, and it had a beautiful view. It was pretty nice :)

          I’m glad you have good care where you are. It sounds like you’re both in good hands and I hope your son will be healthy whenever he’s delivered. All the best!

          • Rachel L

            Also, it probably wasn’t clear in what I wrote that I saw multiple Obstetricians throughout pregnancy as I was in Public Hospital Obstetric Care, which means you attend a clinic and see whichever doctor calls your name. So I didn’t have much continuity of care, and I don’t think I had the same doctor twice in those last 8 weeks. I very much doubt the same would happen if one were seeing the same doctor at each appointment.

            It also wouldn’t have been ignored if I had been in Midwife Care, as the midwives are very careful about any abnormalities. Doctors are more likely to make a judgement call and ignore procedure (like refusing me iron studies). Had I been under Midwife Care, I would have been referred to a doctor, who would have been obliged to do an ultrasound. Next time, I’m going to insist on Midwife Care, as my pre-existing conditions didn’t seem to affect pregnancy at all.

          • Young CC Prof

            Most hospitals in the US are the same way: Freedom of movement through the first stage of labor, comfortable private room, optional pain relief, visitor of your choice to support you. My friend had a baby last summer, and when I looked at the newborn pictures, at first I thought they were taken in a living room. Then I realized the baby was wearing a hospital blanket, and I was seeing the maternity ward.

      • Maria

        As to the “heaps of extended family in the room” I imagine that people who are comfortable having their birth filmed and televised are probably those who don’t mind having lots of people in the room with them.

        • Young CC Prof

          Good point. I definitely only want one person in the room with me other than medical personnel, and if I SEE a camera during labor, I’m breaking it. I definitely wouldn’t be volunteering for something like that!

  • http://www.hfme.org/ Thy Miocena

    Putting reduced costs over mothers and babies welfare and very lives. It will be a waste of money in the end, an international embarrassment and the senseless loss of lives that can never be replaced.

  • http://www.hfme.org/ Thy Miocena

    I don’t like midwifery at all not even the CNMs. It is a really misogynist philosophy its core, dehumanizing women and treating them like walking vaginas. With what we know about human evolution no time is really a good time for vaginal birth.

  • R T

    I belong to a 2nd and 3rd trimester loss group on Baby Center and one of the women on there just lost her son at 38 weeks. She was all sorts of high risks and having NST a couple times of weeks. She went to the hospital concerned her baby hadn’t been moving. The NST was very poor. Even after stimulating the baby he only opened his mouth and moved a foot once. She was extremely concerned but the doctor on duty told her to go home, the baby was just sleepy. She begged him to do a her section right then and there a few days early. She told him something was really wrong and with all of her health issues (GD, blood pressure etc) surely it would be okay to move the csection up. The doctor told her there was a new “law” he couldn’t do a csection before 39 weeks unless it was a true emergency. He said he would get in trouble for doing the csection early. She went home in tears and waited until morning and went back to the hospital. By this time, her son had died from a true knot in the cord. However, she said the doctor had fudged the records from the day before. It said “vigorous” movement was noted and nothing about mom begging for a csection. This was her 5th child and she knew something was wrong. Now the doctor is trying to tell her the knot in the cord probably wasn’t what killed her son and it was just a fluke. The knot was tight she saw it with her own eyes, but the doctor is denying it could possibly be the reason the baby died! What can this mom do from this point? She’s so angry, frustrated, guilty and feels helpless. She can’t believe the doctor is going to get away with this!

    • Young CC Prof

      Excuse the shouting, but, WHY THE HELL DO THESE PEOPLE DO NSTs IF THEY’RE JUST GOING TO IGNORE THE RESULTS!?!?!

      That is just awful.

      • Karen in SC

        Awful, and that damned 39 week “rule” rears its ugly head once more.

        • CanDoc

          No. No, no no. This is a gross misapplication of ANY “39 week rule” by a clinician who for whatever reason was looking for justification to delay delivery – maybe the OR was busy, L&D was busy, he was dreading a 5th cesarean at 11 pm…. OR, maybe he really did feel that the baby was okay based on his assessment.
          We do NO *elective* cesarean sections/inductions prior to 39 weeks in our centre. But we DO NOT HESITATE to do a medically necessary one – for poorly controlled diabetes, cholestasis, pre-eclampsia, concerning fetal status, ANY indication where risk to fetus is higher than risk of prematurity.
          Tragic, I just want to cry for this woman.

          • Young CC Prof

            Well, maybe someone HAD recently yelled at that doctor about doing “too many” births before 39 weeks. If that’s part of the reason, it’s most unfortunate.

          • R T

            I don’t doubt it! I begged for a csection before 39 weeks and my Perinatalogist said he was under too much pressure from the hospital administration to cut back on his csections before 39 weeks! I had a partial abruption, GD and SPD and it wasn’t enough to warrant a csection at 38 weeks. I HATE the stupid protesters who stood outside the hospital with picket signs and got on the news protesting the high csection rate! For God’s sake, they have the largest perinatal special care unit on the east coast and a level III NICU. High risk women get transported there by helicopter from as far away as Hawaii! Of course, they have a high csection rate! You’re protesting is going to cost babies their lives!

          • rh1985

            If they are absolutely going to refuse c-sections because of a few freaking days then they should admit for continuous monitoring not send mothers home for the baby to die overnight in utero.

          • Anj Fabian

            Absolutely.

          • rh1985

            The more I think about this, the angrier I get. I don’t understand what is so horrible about delivery at 38 weeks that it’s worth forcing the continuation of an already higher risk pregnancy. I just can’t understand it. If a baby born around 38 weeks does have any problem as a result, it is almost always temporary; if something goes wrong from insisting on waiting until 39 weeks, it’s probably going to be permanent (brain damage or death).

          • Karen in SC

            The March of Dimes decided to focus on that since sometimes earlier than 39 weeks the baby might need extra care. Of course, then insurance companies are “yeah, NICU costs a lot.”

            Ironically, 35 weeks is the “full term” go ahead for a birthing center birth here in SC, if labor begins. (in fact the midwives recommend castor oil smoothies if the mother wants an earlier birth).

          • rh1985

            It’s one thing to discourage 100% elective inductions/c-sections before 39 weeks. But it’s getting to the point of insanity when perinatalogists (who of course are going to care for more pregnancies where there is a medical indication for early delivery) are told they need to lower their rates, and medical reasons are no longer good enough it needs to be immediate definite life or death emergency. I’d like to think in that situation I’d refuse to leave until they either delivered my baby or admitted me for monitoring, but in reality, patients don’t really have that much control.

          • Certified Hamster Midwife

            What health insurer would pay for that?

          • Young CC Prof

            Actually, insurers pay for pregnant women to stay in the hospital all the time. It’s cheaper, day per day, than the NICU.

          • Certified Hamster Midwife

            You’re right. I instinctively assume that all insurance companies are short-sighted and inefficient. I should know better.

    • Amy Tuteur, MD

      She needs to have a lawyer review her chart. If there is any evidence of tampering or changing the record, she has an excellent case against the doctor. It should be free for her to consult a lawyer since malpractice lawyers get paid only when they win a court case, not for consultations.

      Of course it won’t bring her baby back, but it will allow her to inform the public and the hospital will likely take disciplinary action as a result.

    • rh1985

      That is sickening. I somewhat blame the foolish push to avoid deliveries before 39 weeks at almost any cost, but the doctor should still have been non-stupid enough to realize that baby was in bad shape and it WAS an emergency!

    • http://www.electivecesarean.com/ Pauline Hull

      RT – please get in touch regarding this case if the mother is happy for you to do so. I work with a charity that deals specifically with stillbirth and cord related issues and would be keen to put her in touch with them. Thank you.

    • http://shameonbetterbirth.wordpress.com/ Shameon Betterbirth

      SHE CAN NAME AND SHAME THIS JERK ONLINE. She can start a blog like mine about her ordeal so that he won’t get to forget what he did to her and the baby. She can go to MD rating websites and tell the world what happened. She can complain the hospital about falsification of records. She can complain to the medical board about the same thing. He will think twice about fucking with a patient after that- he can know how much trouble one person can cause if they need to protect others.

      Its a small condolence. Nothing can replace what she has lost. All there is to do is focus on preventing this in the future.

    • Rachel L

      So very sorry to hear about your Baby Centre friend. That is just appalling. Throughout my pregnancy – actually, with all the health problems I have had since adulthood – I learnt that we absolutely MUST advocate for ourselves and our babies. No-one will do it for you, and when all goes wrong, they will not be there to deal with the consequences.

      So please Mums, please, when you KNOW something is wrong, if you get the wrong answer, go elsewhere, demand to see a more senior doctor, do not give up. Your instincts may well save your child’s life, or your own.

      I had two of these instances in my pregnancy, thankfully I stood up for myself and the outcome was fine.
      1. I have a history of low iron and B12. I wanted my iron tested during pregnancy, but the hospital obstetrician refused. I went elsewhere and yes, it was again low and well below normal for anyone, let alone a pregnant woman who might lose blood at delivery.

      2. I knew something was wrong as my tummy wasn’t growing. Each time it was measured it was the same, for about 8 weeks. Bub was engaged very early, but the doctors kept saying “oh, he’s just moved down”. No, he hadn’t moved down at all. On my due date, my husband attended with me and yet again, tummy hadn’t grown. Obs was going to do nothing, but my husband pushed, saying “will you do an ultrasound?” She agreed, and it turned out my placenta wasn’t really functioning, and there was very little amniotic fluid. Our son’s brain had greater blood flow that the rest of the body which she said indicated that his body was prioritising the brain. She wanted to induce on the spot! As it was I was in early labour and gave birth that night, and all was fine.

      Both experiences showed me how important instinct is, and how you cannot rely on “the system” to always pick up everything. I later found out that testing for iron levels is standard under midwife care in the same hospital. I was put under obstetric care because I had other health conditions – which contribute to my mal-absorption. SMH!

  • nata

    Just looked up the first case. The mws were not following the guidelines – according to them electronic fetal heart rate monitoring should be used during the induction :(, especially if baby’s heart rate was already higher than the norm, which is the first sign of fetal distress and possibly hypoxia :(

  • Comrade X

    Up until the late 1990s, nursing education in the UK was college and hospital based, leading to a diploma (not a university degree) and registration with the official professional oversight body. If you wanted to become a midwife, you had to first become an RGN (Registered General Nurse), and then complete a further course of training in midwifery. Although it was not university-based, or “graduate level”, it was, in essence, not dissimilar from what seems to be the current model for CNM training in the United States. You had to be a “General Nurse” and then specialize.

    Now nursing and midwifery education is largely college or university based, leading either to a diploma or a degree. While clinical practice is still a big part of the course, there is definitely a sense in which things have moved away from that, and been “academized”, in an effort to somehow raise the status of nursing and midwifery as professions. (The UK is still, in many ways, a very classist society, and the idea of a “university education” conferring some kind of special status on someone in and of itself is still a big thing here). Midwifery is now a discipline that can be entered straight from secondary school, without any prior general nursing qualifications.

    Midwives almost all work in NHS (National Health Service) settings, either in hospitals or in the community. While hospital-based midwives are theoretically supposed to be part of a seamless, co-operative, multi-disciplinary team also including paediatric nurses, paediatricians, general practitioners, gynaecologists and obstetricians, stories of “turf wars” and philosophical chasms abound. As the social “status” of midwifery has risen, and the independent remit of midwives has increased (“consultant” midwives often have limited prescribing powers, and in an average “normal”, “healthy” pregnancy, a woman might not see a qualified doctor at any point from the positive pregnancy test to several weeks post-partum), the amount of “turf” that needs to be “protected” seems to have ballooned as well. Note that I am *not* saying that midwifery is *not* a “real” “proper” “respectable” profession – I am saying that in British society, it seems that the need to “prove” this has taken strange and sometimes dangerous turns.

    At the same time as the whole “turf war” bullshit has developed or increased, it seems that woo-based ideology regarding pregnancy and childbirth has also gradually slipped in to midwifery education and practice. I don’t necessarily mean crazy magical thinking along the lines of cinnamon-breath and affirmations stop bleeding – but certainly along the lines of “unmedicated vaginal birth with limited monitoring is a morally superior ideal” kind of thinking. I have no doubt that there are many experienced, older midwives still working within the NHS who were trained in the “bad, old, medicalized” days, who would have no truck whatsoever with this bullshit. But the idea that women who are too worried about safety, or women who do not cope “stoically” enough in the face of extreme pain, are somehow wimpy and inferior and weak and overly-demanding is definitely holding sway.

    There is almost certainly an undercurrent of eugenicist instinct underlying some of this – the idea that a woman who wasn’t a good, stout, strong, healthy, vigorous and not-overly-loud pusher of babies out of her vagina had no business becoming pregnant in the first place.

    It is strange that the “raising” of academic “standards” in midwifery education seems to have coincided with an actual decline in the standards of actual midwives. I suspect that the diploma course education itself is probably increasingly ideological, with students having it drilled into them that “promoting normal birth” is somehow one of their primary professional objectives, as over “keeping your patients medically safe and reasonably comfortable”.

    All in all, as I’ve said before, it makes me almost grateful that my gynaecological issues will necessitate consultant obstetrician care in any pregnancies I undergo. I hope against hope that this report signals the beginning of a culture shift in British maternity care. A few big negligence payouts might also prompt the government to stop considering midwife-led maternity care as the “cheap” option.

    • Wren

      Thank you. You said a lot of what I was planning to after getting the children to bed.

    • tilmorning

      Thank you – said everything I wanted to say but better. Great insights into the class system.

    • AlexisRT

      I agree, but I still feel that some of the midwives’ complaints are valid. The best trained midwives will do an inadequate job if there aren’t enough of them, and every report says there aren’t.

      There’s also inadequate consultant cover. A consultant at Liverpool Women’s said they should have 24/7 cover–they don’t, they have it 14 hours a day. No funding for more. (This is the busiest unit in the UK, BTW.) It is no good telling the midwife to ask the consultant when one is not available.

      I was quite glad to be done with the midwives during my first pregnancy but I still feel that they are being set up to fail. The government will never give up on the “cheap” option–they have taken it and made it cheaper.

      • Amy Tuteur, MD

        Yet, if the midwives themselves felt that the deaths were due to understaffing, these cases would have been a perfect example to highlight their complaints. Instead, they chose to bury the cases, because even they understood that staffing has nothing to do with these deaths.

        • Siri Dennis

          Staffing levels are never an excuse for poor care. Never. There is always time to do what needs to be done, and there is no such thing as being too busy to give optimal care. In fact, doing things by the book saves time in the long run. If you’re in the room with a labouring woman, starting a CTG takes no more time than simply sitting there. This was gross failure, and there is no excuse for it.

      • Comrade X

        I agree that understaffing is certainly an issue.

        But if the Royal College of Midwives were serious about serving women and children and addressing shortfalls and problems, they would have said something along the lines of “We don’t have enough midwives!! Women are having to be left in their rooms by themselves for hours at a time during labour!! We also don’t have enough obstetricians to call in when things go south! And we don’t have nearly enough anaesthetists, so women are being left with totally inadequate pain relief during a very vulnerable time!! Come on, British Government – start funding maternity care properly and providing women and their children with these great, professional, seamless, multidisciplinary teams!!”

        But they always focus almost exclusively on more MIDWIVES (only), and don’t seem to give two hoots about the other stuff.

        We have heard of cases where women and their partners were BEGGING to see a medical doctor, ANY medical doctor, for a second opinion during labour, in the middle of excellent, full-service hospitals, and having their requests FLATLY REFUSED by midwifery staff. That’s not understaffing. That’s gross, deliberate, turf-protecting negligence. Understaffing would be “We paged and paged and paged for the obstetrician, and she didn’t turn up for nearly an hour!!” Not “We totally refused to page any doctor for this loud-mouthed weak terrified bitching baby of a woman and her pathetic husband.”

        Trying to delay and delay and delay getting a woman an epidural deliberately until she is too dilated or the anaesthetist goes home also isn’t a staffing or resources issue. It’s an ideological issue. It’s a deliberate violation of your patient(s) and your oath, as far as I’m concerned, and has nothing to do with money or staffing.

        Of course there are staffing issues, money issues, political issues (don’t want to start some kind of political war here, but the current government is strongly suspected by many, myself included, of attempting in many ways to undermine the NHS for political reasons). But there is also an issue of the underlying fundamental philosophy underlying maternity care by different providers.

        If midwives are going to be the “gatekeepers” to the rest of the “team” – they are going to have to show that they are trustworthy in fulfilling that role. At the moment, it seems that many like to keep the “gate” inappropriately locked in a way that is paternalistic, anti-hypocratic, quasi-sadistic, and just plain unsafe. That’s got to stop.

  • Lisa the Raptor

    Oops. Looks like those masters degrees do make a difference. Oh and I guess they can’t use Europe anymore to sway their point.

    • Lisa the Raptor

      Or is it that the UK midwives don’t use the medicinal model of care as said below? Or a bit of both?

      • Anj Fabian

        It’s hard to say. People tend towards what they know best. If you’ve spent years in nursing and then add on midwifery skills, you will have confidence in both sets of skills and likely use both.

        If you’ve never learned nursing, or only learned some skills and never had the opportunity to train and use them, then you’ll rely on what you know best – midwifery.

        • Siri Dennis

          As a direct entry midwife, I prided myself on no one being able to tell the difference; what you offer isn’t one model or another, it’s holistic care within certain strict rules, guidelines and policies. I never needed a nursing qualification, as I made sure (and my mentors did) I had all the applicable skills and knowledge. Basically, you have to have whatever it takes to give safe, appropriate care at all times. Most patients are young and fit, and don’t need ‘ nursing care’ as such (apart from the odd bed pan); any patients that do, are given it. It’s not rocket science to run a drip or set up a pump; neither is suturing, phlebotomy or scrubbing in theatres. There are good and bad midwives, and they don’t divide along the direct entry/nurse first line.

          • Box of Salt

            Maybe this is a stupid question.

            If you are a direct entry midwife (or CPM), how and where do you learn to take a BP? That’s a nursing skill, and extremely important for the care of pregnant women.

          • Wren

            A direct entry midwife in the UK is completely different to a direct entry midwife or CPM in the US. I considered it at one point and looked into how it was taught. It’s a 3 year (normal degree length here in the UK) university-based course taught in a similar way to the nursing courses.

          • Box of Salt

            I know I’m quibbling a bit here, but I think it’s part of the problem.

            Siri posted “Most patients are young and fit, and don’t need ‘ nursing care’ as such”

            BP measurements are ‘nursing care.’ Pregnant women need them, young and fit or not.

            It’s simply not true that “appropriate care” by a midwife does not include any ‘nursing care.’ Exactly where is the line drawn? If the direct entry midwives are being trained that those nursing skills are not needed, its sound like they’re on the wrong side of it.

          • Siri Dennis

            I didn’t put it clearly enough. Of course all pregnant women need their BP taken, as well as pulse, temp, fetal heart, abdominal palpation etc; I guess I don’t think of those as nursing care because they are part and parcel of midwifery. As are cannulating, running a drip, managing a pump, suturing a tear, giving injections, prescribing medication etc. The fact is though, pregnant women are generally younger and fitter than many other patients, and even after a section are up and mobile the same day. The bottom line is, as a midwife you need the full range of skills, from doing very little as a baby is born spontaneously to full-on care on very ill women on mag sulph, who really do need proper nursing care.

          • Siri Dennis

            What Wren said. I was 27, with 3 kids of my own, when I entered a midwifery degree programme. We learned stupid woo rubbish in class, and essential clinical skills on the wards. Taking a BP, performing an examination per vaginam, interpreting a CTG, assessing newborns, running a drip, etc etc. Nothing CPM-like about it.

          • An Actual Attorney

            I don’t think (based on memory and that she writes “theatre”) that Siri is a US DEM/CPM. She’s a midwife in the UK? Canada? and means “direct entry” differently than we do.

          • auntbea

            There is an old tale, perhaps you’ve heard it, about a plumber. A man has a toilet that won’t go and he calls the plumber, who looks at it for a few minutes, hits it once with a hammer, and then it works! He tells the man it will be $200. “$200!?!” says the man. “For what?!? All you did was hit it with a hammer. Anyone could have done that” “You’re right,” says the plumber. “Anyone can hit a toilet with a hammer. But knowing *where* to hit it? That’s what costs $200.”

          • Siri Dennis

            I never hit any baby with a hammer. That wasn’t me. And I certainly didn’t charge extra for it; it was covered by my salary. Some parents liked to bring their own hammer, but that was their choice…

  • http://Www.awaitingjuno.blogspot.com/ Mrs. W

    And how many deaths are quietly mourned – never to be examined in full? How many near misses go without complaint, thankful not to be in the most awful statistics? There’s a lot of taboo around birth, and frankly I wouldn’t be shocked if the reality is even worse than what has come to light.

  • Hannah
    • Hannah

      Oh, sorry, I see it’s linked to in the post. :-S

      • Hannah

        Actually, this is different, it’s a more in depth investigation into one of the cases, here are the other two:

        http://www.ombudsman.org.uk/__data/assets/pdf_file/0019/23383/NWSHA-MR-L-Report.pdf

        http://www.ombudsman.org.uk/__data/assets/pdf_file/0004/23494/NWSHA-MR-M-Report-2.pdf

        • Anj Fabian

          “The Trust commissioned an external review
          of Baby L’s care but this was difficult because
          Baby
          L’s observation chart went missing
          around the time he was transferred to another hospital.”

          Now I want to see an audit of the medical records.

          • DaisyGrrl

            I think the reason the reviewing midwife gave everyone a pass was because she didn’t have the education/capacity to appreciate how much they screwed up. This is very scary for any woman who has to give birth under their care.

          • Anj Fabian

            When it’s your ass on the line, you take these responsibilities more seriously.

            The trusts seem to have a real problem holding ANYONE accountable. If you needn’t worry about being fired for misconduct, your motivation is low. If investigations are rare, then why should you worry? Why should you pay attention?

            People talk about lawsuits in the states. Yes, lawsuits can have negative effects, but they keep people focused on avoiding bad outcomes. Healthy, happy people don’t sue.

        • Anj Fabian

          For Mrs M and Baby M (double fatality) there was an apparent near total lack of interest in investigating the deaths by the trust. It’s shocking because the Mrs M was both a high risk mother (diabetes) and she was being induced (standard of care requires cEFM).

          I was trying to come up with someone or some organization to compare this level of callousness to, but the only person that came to mind was Lisa Barrett.

          • DaisyGrrl

            In Mr. M’s report, Midwife A, the midwife responsible for deciding not to investigate, was the Trust’s maternity risk manager (the person accountable for clinical risk there – para 37). She was also present at Mrs. M’s labour (para 72), but only in a supporting role. She accepted the Trust’s findings and decided that there was no need to independently investigate the level of care provided by midwives that she worked with.

            HOLY CONFLICT OF INTEREST, BATMAN!

          • Dr Kitty

            Which is exactly the point the regulator is trying to make.

            In nursing and medicine the regulatory functions are separate from the support and supervisory functions. In midwifery they aren’t.

            You cannot both be someone’s mentor and supervisor AND be in charge of investigating and sanctioning them if they mess up.

            Cathy Warke has the brass neck to say that the midwifery system was “the envy of other professions” during an interview on Radio 4 yesterday morning.Ha Ha…nope….unless by “envy” you mean that other poorly performing medical professionals wish that their oversight was so lacking so that they would be able to get away with more…

            Midwives have NO BUSINESS assessing or caring for sick newborns. That is what paediatricians and specialist paediatric nurses are for. MWs don’t have the training to recognise and manage sick babies.

            In the hospital where I did my OB Gyn rotation the OBs used to to the newborn assessment, then they decided that they didn’t have the expertise, so the Paediatricians did it. That was the routine NEWBORN ASSESSMENT OF HEALTHY BABIES.

          • DaisyGrrl

            Absolutely. I struggled through the reports because, being Canadian, I found it difficult to understand the exact reporting structure. Is a supervising midwife one who works daily with the others or is there some distance? I absolutely agree with the main report (separate the supervisory and regulatory functions) but didn’t really realize how bad it was until reading those parts of Mr. M’s report. If you were present at the event, you should absolutely not be investigating the event (whatever your role was)!!!

            Here in Ontario, midwives organize into “collectives” and have privileges within set hospitals. In my city there are a few collectives that practice at different hospitals, so I would expect a review to be conducted by a midwife with no direct working relationship to the one under complaint. That would be very feasible. I don’t know how feasible it would be in the area where these deaths occurred, or if someone from a different region would have to become involved to assure independence.

            I was also appalled at the quality of the investigations. One would hope that the midwives charged with investigating complaints are actually trained in conducting a proper investigation but based on the Ombudsman’s findings, that doesn’t appear to be the case. They failed to even go to the basic level of what happened vs what were the protocols in place at the time then follow through with why protocols weren’t followed and evaluate shortcomings in care and whether they impacted the outcome of the incident. As a layperson, that’s what I would expect from an investigation.

          • Young CC Prof

            My brother was born in a freestanding birthing center, attended by crunchy midwives. (Second birth in a mother who’d had a pretty simple first birth.) And when he was out, what did they do? Called the center’s on-call pediatrician in for a newborn assessment. Of course they could tell he was breathing and pink and not in need of emergency resuscitation, but they didn’t try to judge whether he was adjusting to outside life properly overall.

          • Siri Dennis

            In the UK, you’d not be able to call out the paed for every delivery. I assessed every baby I delivered, unless I had a prior reason to bleep the paed (eg for surgical or instrumental births, meconium, expected problems etc).

          • Wren

            I had one there for both of my births in the UK, but the first was a C-section and the second did have some serious concerns at the end. Both times the hospital did require a paed check over my baby before we were discharged in addition to that though. I’m not sure if that was a local thing or the norm in the UK overall.

          • Siri Dennis

            Yes, every baby has a second, more thorough check, normally by a paed, prior to discharge. And discharge can mean six hours, or a couple of days.

          • Siri Dennis

            They have to be able to assess newborns. It’s the delivering midwife who performs the very first check, and it’s midwives and maternity assistants who care for babies on the postnatal ward. Granted, most babies known to be at risk will have a paed there at delivery, and arrive on the PN ward with a cannula and instructions re meds and obs. But of course a midwife has to be able to do those obs! Paeds don’t come and do them. The midwife does them and needs to know when to act to get the baby seen. And some neonates go downhill without prior warning. Are you going to get paeds to staff the postnatal and labour wards?

          • auntbea

            Um, yes? I have never heard of a labor ward that didn’t have neonatal peds on staff.

          • Siri Dennis

            No, no, I meant get paeds to replace midwives. I know they employ paeds, but paeds don’t expect to be called to every birth or to do obs on babies. The vast bulk of the work is done by midwives.

          • auntbea

            And that seems like a false economy. It seems like it would be hard for any one person, particularly a person who did do a full stint through medical school, to know enough about OB and pediatrics to do the job of both without supervision. Though I think that may be the point you are making.

        • DaisyGrrl

          Thanks for posting those. They are even more appalling than the summary report.

  • Amy Tuteur, MD

    This is really an indictment of the “midwifery model” of care. The medical model Is the only safe, scientifically based form of care. When midwives practice according to the medical model, starting from the basic premises that childbirth is inherently dangerous and that outcome is far more important than process, they can be excellent and safe practitioners. When they jettison science for “different ways of knowing,” it is inevitable that babies and women will die preventable deaths.

  • attitude devant

    Why is it that midwifery, even highly trained and regulated midwifery, has this blind spot toward taking action to improve outcomes? Here we have a well-educated group of midwives resolutely sticking their fingers in their ears and humming. Is it just built in to the midwifery model of care to value process over outcome? Is it some weird deafness to outcomes measures?

    • Amy Tuteur, MD

      It’s an excellent question, and I’m afraid the answer is very disturbing. I suspect that fundamental problem is that instead of being committed to patient well being, as are all other healthcare providers, midwives are committed to the process of vaginal birth, envisioning themselves as its guardians.

      They justify it by claiming that vaginal birth is safer and “better,” despite copious scientific evidence to the contrary., but it is nothing more than self-interest. They promote themselves above the wellbeing of their patients and the results are horrifying.

      • attitude devant

        My thoughts were along those lines too. Very disturbing indeed. This is why I always cringe at the appellation ‘birthkeeper,’ which explicitly enshrines the process as the thing to be protected. I prefer to be a lifekeeper, a mother-saver, a child-protector. Obviously.

      • Wren

        In my experience as a mother, and volunteering in my local antenatal department before that, I would actually argue that the change in nurse and midwifery education has created or at least increased some of the problems in UK midwifery. The older midwives I knew (this was 10+ years ago as a volunteer and 6-9 years ago as a patient) were less enamoured of the midwifery model than the newer ones.

        I mean that not requiring a nursing registration first combined with moving nursing and midwifery education into university degree courses has led to negative results.

        • Siri Dennis

          The problem lies with the calibre of midwifery lecturers; several of mine were steeped in woo to a ridiculous extent. Look up Sara Wickham’s writings on Anti-D; she was one of my lecturers, so you can see what an uphill struggle it would have been to learn anything useful. She and another lecturer, Lorna Davies, were reprimanded for telling us to manage PPH by putting baby to the breast! And their prize for the most yes-woman-like student? A trip to The Farm!! (Laughs hysterically). I didn’t win the prize.

          • Siri Dennis

            Sara and Lorna shot my friend down in flames for suggesting that babies can thrive on formula. We were a very divided group of students, with some falling for the woo and others getting their knowledge from experienced midwives.

          • Wren

            Ugh.
            Don’t plenty of babies actually thrive on formula though? Ignoring reality is not something I want any health care provider doing on a regular basis, let alone those teaching the next generation of health care providers.

          • Siri Dennis

            Of course they do. Our lecturers were terrible woo-mongerers, and those of us who thought differently were marginalised and called doctors’ handmaidens.

          • Anj Fabian

            Wear that label with pride!

          • Comrade X

            Doctors’ handmaidens!! Lol!! You should have given yourselves a “theme tune” of “Ride of the Valkyries” and started humming it whenever the woo-monster came near.

          • An Actual Attorney

            Jeebus – I’m avoiding Actual Legal Work today and googled Wickham. I found this in the official blurb for her book on Amazon: ” Are women’s bodies really fallible, or could some women’s need for anti-D be caused by medical intervention in childbirth?”

            OMG – to consider, women’s bodies might not be infallible??? She shouldn’t take care of a pet rat, let alone be a lecturer.

          • Comrade X

            Are women’s bodies really fallible? Is this for real? I never realized my vagina was like the pope speaking ex-cathedra….

          • An Actual Attorney

            Couldn’t make this shit up: http://www.amazon.com/Anti-D-Midwifery-Panacea-Paradox-2e/dp/0750652322

            Although if I could draw, I’d love a pic of a vagina with a little pope hat and Prada shoes, like the old pope.

          • Siri Dennis

            Needless to say, she and Gloria LeMay love and respect each other… Sara also promotes the eating of turkey as a remedy against pre-eclampsia.

    • auntbea

      Honestly, I think many organizations have this problem. I see this all the time when I or colleagues attempt to evaluate aid programs: even though these program have the (entirely genuine) goal of improving the lives of the poor, it can be like pulling teeth to convince them to find out if, in fact, the lives of the poor under their care are improving.

      Or consider how many teachers resist having their students undergo standardized testing, even though that’s pretty much the only way to determine whether they have effectively taught the students what they are supposed to know.

      I am not sure how self-regulation came about in the medical profession, but I am willing to bet that the advent of high cost lawsuits and the concurrent rise in malpractice insurance did a lot to improve it.

      • Young CC Prof

        We’re facing the same issue in education, with the push towards outcomes assessment and student progress

        In medicine, the outcomes are usually fairly straightforward. (Of course, it’s not always easy, arguments can be made about length of life vs quality of life vs cost-effectiveness vs patient satisfaction.)

        In education, we have very little agreement about what the right outcomes to measure even are.

        • The Bofa on the Sofa

          In education, we have very little agreement about what the right outcomes to measure even are.

          Yep.

      • LibrarianSarah

        To be fair, a lot of teacher are against standardized testing because it leads to districts to “teach to the test” and forces teachers to just drum a bunch of facts into kids heads as quickly as possible. Things like critical thinking, writing skills, the arts and physical education get thrown by the wayside in order to make sure that kids fill out the right little bubbles.

        Throw in the epidemic of cheating and the fact that “inner-city” schools end up getting even more of their funding cut because kids who go to school hungry don’t do as well on the tests and you have a more accurate idea of why teacher are against standardize testing as oppose to lazy teacher that don’t want to be held accountable.

        • Young CC Prof

          Definitely. We LOVE it when the state compares different community colleges on their graduation rates, really we do! Never mind the fact that Neighbor CC has twice the funding we do, and that half their students enter college-ready, as opposed to a mere handful of ours, clearly that has nothing to do with the stark difference in our graduation rates.

          • auntbea

            That’s not a fair use of data, nor are most types of outcome data without context attached. But it IS reasonable to investigate whether a) students are coming out with more skills than they came in with and b) whether your college is doing better or worse in this regard than other colleges with similar student populations. Why would you NOT want to know that?

          • Young CC Prof

            We do want to know, and we do measure a great many outcomes. We’re just afraid of having our funding further cut essentially because we are underfunded.

            I am very much in favor of measuring educational outcomes. But in recent years, I’ve seen a great many people do it wrong, sometimes to the detriment of the vulnerable student populations they’re trying to help.

        • auntbea

          I used to teach in an under-resourced school and I don’t buy it. It is these students who MOST need to participate in testing.

          First, when the test is of basic literacy and numeracy, teaching students to “fill in the right bubbles” is exactly what teachers SHOULD be doing. Students really need to know the right answer to that stuff.

          Second, we need hard evidence to show that students graduating from these types of high schools are not succeeding. It was only because we took these along with our students, for example, that we learned that I was the only TEACHER in the high school who read above a 5th grade level; the rest were convinced that since they had to college, they must read at a college level.

          P.S. Whether we tie funding to scores is a different issue, but avoiding testing altogether is voluntarily tying your hands behind your back.

          • Young CC Prof

            Definitely, we need testing for them. What we don’t need is firing threats against the GOOD teachers in these schools just because they aren’t achieving the same results as a suburban district. Some state guidelines are written with absolute achievement goals, rather than relative ones.

            “Only ten of your students are reading on grade level! You fail!”

            “But at the beginning of the year, my class was on average three years behind, and now they’re one year behind. Doesn’t that count?”

            “Nope!”

            It’s really tough to measure outputs rather than inputs, so you can actually evaluate the effectiveness of a particular process. (This is what I actually do all day long…)

          • auntbea

            Does the conversation you outline above actually happen? I am willing to believe you, but every interaction I have ever had with using testing to evaluate me has involved either pre-tests and post-tests or comparisons with matched student populations.

          • Young CC Prof

            My high school science teacher friend claims that yes, he is negatively evaluated for not meeting an absolute standard. He’s not getting fired, because his boss knows he’s achieving significantly better than expected results, but in the eyes of the state, he’s a less effective teacher.

            Actual teachers, including most administrators, understand the complexities, but government policies and administrators newly brought in from outside often wind up disastrously oversimplifying.

            If you really want to get into this, read Matt Read’s blog. He’s a community college administrator and kind of a genius. Sometimes faculty can be kind of narrow in focus, he’s really helped me see the big picture on a lot of topics. http://www.insidehighered.com/blogs/confessions-community-college-dean

          • Sullivan ThePoop

            I have a friend who is an English professor who had problems getting a job and took several jobs at local high schools and she not only had a problem with the entire curriculum and the students it was turning out because all they did was teach to the constant standardize tests, but the administrators used them as a way to fire people they didn’t like by transferring students at the last minute.

          • R T

            I’m going to tell her this! Thank you!

    • mel

      because it is ‘all about them’ and not the patient and or child

    • Siri Dennis

      Bear in mind that each hospital evolves its own culture, for better or worse. The reports state that Furness General, the common denominator, struggled to recruit AND RETAIN high calibre staff. This strongly suggests a very unhealthy culture, where good staff would flee and those who remained buckled under and became part of the problem. Hospital scandals are nothing new – remember the Bristol heart surgeons? It takes a whistleblower of some kind to bring it to the public’s attention.

  • Mel

    How do midwives justify maternal deaths?

    I can see all sorts of clap-trap dragged out for newborns – brand new babies are in a much more precarious situation as their body systems work without maternal support. Since some babies will die at birth due to birth defects that are incompatible with life, it’s pretty easy to lump any baby who dies at the hands of a midwife into that category.

    But what about the moms who die? I really don’t know of any women in my generation or my mom’s generation who died in childbirth at a hospital. What stupid rationale do they drag out for moms who die? “

    • attitude devant

      Actually, maternal deaths do happen. They are very rare in the US and UK, not because childbirth is safe, but because most of the causes of maternal death have been identified and are now aggressively managed. But when you stop treating common conditions appropriately (post-partum hemorrhage, PIH, chorio, obstructed labor) you will see maternal deaths start to increase.

      • The Bofa on the Sofa

        But what are midwives doing dealing with these cases?

        I thought they were supposed to be restricted to “low risk”?

        • Young CC Prof

          Some risk factors politely show up ahead of time, and the mother is transferred to a higher level of care. PPH and obstructed labor are things that go wrong DURING birth, sometimes even in low-risk cases. The midwife’s job is to recognize it, call for help and stabilize the situation.

          When the midwife wants to minimize calling for help, then you’ve got a problem.

          • Siri Dennis

            Or when doctors are hard to get hold of, slow to respond, or useless once there…

        • Hannah

          That’s not strictly true. In the UK midwives are also the bulk providers of obstetric nursing, and so will provide nursing care at all risk levels.

          • Anj Fabian

            This I have an issue with:
            “will provide nursing care at all risk levels.”

            because they aren’t nurses. If they are doing that work, they SHOULD be nurses. They should have the full RN equivalent training.

          • Siri Dennis

            No, they provide midwifery care. Not nursing. There are differences.

          • Amy Tuteur, MD

            Actually, midwifery care is a subset of nursing care. It is the conceit of midwives that it is a separate discipline. Midwives’ lack of knowledge of basic nursing and medical care is at the heart of substandard care.

          • Siri Dennis

            With respect, I consider midwifery to be a separate discipline, and would hold myself to a higher standard than what I’ve seen of nursing care. That’s not hubris, it’s actually humility. Because I am allowed greater scope for autonomous practice, I owe it to my clients to go above and beyond in terms of my practice. And I never forget where I fit into the multiprofessional team; one of my main duties is to recognise when things are no longer normal, and call in medical assistance.

        • Hannah

          That’s not strictly true. In the UK, midwives are also the bulk providers of obstetric nursing and so will provide nursing care at all risk levels.

          • Wren

            Yes. Even when it was known I would have a c-section as soon as I could get in there (needed it that day, but not right that second or anything) nearly all of my care was from midwives, both before and after the birth, and a midwife was there in the theatre too.

            In my limited experience, there is a wide variance in culture on maternity units and it affects how well the midwives work with the doctors, which can lead to midwives not bringing in doctors when they should. I have mentioned before that my hospital created a midwife-led birth centre between my two births there. Most of the midwives who stayed working in the regular labour ward were the type to work well with the doctors. When there was a concern about my labour right at the end, the midwife didn’t hesitate to call in docs even though in retrospect they were not needed. The room was suddenly full of people, I pushed her out and all but the midwife melted away as she was obviously ok.

        • Siri Dennis

          As a staff midwife in hospital, you’re expected to look after all women, regardless of risk. Consultant obstetricians are a rare sight indeed, registrars may be bleeped if need be (and will perform c/s and instrumental deliveries, but not attend spontaneous births), and the same applies to paeds, anaesthetists and junior doctors. It’s not as if some women will be cared for by an obstetrician while on labour ward; the main professional will always be a midwife. And you’d better hope the reg on call is an amenable one, or not taken up with a gynae emergency. Caring for high risk women can be very scary and lonely…

      • Mel

        I agree. I think it’s already happening in some of these wards as indicated by the research into the 14 infant deaths and 2 maternal deaths. Since maternal death in hospitals are very, very rare, how exactly do midwifes justify maternal deaths?

        • Siri Dennis

          Midwives make easy targets, as there is always a midwife involved even in the most high risk cases. Doctors often fail in their duty too, but they are harder to discipline or sacrifice. I often struggled to get the registrar even to sign the patient record, let alone write up properly what they did and said. So in addition to making my own contemporaneous entries, I’d have to write eg ‘reviewed by Dr so and so, obstetric registrar, who declined to make an entry in this record’. The nearest miss to a maternal death I had was a woman who had a c/s after a long labour. She was left on my ward during handover, and I immediately realised she was haemorrhaging. I pulled the emergency bell, and the registrar and SHO came up; they told me to increase her syntocinon drip (which I’d already done) and do 5 minutely obs. Then they went away. By the time they entered the lift, the patient became unconscious. I ended up pushing the bed downstairs to labour ward yelling all the way, and she was taken back to theatres. I found out next day she lost her womb and went to ITU; she was lucky to be alive. All the care she got post section was substandard; she wasn’t recovered properly, her bleeding wasn’t taken seriously, and she very nearly died. I was told off for yelling as I could have ‘frightened someone’. There was no team approach, and I couldnt save her singlehandedly.

          • Anj Fabian

            That story makes me cry. And rage.

            You must have felt so alone and terrified.

          • Siri Dennis

            It’s what finally prompted me to leave midwifery for health visiting. After writing screeds for risk management and seeing it have zero impact I thought, this is too dangerous! For women, and for me as a potentially expendable staff member. Someone wrote the other day of midwives conspiring to drop a junior doctor in it, but I assure you, as a midwife you’re much more vulnerable. You can never refuse to care for anyone, no matter how high risk or how unsupported you feel.

          • moto_librarian

            Jesus. How awful. If it hadn’t been for you, she would have died.

          • Comrade X

            That’s appalling!!

    • Siri Dennis

      To be fair, all the maternal deaths I’ve heard of have been high risk cases where doctors were already involved, eg an anaesthetist who bled to death after having twins at her own hospital. Or they were women who drowned during eclamptic fits days after the birth, or went into multi organ failure of unknown origin. And managing AFE takes a team approach, not a single professional’s input.

  • attitude devant

    “The benefits of midwifery supervision” such as that the midwives are allowed to practice without any hindrance, obviously. And people say we OBs are arrogant!

  • Young CC Prof

    Well, the good news is, the authorities are looking into the matter, and MAYBE the NHS will start to change its stance on giving naturalist midwives total control over so many births.

    I think the report hit the nail on the head, though. The problem is not that a few midwives dropped the ball, resulting in a preventable injury or death. Doctors do that, too. Everybody screws up sometimes. There are two key problems:

    1) The deaths that I’ve heard the full story on, MULTIPLE people dropped the ball, over a period of hours or days. Sometimes a patient specifically asked for a physician or another opinion and was denied for no good reason.

    2) The even bigger problem is that the current oversight structures are clearly not working. Yay Ombudsman for seeing that.

    • thepragmatist

      And the ideological framework is terribly flawed. I hope our government in Canada sees this before they jump FULLY on the bandwagon.

      • DaisyGrrl

        Sadly, I think they’re already fully on board.

      • Anka

        Sorry, late to the party here, but which bandwagon? Is Canada going to follow this NHS model? In my city, at least, there’s a midwife shortage so I don’t see how it could be possible, but I did encounter unpleasant woo from nurses during my labour in a progressive hospital with a high-risk unit that gets all the c-sections, so I’m a bit worried.

  • Anj Fabian

    Wow. That’s the some of the worst aspects of American CPMs enshrined in the institutional health care.

    Lack of oversight.
    Lack of accountability.

    I would bitterly add “Babies die under midwife care in hospitals too!”.

    • attitude devant

      I would ask Cathy Warwick just exactly what the midwives are protecting the women and babies from, appropriate interventions? And how can the supervising midwives make the claim to impartiality? Does she mean they are impartial in that essentially NO ONE gets sanctioned? Is that the kind of impartiality she means?