It’s enough to make a person cynical.
1. It has become startlingly, painfully clear that UK midwifery promotes vaginal birth above the well being of mothers and babies.
2. Not surprisingly, the amount of money paid for bad outcomes and the cost of insurance coverage have skyrocketed (A fifth of maternity funding spent on insurance).
3. Only 6 months ago, a UK government report delivered a scathing indictment of UK midwives, and their weak system of self-supervision that allows them to avoid accountability for multiple maternal and infant deaths.
It is unfathomable, therefore, that a government health group has just recommended more homebirths.
More women should give birth with only midwives present, including at home, because that is better for them and their babies than labour wards where doctors are in charge, the government’s health advisers say on Tuesday.
Midwives should advise mothers-to-be who already have at least one child and whose latest pregnancy appears straightforward to opt for a midwifery-led unit (MLU) or a home birth when deciding where to have their baby, the National Institute for Health and Care Excellence is urging.
The 40% of women giving birth who are first-time mothers should also be advised to choose either location, Nice is recommending in draft guidelines to the NHS in England and Wales.
Both groups of women should select either location “because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit”, Nice says.
Let’s me amend my previous statement:
It is unfathomable for a system that purports to care for mothers and babies to encourage UK midwives, who have caused unbelievable suffering by failing to adequately monitor and care for laboring women and their babies, who have failed spectacularly to supervise themselves and learn from their errors, to increase a practice that leaves midwives with even less supervision than before.
Of course it makes perfect sense if your objective has nothing to do with mothers and babies and, instead, is devoted to the twin aims of fulfilling the ambitions of midwives and saving money.
UK midwives have demonstrated over and over again that they value their personal autonomy over the lives of mothers and babies:
They apparently believe that their autonomy resides in “normal birth,” woman’s wishes and women’s health be damned, and they have relentlessly promoted “normal birth” to catastrophic effect. Increasing the proportion of homebirths is the next logical step in increasing the autonomy of midwives, but it mind bogglingly cynical for a system that is supposed to promote the health of mothers and babies.
It is cynical on a variety of levels.
First, is a cynical misuse of the results of the Birthplace Study. I have long maintained that Birthplace Study appeared to be designed to reach the conclusion that homebirth is safe regardless of what the actual data showed. In order to achieve the desired result, the investigators created eligibility criteria that are substantially stricter than the actual eligibility criteria for homebirth in the UK. So the Birthplace Study NEVER showed that homebirth in the UK is safe. It showed that homebirth might be safe if the eligibility criteria were substantially tightened.
It is cynical because there is a growing body of evidence, particularly from The Netherlands, that midwives caring for low risk women (home or hospital) have a higher perinatal mortality rate that obstetricians caring for HIGH risk patients.
It is cynical because there is no evidence that increasing homebirths will address the known deficiencies in midwife death rates.
It is cynical because in a system already struggling with a shortage of midwives, it defies reason to promote a practice that has the impact of increasing the shortage by assigning two midwives to one patient at home, instead of centralizing the location of births so that two midwives can each care for multiple patients at a time.
But most of all, it is cynical because all the existing evidence points to a need for GREATER supervision of midwives, not greater autonomy.
NICE is promoting the interests of MIDWIVES above the very lives of newborns, its most vulnerable patients.
That’s not healthcare, that’s politics.