A health system was no match for the power of a father’s love

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The Morecambe Bay report has been published and the scramble to avoid responsibility is on. At least 11 babies and 1 mother died at Furness General Hospital because the midwives cared more about promoting natural birth and preserving their own autonomy than they did about whether babies and mothers lived or died. The midwifery administration refused to discipline the midwives involved, and the hospital was more concerned with its business status than protecting patients. A massive health care system, the National Health Service (NHS) failed in its legal and moral responsibility at every level, bottom to the very top, hiding, eliding and dissembling to protect the wrong doers initially, and eventually to protect themselves. They brought an enormous amount of bureaucratic power to bear, essentially everything they could muster, and yet they lost.

They were defeated by the power of a father’s love.

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Joshua Titcombe died when, despite the pleading of his parents for 24 hours, midwives refused to call a pediatrician to care for him when he was obviously ill. They waited until he was nearly dead to call for help and by then it was too late for the help that almost certainly would have cured him had it arrived earlier. The midwives rebuffed his parents, the hospital administration tried to convince them that no one did anything wrong, and the bureaucracy of the NHS insisted that appropriate care had been provided.

But James Titcombe, Joshua’s father, refused to be put off and he refused to be silent. He was treated to stonewalling and abuse on a scale that is difficult to imagine, but he did not give up. Why? Because his love for his son was stronger than even the mighty NHS.

They say that statistics are human beings with the tears wiped off, and that’s certainly true in this case. It is important to deal with the statistics: how many died, how many midwives valued natural childbirth above safety, how many levels charged with oversight ignored their responsibilities in favor of their reputations. It is appropriate that, going forward, attention will be focused on statistics, but we should take a moment to consider the human beings and the floods of tears behind those statistics.

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I first wrote about Joshua in November 2011 after being contacted by his father James (Joshua’s easily preventable, tragic hospital birth death).

[He] contacted me to share more details about Joshua’s birth and needless death. He gave me permission to share with you the presentation he created to ensure that Joshua will be remembered and that his death will serve a purpose, focusing attention on the substandard midwifery care that is the result of midwives protecting their “turf” and refusing to refer complicated cases to obstetricians and pediatricians.

James was treated appallingly by those who were supposed to search for the truth.

According to The Independent:

The family were left deeply hurt on two occasions after seeing internal email exchanges between Trust staff. One followed an email from Mr Titcombe in June 2010 saying he would be stepping back from his inquiries after “becoming extremely distressed and anxious” about the investigations progress.

Informing the Trust’s head of midwifery of the email, the Trust’s customer care manager wrote: ‘Good news to pass on re [Mr Titcombe]’, and received the reply: ‘Has [Mr Titcombe] moved to Thailand? What is the good news?’

In another email from August 2009, later seen by Mr Titcombe, a discussion of a midwife’s statement to the Nursing and Midwifery Council (NMC) concerning the circumstances of Joshua’s death was subject lined: “NMC shit”.

Despite that, James pressed ahead. In February 2014, he and his wife received an apology for the NHS Ombudsman acknowleding that the hospital had failed to properly investigate Joshua’s death and that the Ombudsman’s office had subsequently refused to investigate at all.

James was quoted at the time of the apology:

Joshua’s death has had an unbearable impact on our family, we miss him every day and continue to be haunted by the trauma of his short life and his horrific preventable death. The last five years have been made so much worse because of the way the trust and other organisations responded to his loss.

The Morecambe Report on Joshua’s death and the deaths of other babies and mothers was published last week and it corroborated everything that James had claimed. The midwives DID have a cult of natural childbirth that took precedence over safety; they DID refuse to call other specialists when they were needed: they DID fail to investigate Joshua’s death and discipline their colleagues; the hospital DID cover up the midwives’ wrong doing; at every level the NHS DID ignore the concerns of the family, fail to properly investigate, and treat James contemptibly.

The Morecambe Bay report is vindication, but it does not bring Joshua back. James was once again quoted in The Independent:

I really recognise now when we talk about missed opportunities in this report, that for me means not having a six-year-old. Even after all these things were going wrong, nothing was done and patients were allowed to die.

It is very hard to forgive the deliberate covering up when it’s had such an impact…

Joshua Titcombe died a preventable death because the people who were supposed to be caring for him put their needs ahead of his needs. A family was shattered and his parents will grieve for the rest of their lives.

But though his life was short, his impact will be profound. His death was not in vain, because the failings that led to his death have been exposed and now can be addressed. His death was not in vain because his father loved him so much that he never stopped fighting for the truth.

The NHS is an extremely powerful organization. But it was no match for the power of a father’s love.

  • guest

    I want to apologize. I don’t know Amy Tuteur, obviously, and shouldn’t assume her motivations. Maybe this is the way you feel you need to improve birth. I would just suggest that honey draws more flies than vinegar. I shouldn’t have gotten on here in the mood I was in. I won’t respond to posts below not because I don’t agree with what I posted but because I don’t have the time. I read your blog quite often. I don’t agree with it all. I use it as study actually. Most of the time, I get frustrated with the midwives because I can see the red flags and would have transferred care long before.I am one of those homebirth midwives you hate.

    I don’t TRUST birth. I have more of an approach of respect birth. I usually never post here and really don’t know why I did tonight. I believe in informed consent and free choice and respect for a woman’s choice in birth. Statistics is not just about death … it is also injury. The US isn’t fairing too well. We have double the maternal death rate as Canada. Midwives aren’t the cause of that. Until the medical field realizes that death isn’t the only indicator of a successful birth, there will be continual growth in out of hospital births. You can have a c-section and have a woman feel good about it and one that leaves a woman feeling violated in the same situation.

    When a doctor/hospital makes a woman feel trauma equivalent to rape and justifies it with a healthy baby, there is something terribly wrong with our system. If you haven’t, you ought to read improving birth stories. I have heard so many in person, it breaks my heart. God bless each of you! My apologies for my interruption.

    • Amazed

      How very interesting. A threefold increase in the number of homebirths is a huge thing but a threefold increase in perinatal death at the hands of your colleagues and possibly, yourself compared to comparable hospital births is no biggie. Biased much?

      I don’t know whether Dr Amy hates you. I know I don’t. I feel like I should pity you, with your determination to bury dead babies twice and bury your head in the sand. But I can’t. I don’t know whether you killed a mother or baby yet but if your writings here are anything to go by, you’re dangerous and it’s just a matter of time and luck. So my pity is for those you misinform. Hopefully,there aren’t any preventable deaths and/or damages in your wake.

  • rh1985

    in other NHS news, anyone see this? (apologies if it has been posted already)

    http://www.bbc.com/news/uk-scotland-glasgow-west-31831591

    I hope this results in changes to the system and less vaginal birth at all costs.

  • GUEST

    I feel for those parents and their loss. But the assumption is that only midwives are negligent. Doctors are negligent every day. Maternal death is up. Oh but wait that’s right… those numbers don’t count according the the 12 things not to say. They can’t count, because we argue facts are wrong or misrepresented when it counts against us. Or the fact epidurals and medicines that make a previously low risk mom now a high risk mom with high blood pressure and fetal heart problems.

    Difference OBs pay lawyers to shut up patients as part of settlements. We aren’t about accountability here. If you were you would be screaming about maternal malpractice that doctors should be held accountable for. While thousands upon thousands of women feel raped after an OB violates their choice. I have seen it first hand. You want to lower homebirth numbers, why don’t you focus on improving birth. But no, Amy, you are about screaming about 1-2% of births, while the 98% percent are out there doing 35% c-section rate.
    While women get ripped apart because they dared to ask to not have an episonomy, talk about that? Women not given the choice to to try for a VBAC but wheeled in screaming to operating rooms that they don’t consent to a surgery: even though federal law states that it is illegal to force a procedure on a woman for the sake of an unborn child. Women told they have NO say in the delivery and their bodies. I have heard sickening stories of woman and doctors. Doctors that physical violated and “punish” them for daring to ask for a natural birth in a hospital.
    It is like someone on the Titanic worried about a lifeguard at the pool instead of the gaping hole in the hull. I believe all birth needs to be improved, but to focus just on midwives and not doctors is hypocritical. A little afraid to take on the negligent and criminal activity of your own. Do you really care about women or just your own small bit of fame?! The majority of deaths here because of the volume is one by doctors.
    I work at a birth center with over a 1000 births,not one maternal or fetal death at the center, at home or in a transport. Not one. No injuries.
    I agree there needs to be some change in training, not just midwives, but doctors as well. You are part of the problem, not the solution.

    • Amy Tuteur, MD

      Who said only midwives were negligent. No one.

      How about addressing what I wrote instead of what you wish I had written.

      And are you equating a dead baby with an unwanted episiotomy? We aren’t going to have much to talk about if you think they are even remotely equivalent.

      • guest

        Are you saying doctors don’t have negligent deaths? I haven’t seen one on here.

        • The Bofa on the Sofa

          Wow, I have no clue how that follows in the least.

          • guest

            Maybe not on this topic, but it is the general flow of this site. This was just the last article I read on here.

          • The Bofa on the Sofa

            OK, so it doesn’t follow for this topic, and as a regular reader here for multiple years, it’s clearly an incorrect characterization of the “general flow” of this site.

            In fact, there have been entire posts dedicated to the topic of doctor negligence. So to project suggest that is what she has said is nothing but a straw man.

            The odd thing was, that was your response to Dr Amy’s request that you address “what I wrote instead of what you wish I had written.” And your response is to create a straw man.

      • guest

        You are putting a finger in a whole in a dam while the dam is starting to break. More women are choosing homebirths because the ob care in America is broken and abusive. So if you tried to fix that, you would “save” more women/babies by not making them choose. Instead you go and attack a whole line of work and make generalizations. (1000 births and no death/injuries. We have a better rate than many doctors.).
        Guess it has just been luck not training.
        You sit around throwing rocks. You have all this following and this is all you do?

        • The Bofa on the Sofa

          More women are choosing homebirths because the ob care in America is broken and abusive.

          Yet, more than 98% of women in the US give birth in hospitals, most using OBs.Not very broken at all.

          And the results for midwives in terms of bad outcomes is known, based on their own data. And you know what? They are a lot worse than doctors. Their own data shows that to be the case.

          • guest

            Give it some years and let’s visit it again. Takes time for change. We have seen a 3X increase in 3.5 years. Unless things change. BTW, I am not anti-doctor. I loved my last birth with a doctor … she was amazing! Too bad she is retired.

          • Certainly it takes time for change. Who wants to watch morbidity and mortality increase in home births?

    • Young CC Prof

      In hospitals, there is roughly one baby death per 3000 low-risk births, lower if you, for example, screen out known congenital abnormalities. 1000 births without a death really isn’t all that impressive.

      • guest

        I agree we haven’t delivered as many as a hospital and can’t realistically compare deaths. But average injury is 6-8 birth injuries (on the low end of estimates)… I would say we have much better statistics in that regard.
        http://www.birthinjuryguide.org/

        • Young CC Prof

          That site is run by medical malpractice lawyers, you know.

  • GUEST
    • Amy Tuteur, MD

      Are you suggesting a midwife could have achieved a different outcome?

      • guest

        I don’t know. If she was kept lying on her back in the worst position possible to deliver maybe. The difference is bias. You assume because he was a doctor he is innocent and his decision was appropriate and if it was a midwife it would have been automatically the wrong decision.

        • Amy Tuteur, MD

          Right. You don’t know. You don’t even have a clue because you seemed to have missed the point that this was a premature baby with multiple congenital anomalies including a grossly enlarged abdomen due to fluid. The issue in that case is whether a classical C-section (necessitating future C-sections for all deliveries) was appropriate for a child that was not going to survive.

          You are just grasping at straws trying to excuse the pathetic, unethical behavior of the midwives.

          • guest

            He crushed the skull. If the didn’t know the baby had anomalies, he still crushed a skull. If he did know she had anomalies and did a vaginal birth …. hmmm negligence. I will go to all lengths?
            Backardjiev, however, refused to perform a C-section, telling the mother, 24-year-old Rachel Melancon, that she would have a scar afterwards. Instead, the doctor used forceps to help deliver the baby. Angie Coats told reporters that the doctor struggled with the forceps, and “even put his foot on the bed” to try and pull the baby out.

          • Amy Tuteur, MD

            Sorry, I didn’t read the link and assumed it was a link to a different case. The underlying issue is the same. A midwife could not have had a better outcome. The appropriate treatment was a C-section but doctors are under pressure from natural childbirth advocates such as yourself to reduce C-sections. One way to do that is to increase forceps deliveries. Had this baby been delivered by C-section, NCB advocates would have claimed “unnecessarean.”

            By the way, can you tell us what happened to this doctor in the wake of the tragedy?

          • guest

            The parents were asking for a C-Section. But it is now NCB advocates? C-sections are up to 35% … you aren’t doing less c-sections, you are doing more. You mean another crushed skull? Sorry for being a pathetic midwife grasping at straws.

          • Amazed

            You think you’re so smart and caustic but you’re making the perfect description of yourself. Care to find a case where less interventions were needed and not more?

    • The Bofa on the Sofa

      Wow, a parachuter comes in to tell us all about doctor malpractice, and comes up with… that case in Texas where the doctor used the forceps inappropriately.

      Aren’t you clever.

      Of course, had you actually read the comments of thread, you would have seen that it has already been discussed extensively, in this thread and on this blog. I even list it as an example of a case where we’ll concede, for the sake of argument, that it is a case of medical negligence. OK, there’s one.

      Meanwhile, there are dozens of examples that we could talk about for midwife negligence killing babies, even with the direct experience of people here.

      But since you have one case where arguably a doctor did it, that makes it all equal, right?

      Nonsense.

      • guest

        There our thousands of cases of deaths from negligence. Why not do a search on shoulder dystocia and lawsuits? or lawsuits and start naming all sorts of delivery problems. As stated earlier, doctor’s lawyer make silence a requirement for settlement. Silence any truth.
        Addressed in comments or in a blog post?

        • The Bofa on the Sofa

          There our thousands of cases of deaths from negligence.

          Tell us about a few. Because you know, we hear this claim all the time, but whenever we ask for examples, it’s silence.

          If there are actually thousands a year, you should be able to provide, say, three examples, in addition to the Texas forceps case. Shouldn’t be hard, right?

          • guest

            Here is just a few from one lawyers office from one hospital. Of course, silence on which doctors and hospitals.
            http://www.lubinandmeyer.com/cases/caselist.html
            Quote here http://www.aitkenlaw.com/birth-injury/

            a birth injury occurs in about 27 of every 1,000 births. Sometimes these injuries are unavoidable, but more often they are the result of medical mistakes or medical negligence (i.e. failure to act to prevent such injuries) on behalf of doctors and/on fact, sources say that a birth injury occurs in about 27 of every 1,000 births. Sometimes these injuries are unavoidable, but more often they are the result of medical mistakes or medical negligence (i.e. failure to act to prevent such injuries) on behalf of doctors and/or nurses.

            But they are lawyers so they are probably lying. But even if they are half true … do the math.

          • The Bofa on the Sofa

            How many of these are settlements? In fact, most of them.

            I was just looking at the first case.

            “We have reviewed this case thoroughly and Edward was monitored closely
            by a team of experienced medical experts,” the hospital said. “They
            performed early medical and surgical interventions to save his life,
            using the most advanced techniques available. Our care team is saddened
            that the best medicine available could not give him a better outcome.”

            The doctor’s most likely saved the baby’s life.

            In fact, there is NOTHING in the description of that case that reports anything that can be described as negligent care of the doctors. There was a terrible outcome, but what is the negligent care?

            The baby was premature with a condition that maims half of babies with it and kills 15%.

            Of course, had YOU been the midwife, it wouldn’t have even been close. The parents wouldn’t have a live baby, and, moreover, they wouldn’t have any recourse

        • Amy Tuteur, MD

          Silence? I hardly call a story on the ABC News website an example of silence.

          Did his colleagues absolve the doctor of responsibility for the baby’s death as the midwives in Morecambe Bay did? No.

          Did the hospital administration absolve the doctor of responsibility as happened in Morecambe Bay? No.

          Did 10 OTHER BABIES die in similar circumstances and their deaths were absolved as well. No?

          So the reason think this case justifies what happened in Morecambe Bay is ….?

    • rh1985

      That is a horrible, horrible tragedy. However, at least the doctor can be held accountable. His license will be investigated, he can (and is being) sued, and every hospital in the area has banned him from delivering babies at their facilities.

  • guest
  • Jen

    This story is so unbelievably heartbreaking. I have the deepest admiration for their persistence and strength in fighting to make sure other babies and families don’t suffer the same way. The behavior of those midwives was absolutely monstrous. It’s terrifying to think that they are considered medical professionals and have any sort of patient contact.

  • sdsures

    Are parents (and subsequently, their babies who are the patients) encouraged to not question doctors or midwives, and to behave like good little sheep?

    • Bugsy

      Question your OB. Don’t question your midwife as much, as long as she supports the all-natural.

      <–Seems to be the mantra I've heard.

      • sdsures

        She’s less likely to be able to answer questions, too.

  • CanDoc

    I choke up every single time I come across the story of James, Joshua, and their family. Thank you, thank you, Dr. Amy, for speaking truth where it needs to be heard.

  • Montserrat Blanco

    I can not express properly with words how sorry I am for those families loss.

  • James’ story is inspirational and demonstrate tremendous courage and perserverance. As a result of his efforts, other families might be spared the same heartbreak of a preventable infant death.

  • Lisa C

    Please pass on deepest sympathies to the Titcombe family. What happened to them is inexcusable. I don’t even have words to fully express how horrific their story is. I hope that they find some comfort in the Morecambe Bay report and I sincerely hope that the people involved in covering this up are held accountable.

  • Cobalt

    I feel so badly for this family, and the other families hurt by this whole shameful pile of lies. The father’s ability to persevere is commendable for the results it achieved, and hopefully the tide will turn to ethical birth ideologies in the light that shines on this tragedy.

    Nothing will ever replace Joshua though, and for that pain I can only say I am so, so sorry.

  • Sue

    Thank you for this poignant post. There is, at least, some reassurance in seeing that persistant activism can pay off.

    Meanwhile, OT – a breastfeeding thread on The Conversation – and a lactivist who compares breastfeeding to “learning how to swim” gets soundly called out.
    https://theconversation.com/starting-with-feeding-and-ending-with-weaning-everyone-has-an-opinion-38388#comment_612819

    • Who?

      I really don’t know how to respond to this post-so many lives damaged and ruined on the altar of extremism. Imagine if (say) cardiac specialist nurses tried to pull this kind of caper, they would be shut down so fast they would lose track of the days of the week. Let this never happen again, it should be a case study in both doctor and nurse training, and potentially in management training as well.

      Isn’t The Conversation great? I think I may be a little in love with Edwina…

      • The Computer Ate My Nym

        Imagine if (say) cardiac specialist nurses tried to pull this kind of
        caper, they would be shut down so fast they would lose track of the days
        of the week.

        I’m not so sure. If there was a push for cardiac nurse run wards because it was though to be cheaper and the nurses were able to convince at least some patients that “normal heart care” was better and that doctors were evil…it might fly. The major driver here is cost and the desire to cut medical costs at all, er, costs, but the ideology gives it a fig leaf of respectability.

        Compare to, for example, the “patient satisfaction” stuff in the US. High patient satisfaction is actually correlated with worse care and worse outcomes yet it is being pushed by insurers, particularly Medicare, because “poor patient satisfaction” is an excuse to cut payments.

        They’d get away with it–if they spun it right.

        • nomofear

          I have a family member who works for a large insurer, and they actively fight the doctorreview.com stuff/”patient satisfaction” all the time. They have amazing metrics that calculate a doc/practice/hospital’s success rate on patient OUTCOME, and have a rating system that comes up next to the doctor’s name when you look in their directory – but you’re right, people always go “but my (family member/doctorreview.com/gut feeling) LOVES x doctor” – okay, but, literally, our metrics show a higher rate of accidents/disfigurement/death if you go that way…and it falls on deaf ears.

          • The Computer Ate My Nym

            Yep. Though, of course, you also have to consider patient risk factors when looking at outcomes. Classic example here: outcomes of appropriately practicing CNMs versus OBs: the OB infant mortality is higher beause they take on higher risk cases, not because they do worse.

          • Dr Kitty

            That is an argument cardiac surgeons have used against having their mortality rates made public.

            If you do risky, life or death surgeries, even if you are very good at it you might have a worse mortality rate than the guy who isn’t as good a surgeon and who takes on only easy cases in fit young patients.

            They make a rather good argument that presenting the mortality rate rather than adjusting for patient mix and type of surgery is unhelpful, as it discourages surgeons from taking on risky cases or innovating and doesn’t tell patients who is actually good.

            Life is not like ER or Grey’s anatomy where the risky surgeries always work out. Often they don’t, but it would be wrong to penalise the surgeon because of they choose to undertake more complex cases with less certain outcomes.

          • The Computer Ate My Nym

            It’s a tricky thing to sort out…there are some areas where it’s not clear what the causative factor is. For example, having Medicaid is an independent risk factor for death in at least some cancers. Is that because of some aspect of Medicaid patients (poverty, poor health, etc) or because the practitioners who take Medicaid tend to be poorer quality? Or both?

          • sdsures

            Is oncology a fair comparison? Cancer sucks, is a complex bunch of different things (“things” is the best I could come up with; I’m foggy from my meds; I mean to say that cancer isn’t just “one disease”) and is very often associated with poor outcomes (depending on the type of cancer, age of patient, risk factors, environmental factors, stop me any time…).

            Another example that’s been discussed on this site is the rates of cesarean sections at various hospitals. At hospitals where high-risk moms give birth, there is going to necessarily be a higher rate, yes? than at a middle-of-the-road hospital where low-risk women give birth.

          • sdsures

            Derek “McSteamy” Shepherd on “Grey’s” drives me nuts because he’s always doing flashy, complicated surgeries, when in real life, the bread and butter of most neurosurgeons deals with less complex surgeries – for example, in my experience, shunt revisions and insertions. Piece of cake – the surgery, if no complications arise, takes about an hour. You can actually watch on Youtube (if you’re not squeamish) a filmed neurosurgery where the surgeon inserts a cerebral shunt into a very small baby, possibly a preemie like I was. Inserting the shunt takes about 10 minutes. Even in patients who have tolerated past surgical revisions well, infection remains a serious risk with any subsequent revision. Hydrocephalus is such a variegated disorder that some patients can go for decades not needing any revisions, whilst others need them much more frequently.

            However, I know more than one person with hydrocephalus who has had many serious complications and surgeries, the most serious of which was an infection.

            Sadly, despite very good treatment with big-gun antibiotics and her staying in isolation one step below airlock, she died the day before they were going to release her into the regular ICU with plans to revie her again. 🙁 Alexa had Chiari malformation secondary to Ehler’s Danlos Syndrome, and the Chiari in turn caused hydrocephalus. From what her parents have said, the doctors believe she came into the hospital with the infection that eventually killed her; very severely increased intracranial pressure didn’t make things much easier.

        • sdsures

          My migraines are being treated with Botox injections every 12 weeks on the NHS. Initially, my neurologist himself did the injections, and eventually, more (nursing) staff were available to be trained in the procedure. The Botox clinic is now almost entirely nurse-led. So far, things have gone off without a hitch. However, my neurologist still keeps an eye on things; the nurse-led clinic means that he can devote more time to more complicated cases, his research, etc (ie Parkinson’s research) that cannot be adequately substituted by a nurse-led scheme.

          So, in *some* cases, where procedures and outcomes are largely non-emergent and predictable, using a nurse-led approach can work well.

          But that certainly doesn’t extend, in my view, to L&D, because things can go disastrously wrong in a heartbeat. Unlike labour, the worst that can happen with Botox injections is not being able to target the precise area of muscles they want, but in that case there are other angles of attack that paralyse the same muscles. (There was the one time when my neuro accudentally Botoxed one of his own fingers.)

          What the midwives did here is wrong, and I am saddened by Joshua’s death. I have experienced VERY stubborn nurses when I have been an inpatient, and it eventually turned out that my assessment of the situation was right, and they were wrong. You must be persistent to get what you want, even if it’s basic care.

          • Who?

            Does it help for the migraines? I’ve heard tell of it but haven’t spoken to anyone who is using it.

          • sdsures

            It does indeed help, but it takes about 3-4 sessions to feel the effects. I’m getting my 7th session in mid-April. What’s sort of frustrating is that it’s not working well enough (in a sense) for us to titrate me down a bit off Depakote, which I’m currently on 2000mg daily as well. But broadly speaking, yes, it’s been working for me. Different patients respond differently.

          • Who?

            Good luck with it.

          • sdsures

            Thanks!

          • The Computer Ate My Nym

            A lot of the issue, IMHO, is about knowing one’s area of competence and limiting scope of practice to those areas. I have (unfortunately) seen surgeons make spectacularly poor medical decisions because they were too lazy, arrogant, or embarassed to call an internist to manage a medical complication that was out of their field. Any practitioner at any level needs to know when they’re getting out of their area of expertise and need to call for help. One of the problems with NCB (besides CPMs being nearly as arrogant as surgeons at times) is that the NCB ideology says that birth is “safe”–and why would you call in a bunch of help to do something “safe”?

          • sdsures

            As have I.

        • Who?

          That’s depressing, as are the comments below about ‘satisfaction’ trumping ‘results’. As nomofear points out, insurers will follow results, because it is cheaper for them if things are right first time, but that ‘we love Dr x is still a factor.

    • The whole breastfeeding thing is astonishing to me. Lactivists are, I’m convinced, enamored with the idea of lactation being some superhuman ability that omg! Provides! Sustenance! To! Babies! rather than taking the time to develop a skill anyone else is actually interesting in hearing about endlessly.

      IQ and body weight of the infant even out, typical first-world life and vaccinations make the boost of immunity nice but ultimately unnecessary, and the disruption it causes struggling mothers most definitely isn’t worth the guilt-mongering.

      Unless you have the stigmata, bodily secretions just aren’t notable achievements imo.

      • Bugsy

        Wow…imagine if we could convince lactivists to focus their energies on other body secretions. The value of boogers….ear wax…feces…perspiration!

        Wait, never mind. On second thought, the infatuation w/ bodily secretions seems not unlike life w/ my 2-year-old.

        • demodocus’ spouse

          or middle schoolers

  • lilin

    Is anything happening to the midwives? Aren’t they getting locked up for denying a baby medical care until it died of infection?

    • Sue

      ANd, also importantly, are they tackling the culture and the system? Otherwise another groups of MWs will step up and do the same.

    • The Computer Ate My Nym

      No. As I understand it, some of them are still working.

      • sdsures

        That’s terrible. But not surprising.

  • Puffin

    These horrific events, and the terrible treatment of the Titcombes while pushing for answers, strike me more as turf wars than NCB ideology at work, though I don’t doubt that has a part to play.

    It seems to me more that the midwives were more interested in protecting their own practice rights than in protecting their patients. Seems a common theme, midwives refusing to admit when they are in over their heads then refusing to take accountability for their avoidable bad outcomes.

    My family and I have been seriously considering relocating to the UK after my medical training is complete (5 more years, at least) and so I’m reading about this with a great deal of interest because it gives me some cause to really consider whether the system’s problems – which are different from, but not necessarily greater than those the provincial systems here in Canada face – are too profound for me to choose to be part of it. I really don’t know yet, but this gives me pause.

    • Amy Tuteur, MD

      The midwives dress their self-interest in purported commitment to “normal birth.” It gives them ideological cover.

      • Puffin

        Fair enough. Can excuse any number of sins, I suppose, if you swear up and down they were done with the best of intentions.

    • My sense is that the problems of the NHS are perhaps “less intractable” than the problems in Canada. They have parallel private care – and that changes things quite considerably.

      • Christina Maxwell

        We have very little private care. Perhaps you are thinking of Australia?

      • sdsures

        One thing about doctors in Canada vs the NHS:

        In Canada, if you choose to practice privately, you *absolutely* have to stay with private practice, and vice versa with public practice. In the UK NHS, you have some leeway to do both. I’ll double-check that with my English hubby. 🙂

    • sdsures

      I’m originally from Winnipeg and now living in the UK. So far as I can tell, there haven’t been many serious problems for me in either system. I expect to have to wait long periods for specialist care if it’s not a life-threatening emergency, but it amazes me how some people complain so much about those aspects of the NHS and Canadian system. Yes, people often have to wait long time for things like hip replacement, but speaking entirely in terms of medicine, is it fair to say that a hip replacement is not a medical emergency, despite ackowledging the serious effects that wait may have on the patient? If it were actually killing them, then treatment ought to be faster.

  • Tosca

    I re-read your earlier account of Joshua’s death, and the hubris is astonishing. I can understand why woo-infused midwives would fail to call a dr. before or during birth…but after? Did they think the dr. would prescribe a retrospective epidural or something? My mind is boggled.

    • Cobalt

      Once you’ve had your natural birth you have to start your natural breastfeeding, and breastmilk cures everything.

      • sdsures

        I often wonder how the children of these “magical natural births” are faring as they grow up.

  • Amazed

    Thank you, James, for not giving up in the face of the casual cruelty of leading healthcare “professionals” who sabotaged your efforts, ridiculed you, and demeaned you. I guess they didn’t realize that after losing something as precious as a newborn’s life, their scorn and heartlessness weren’t likely to cower you into submission. Thanks for initiating a change for the better and revealing the frightening face behind the all natiral approach – a face of casual dismissal of human lives, thus saving other families from going what you went true.

    Finally, justice prevailed, as cold comfort as it is.

  • Kelly

    That photo where the mother is crying and their daughter is looking on makes me tear up every time. This treatment is awful. I am glad they had the fortitude and strength to get justice for their innocent child.

    • the wingless one

      A lot of the pictures of the families who have lost little ones posted on this blog and Hurt by Homebirth are really tough to look at. This one though is always especially gut-wrenching. The anguish is so palpable. I just feel so awful for this family, that poor baby and everything they lost for no good reason.

    • toni

      It’s so jarring it’s hard to know what to say. I think this is why there aren’t many comments for this post. we talk constantly about the consequences of non-intervention and madwife (not a typo) ego but when you actually see a picture of a family like that it’s so distressing you don’t want to face it. what a perfect, beautiful little boy.

    • Sue

      The mother’s obvious extreme distress, while holding that little lifeless body, is such a powerful image. May it inspire not just emotion, but also change.

  • moto_librarian

    Thank you James. I am so very sorry for your entire family. We will continue to do all that we can to honor Joshua’s memory by ensuring that arrogance and incompetence do not claim any other precious lives.

  • Dr Kitty

    Dr Amy, thanks for this.
    I have the greatest respect and admiration for the Titcombes and everything they did to get justice.
    If you are still in contact with the family, please pass on both how sorry I am for their terrible experience and my gratitude for their strength and determination to fight for the truth.

    The things that were written about James in public forums by midwives, the cover ups and denials, all of it is simply disgraceful.

    Dr Kitty
    An NHS doctor, who is horrified by what happened in Cumbria, and the callous disregard for the suffering of the victims that was displayed throughout this sorry affair.

    • Guestleh

      Weren’t there midwives who insulted James on Twitter? It’s hard to come up with language that truly expresses how reprehensibly they behaved. Attacking a grieving father to defend their turf. Horrifying.

      • Dr Kitty

        Yes, yes there were.