In the wake of the Morecambe Bay Report, which investigated the deaths of 11 babies and a mother and placed blame squarely on a midwifery culture that valued “normal birth” above all else, you might think that UK midwives would be in a mood of somber reflection about their deadly philosophy.
You would be wrong.
Yesterday I entered the weekly Twitter chat at the hashtag #WeMidwives hosted by the Royal College of Midwives (RCM). If I hadn’t been there myself, I would not have believed the smugness, meanness, utter lack of reflection and inability to tolerate criticism that characterized the Royal College of Midwives and its members.
Apparently, no matter how many dead babies, no matter how many dead mothers, being a UK midwife means you never have to say you’re sorry.
The topic of the chat was the latest in deadly midwifery philosophy, the RCM Better Births Initiative.
The Better Births initiative started in May 2014 with the aim of developing service-led and evidence-informed resources for maternity care in the UK covering the antenatal, intrapartum and the postnatal periods.
The three themes that we are focussing [sic] on are:
1 The promotion of normal births for majority of the women and normalisation for all women, achieving normality…
In other words, it is the new iteration of the Campaign for Normal Birth, yet another example of MIDWIFE-centered care.
What about MOTHER-centered care? Don’t be naive. UK midwives apparently believe that if it is good for them, it must follow that it is good for mothers. They seem intellectually incapable of differentiating their interests from their ethical obligations to women and babies.
What is normal birth? It is never explicitly defined, but the fundamental RCM belief appears to be that if a midwife can do it, it’s normal and if only a doctor (obstetrician, pediatrician, anesthesiologist) can do it, it’s abnormal and to be abhorred and eliminated.
You can follow nearly the entire chat on Twitter at #WeMidwives. The topic was “What does better births look like for you and why?” The narcissism of a group of health professionals placing their vision of birth above the mother’s needs and desires is truly mind boggling, not to mention thoroughly unethical.
Below are a few exchanges that will give the flavor of the discussion:
Me: @MidwivesRCM Shouldn’t focus be on what better birth looks like to MOTHERS, not midwives? #WeMidwives
RCM: (No response.)
Me: When will RCM acknowledge that Campaign for Normal Birth led to the Morecambe Bay horror? #WeMidwives
Everyone else: (No response.)
James Titcombe (father of a baby who died at Morecambe Bay): How will better births ensure this type of culture doesn’t develop again? #WeMidwives
Newberry Doula: Inappropriate care fm all levels of staff is more likely in overstretched systems IMO. OBs failed too #WeMidwives
Only one midwife had the integrity to state the obvious:
Geraldine Butcher: @MidwivesRCM @WeMidwives hi need to listen to what we don’t want to hear as well as what we do #wemidwives
The rest of the conversations were meaningless platitudes …
Or worse:
And, of course, the inevitable:
And the chilling:
Why won’t the Royal College of Midwives or its members apologize for the deaths that occurred at their hands?
…[H]ow do we square two dissonant cognitions when one of them is the belief that we are decent people and the other is the knowledge that we have inflicted pain on an innocent victim?
Ask any kid who wallops a younger brother. “I’m decent, but I hit him,” the argument runs, “therefore he must have deserved it.” It’s the most vicious of circles. Aggression begets self-justification, which begets more aggression, and thus do the authors lead us, one small step at a time, down the road to Abu Ghraib and to all those deeds throughout the ages whose doers were never the monsters we’d prefer them to be but just decent people like us.
And at the end of the day, when the time comes for decent people to tell their story, self-justification is left holding the pen.
According to The Advantages of Not Saying You Are Sorry in Scientific American:
Given that apologies offer a relatively simple way to mend relations and heal wounds for victims and offenders, why do people refuse to apologize? Beyond escaping punishment, there may be some psychological benefits to standing one’s ground. For example, adopting a self-righteous stance may feed one’s need for power. If the act of apologizing restores power to the victim, it may also simultaneously diminish the power of the transgressor. Thus actively denying any wrongdoing may allow the offender to retain the upper hand…
A second possible benefit of standing one’s ground in the face of an accusation is saving face. No one wants to admit to being a hypocrite. Inherent in an apology is the admission that one’s behavior failed to align with personal values and morals, as people generally don’t apologize for actions they believe are right and just. Thus when we admit that we are wrong, we expose the fact that we may talk the talk, but we do not walk the walk…
So rather than apologizing for a deadly philosophy and catastrophic failures that resulted in multiple deaths, the RCM and UK midwives have doubled down by refusing to reflect, refusing to take responsibility, refusing to express remorse. Instead they figuratively put their fingers in their ears, blocking those who ask uncomfortable questions in an effort to pretend that criticism doesn’t exist and there is no need to think about past errors. Hence the Twitter chat ended with the RCM praising its members and “celebrating your efforts :)”.
What the RCM fails to recognize is that babies and mothers will continue to die at the hands of their members as long as they continue to evade responsibility for the fatalities that have already occurred as a result of a midwife-centered philosophy that values process over outcome and gives pride of place to midwives’ needs and desires while ignoring those of mothers and babies.
Commentor Cordy, a midwifery student, advised, “don’t be worried she is 1 we are many.”
Here’s my advice:
Be worried!
I may be one, but my voice is transmitted around the globe thousands of times each day. And I’m not the only one. Brave parents, like James Titcombe, battling heartache but faithful to the memory of their precious loved ones will not stop until midwives accept responsibility for their actions and their philosophy.
Be worried!
Your behavior is unethical, immoral, self-serving and harms innocents. I don’t know how many babies and mothers will have to die before midwives will be held to account, but I do know that the day of reckoning is coming.
The RCM’s obsession with “normal birth” drives me batty. I suppose they might argue that “death is normal”, too.
Just google midwives and whistle blowing a whole page comes up from uk midwifery council and others.
I am a social researcher and I was asked to give a talk to midwives on whistleblowing in midwifery. I searched the research literature using several terms (“reporting misconduct” etc.). I was able to find research about whistleblowing in nursing, medicine etc. However, I could NOT find ANY research about midwives as whistleblowers. There were a couple of articles that implied some midwives were bullies and negligent, but that was it. It looks like midwifery researchers do not consider this essential aspect of patient safety (reporting corruption or negligence) worth researching. No one is counting how many times “sorry” should be said, and isn’t.
Irish Medical Times:
http://www.imt.ie/opinion/2015/03/musketeer-midwives.html
I think that’s by Dr Ruairi Hanley, a GP.
He has a reputation for being extremely outspoken.
He’s not pulling any punches in that article.
Yes it is. And, while I could not possibly comment on my “reputation” , I am delighted to discover this very interesting blog! It is a pleasure to read.
Congratulations to Dr Amy Tuteur and all involved
“The truth does not cease to exist because it is ignored”
Kind Regards and best wishes
Dr Ruairi Hanley
For those who were denied access . May I suggest the following?
Clear cookies on your computer. Clear browsing history
Go back to the article .
How you answer the question is entirely a matter for yourselves 🙂
I don’t decide the access policy for the imt website.
Regards
RH
Thank you, Dr Hanley.
Thank you, Dr. Hanley.
Extremely powerful piece and extremely necessary! Is it the power of the midwifery union that allows them to avoid accountability for these deaths?
We have some problems with the inappropriate (and unethical) emphasis on “normal birth” in the US, but it’s hard for me to imagine that US midwives as a group would be publicly indifferent to preventable deaths of babies, if only because of the bad publicity that would follow.
@AmyTuteur:disqus
I think it’s because USA doesn’t have as many midwifery led units. The majority of CNMs in the US practice in integrated units alongside MDs and nurses.
The midwifery led unit concept makes no sense to me. No other service has a separate unit for midlevel practitioners.
“The midwifery led unit concept makes no sense to me. No other service has a separate unit for midlevel practitioners.”
Exactly. But they don’t want to admit that they are midlevel providers. So they try to denigrate OBs by calling them “nothing more than surgeons” and lift themselves up by calling themselves “the experts in normal birth”.
Thank you Dr Hanley!
As a TCD graduate, now practising north of the border, I’ve really enjoyed reading your perspective on things (not just this article).
” I am delighted to discover this very interesting blog! ”
Watch out, Dr. Hanley! It is addictive.
Many of your readers will be denied access to the article, because we are not medical professionals.
Just coming to complain that I WAS denied access!
And I’m now hearing in my head the black dude from Ghostbusters “Ray, when someone asks if you if you’re a god, you say YES!”
Ha! Signed, someone who totally lied and got in.
My mouse finger slipped when asked whether or not I was a medical professional, and I pressed the incorrect response. Ah well.
Punchy article. Will be interesting to see if there is any pushback from the remnants of the Musketeers or their followers.
Same here. I loved that for once, someone was not aiming for political correctness but truth. Well, not for once. Doctors have started taking vocal stance against preventable deaths, especially those caused by sheer arrogance.
My hat is off to you, Dr Hanley! I am not based in UK or the USA but this natural madness and sheer arrogance have already claimed some lives here as well. They are coming – and they are visitors that should be stopped, like their family of tuberculosis, whooping cough, measles, and the rest of them natural. We don’t want to host this reunion!
Thank you all very much for your kind words, greatly appreciated !
A few minutes on the Internet have revealed that some midwives and their global fan club are denouncing me as a “misogynist”. Given that I am highlighting the appalling treatment of women in childbirth I find such attacks to be scarcely credible. Apparently anyone who criticises midwives is now anti-women too…
Seeng as my wife is a Doctor and I am the father of two daughters (one 9 weeks old) I suppose I should laugh at being called a misogynist. But the very fact that they use such words speak volumes about the mindset of those hostile to my view.
Anyway, thank you all again for your kind comments and once again I salute Dr Amy for producing such a wonderful blog!
Kind Regards
R
Misogynist is a very overused insult, which seems to now boil down to disagreeing with women. Perhaps it should be a new aspect of Godwin’s Law: As an online discussion about childbirth and child feeding grows longer, the probability of a comparison involving misogyny increases.
Which is a shame because true misogyny is a real issue, and losing an apt and descriptive word to hyperbole is very disappointing.
That’s an insult also leveled at Dr Amos Grunebaum. of the Cornell study. And we here are all Dr Amy in disguise. They’re getting desperate.
I’ll be very surprised if they are ready to debate you, though. Usually. they avoid Dr Grunebaum like the plague because they know he’s someone who will reply to their comments.
They’re just a group of bullies.
It is, paradoxically, incredibly sexist though to say that every man who contradicts women is a misogynist. It implies that real, rational debate cannot be achieved between people of different genders because it would always be tainted with misogyny. In this logic there is no way men and women could be peers. Anyway, thanks (from a woman) for the article and congrats on the new baby !
Oops, I just realized that this post was 8 months old, but thanks anyway and I hope the little one is thriving !
Here’s one set of midwives discussing the piece and utterly dismissing it:
it doesn’t require proof.
If you’re already clicked “no”, open in a new browser then click “yes”
is it actually legal to do this to official logotypes of another organisation?
yes
Since it is apparently legal to deny women pain relief and women and babies needed medical attention, then hide it and be disrespectful to the victims, I’d put my energy and concern into that.
remember this was also a failure in the TEAM of health care professionals, including obstetricians & paediatricians and in the management of the hospital to deal with the failings. The was a small group of midwives, with one dominant one. The are over 35,000 midwives in the UK. Don’t tar them all with the same brush.
The obstetricians were the ones who blew the whistle. And are you really going to go with the equivalent of “I was just following orders?” Given that the NHS is paying put huge amounts of money for botched births due to incompetent midwives, I think it’s quite reasonable to be concerned about their competence overall. The head of RCNM is still more interested in promoting physiologic birth than preventing deaths. So spare us the excuses.
That’s the thing that drives it home for me. The head is not saying, “This is terrible, we will work to make sure all midwives understand that the way these women acted was unprofessional and not in keeping with the values of the RCM,” she’s saying, “Yay normal birth!” So yes. I’m going to do the reasonable thing and tar them all with the same brush.
When my children were small, I used to tell them that “He did it, too” was no excuse. It’s no excuse for adults, either.
Unless and until midwives take seriously what has happened, apologize for it, and recognize that there commitment to “normal birth” is unethical, they are all complicit.
http://www.jfhc.co.uk/cathy-warwick-reflections-on-morecambe-bay-investigation.aspx
I was born at home In England almost at the hands of a midwife some 50 years ago. My poor mother had been pushing for hours until the doctor came by. Berated the midwife for not calling him earlier and pulled me out with forceps. Yelled downstairs for a corkscrew ( to open a can of ether) just about lost my father. Ok perhaps should not have berated the midwife in front of my parents but this was 50 years ago and he just happened to be riding by. Seems like some things have not changed in British midwifery. My siblings were born in hospital.
But I do remember as a small child the midwife coming by and helping my mother with breast feeding. Is not all bad!
What must have been going through your Dad’s mind at the corkscrew comment! Glad it obviously worked out.
Your poor mother, but omg that’s hilarious with the corkscrew.
My prenatally diabetic aunt had to give birth at home almost 30 years ago, after going into premature labor during a blizzard, and when the paramedics finally got there they had to carry her and the baby out in these heavy black bags – remember, there’s a blizzard, they had to carry them all the way to the last drive-able bit of road – and the neighbors went crazy reporting about the pregnant lady who froze to death while birthing a giant diabetes baby.
And midwives are indeed important. While I believe that birth should happen in the hospital under doctor’s supervision, what with so many things which can go wrong very quickly and the fact that the majority of those things are easily corrected with the large staff and resources only available in hospital, that doesn’t mean that midwives aren’t important.
Midwives provide comfort during pregnancy and labor, advising the mother’s day to day life as her body changes, works *with* obstetricians by using their own nursing degrees to do things such as take blood vitals, blood and urine samples, etc. They’re important to people culturally as well as practically and I for one would hate to see them go.
However, by refusing to take actual medical and science courses, forming a barricade around parents so that they don’t leave their own care, and ignoring irrefutable scientific fact for self-aggrandizing pseudoscience, they’re putting both human lives and their own credibility as a profession at risk.
Dr.amy , I had my first baby in the US with a fantastic Ob who took awesome care of me. I love your blog as it has helped me understand and celebrate my baby’s induced birth. I have now repatriated to the UK and hope for baby number two.
What advice can you give me for navigating the midwifery care system in the UK? Private obstetric care is prohibitively expensive so I will be cared for on the NHS. I just want to make sure me and my baby will be safe.
Advice from all is welcomed. TIA!
See your GP. They will usually be able to advise you on the local options available for antenatal care. They don’t really have a dog in the fight either, and tend not to get involved in the “turf war”.
Remember- you may be offered homebirth or a midwifery led unit, but it is still your choice where to deliver. Make it clear, from the beginning that you are risk averse and that some options are unacceptable to you due to increased risk.
When it comes to analgesia in labour: the NICE Guidance on intrapartum care is quite clear:
“Timing of regional analgesia
1.9.3 If a woman in labour asks for regional analgesia, comply with her request. This includes women in severe pain in the latent first stage of labour. [2007]”
I would suggest printing this out and attaching it to your birth plan if you plan on having an epidural.
Have a notebook at every appointment- you are unlikely to see the same person every time. Make a note of dates, names and times and any advice you were given.
Oh yes…this goes for phone calls too.
If you phone your local obstetric ward or community midwife, the phone tends to get answered as “midwife speaking”, make sure you ask for names.
The nuclear option, which makes it clear that you aren’t happy and are considering a complaint, is to start asking for NMC numbers (nurses and midwives) or GMC numbers (doctors) as well. That’s one to pull out only when requests for analgesia or to see an OB are being obstructed, or if you feel the care you are getting is negligent, unsafe or otherwise objectionable.
Thank you so so much Dr. Kitty. Your advice feels invaluable and I am so lucky to have an excellent GP. I will absolutely be saying NO to homebirth! It is really starting to infiltrate as a viable option to so many of my friends now, because despite all the NHS bashing that goes on, people do seem to be proud of the NHS and trust its practices, sometimes unquestioningly.
However, OT, my local area mums group is doing a lot of campaigning to raise awareness regarding step B testing-thank goodness!
Also, I LOVE call the midwife tv show, but I think it gives U.S. rose tinted glasses on home birth! Another ‘vintage trend’ comings back in perhaps?! Can’t think of anything worse!
Glad you like your GP… if nothing else, their job is to be your advocate.
I think when it comes to maternity care, being clear from the outset about your priorities and goals is helpful for everyone. Just as it is possible to be perfectly polite and pleasant about your desire for a med-free all natural birth, it is perfectly possible to be polite about your desire for a hi-tech, monitored, hospital birth with an epidural.
You’ll also have the option of saying “oh this is all so different from the care I got in the USA…can you explain the reasons why you do it this way instead?”…which may prompt someone to engage their critical thinking skills, and lay out risks/benefits for you.
Dr. Kitty, what is the process one goes through when one gets pregnant in the UK? Do you get a dating scan? who does that? is it at the hospital?
what is the process one goes through when one gets pregnant in the UK? Do you get a dating scan?
Somehow I first read this as “what is the process one goes through to get pregnant in the UK? Do you have a dating scam?” Which would be a very different question from the one you were actually asking. (/comic relief)
I don’t imagine anyone speaking you INTO homebirth. Your GP will refer you to local midwife clinic, all normal antenatal care is done by your midwife unless any complications arise. If they do, u are referred to the obstetrician. If you need an epidural, just ask for it, be ready to wait though if the anesthetist is busy.
Where I am care is very responsible, noone would be pushing u for woo natural birth, unless it’s your choice. Actually, a lot of midwives feel out of place if someone is requiring something unusual like hypnobirth; or a high risk lady demands low risk care.
NMC is hard on people braking the code, it is possible to lose your pin number and right to practice if you misconduct. Practicing and even calling yourself a midwife without registration is illegal.
I think it’s impossible to judge about the sysem of the whole country by one report and some articles and tweets on the internet. I am sure there are cases of misconduct in the US hospital, the difference is – the NHS is open about it and all the reports are public. The private American hospitals would never make such reports available for general public – it is not in the interest of their business.
It also totally depends on your region. Some places are better than others.
it’s good to see a “dr” giving evidence-based info regarding place of birth to a multip.
Almost as good as seeing a “midwife” completely discount a woman’s desire for pain relief.
this comment was in reply to “Make it clear, from the beginning that you are risk averse and that some options are unacceptable to you due to increased risk.” Lottie is a multip & therefore, provided her first birth was without complication, she is NOT at increased risk according to this evidence. And pain relief is available at home; Water, TENS, entonox, pethedine/meptid/morphine are all available at home.
Um…Water birth is dangerous due to fecal contamination and drowning risk. TENS doesn’t work (see http://www.ncbi.nlm.nih.gov/pubmed/21829980). Morphine et al do in fact depress fetal and neonatal respiration, unlike epidurals which use a tiny amount of narcotic or nonnarcotic pain control applied directly to the nerve to control pain. Why use an ineffective and/or higher risk form of pain control when you could get a safe and effective one?
None of those work as well as an epidural. And if the mother is risk-averse, why in the hell would you try to talk her into a home birth?
I had a shower, TENS, entonox and some opiate injected into my hip when I was in agony, so I couldn’t tell you what it was. None of them reduced my excruciation. I could have kissed the anaesthetist that gave me my epidural.
If i ever have another pregnancy, my birth plan will simply say “epidural”.
Yeah, how dare Dr. Kitty give her advice just because she asked!
NICE guidelines on place of birth
Choosing planned place of birth
Women at low risk of complications
1.1.1Explain to both multiparous and nulliparous women who are at low risk of complications that giving birth is generally very safe for both the woman and her baby. [2014]
1.1.2Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth:
Advise low‑risk multiparous women that planning to give birth at home or in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.
Advise low‑risk nulliparous women that planning to give birth in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. Explain that if they plan birth at home there is a small increase in the risk of an adverse outcome for the baby. [new 2014]
1.1.3Using tables 1 and 2, explain to low‑risk multiparous women that:
planning birth at home or in a freestanding midwifery unit is associated with a higher rate of spontaneous vaginal birth than planning birth in an alongside midwifery unit, and these 3 settings are associated with higher rates of spontaneous vaginal birth than planning birth in an obstetric unit
planning birth in an obstetric unit is associated with a higher rate of interventions, such as instrumental vaginal birth, caesarean section and episiotomy, compared with planning birth in other settings
there are no differences in outcomes for the baby associated with planning birth in any setting. [new 2014]
So what do you say to the remarkably robust finding that home birth has a perinatal mortality rate of 2-3 times low risk hospital birth? That has been found in the UK and the Netherlands.
If a woman wants an epidural, she sure as hell isn’t going to have a home birth. Or is that not a legitimate reason for you?
These are the NICE guidelines: guidelines based on the best available evidence.
Lottie didn’t say she wanted an epidural, she wanted safe care. Dr Kitty assumed she wanted an epidural.
The NICE guidelines are heavily influenced by what the people writing the guidelines want to be true. The out of hospital and hospital settings are equivalent only when you include interventions as an “adverse outcome”. If you only include real adverse outcomes (dead or damaged babies, dead or damaged mothers), the advantage is to in hospital units.
OT: Commented on the trending breastfeeding article on facebook. Awaiting a stampede of momma bears baying for blood.
Ughhh.
I love the gaslighting and women telling each other to hush up and stop being so hysterical. IRONY.
lol
OT: Is anyone else reaching an error message if you try to access the 2012, 2011, 2009, or 2008 visual archives?
Yeah, the Snazzy Archives plugin isn’t behaving.
OT: this was posted on Facebook today. I admit to knowing little to nothing about the doctor who wrote it, but I do know she sells supplements on her website and they cost a lot of money.
This is the anit-vax campaigner whose recent proposed tour of Australia was cancelled after many of the venues she had booked pulled out. There was a fairly large outcry when the tour was announced.
BTW slightly on the vax topic, a four week baby died in Western Australia this week from whooping cough, the first in Australia for a couple of years I think.
http://www.watoday.com.au/wa-news/massive-public-support-for-family-of-whooping-cough-baby-riley-20150319-1m2fkp.html
The poor baby and family! Especially the big sister, who would have been looking forward to the new arrival and is probably bewildered and saddened by the loss. The parents would be grieving too, which is terrible and they shouldn’t have lost their baby, but there’s something that much worse about having to explain death to a toddler.
The one positive is that some wonderful news has emerged from this awful tragedy. Riley’s death has led to an expansion in the provision of whooping cough vaccine for pregnant women in Australia. A magnificent legacy, I’m sure lives will be saved.
It is an awesome legacy, but I wish that things had changed without someone dying. It’s also not Australia-wide, as far as I know, it’s only changed the policy in New South Wales. Queensland has been offering the DTaP vaccine to pregnant people in the 3rd trimester since early 2014, with the other state health departments awaiting the outcome of Queensland’s 3 year trial vaccination program before deciding. That may have now changed with baby Riley’s death, but I truly wish it hadn’t to come to that.
Poor baby! I suppose it’s even more shocking because nowadays, when people in first world countries have kids with strong lungs and good latch, they expect that this babies will live to grow up.
This is the woman we managed to get to cancel her planned anti-vax speaking tour around Australia by notifying all the venues of the true nature of the presentations she was intending to give.
She is a DO who used to practice mainstream medicine, now confines herself to “wellness care”. She is a hero of the anti-vax movement.
Apparently this “doctor” doesn’t understand that the only difference between a poison and a medicine is dosage.
You have to be pretty dense to compare preventative medicine to bioterrorism.
Or pretty cynical, as in you think that your readers or viewers won’t be able to tell the difference and that you can make loads of money off the lack of understanding of the distinction.
Nor does she understand that the vaccines in question contain DEAD viruses. There wouldn’t be much point to a terrorist making a dirty bomb full of dead viruses, would there.
This is what they mean when they say “normal”: https://www.rcm.org.uk/top-ten-tips-for-normality-in-birth-for-midwives
“Normal” includes stuff like “Wait and see”, “Put her in a dark room” “justify technology” (i.e., make excuses for not using it), “keep a diary” (they don’t mean records, they mean “how you feel”), and “keep reassuring her she can do this.” I just…. wow.
In other words, be a massively patronizing misogynist while making money by accusing doctors of misogyny.
I’d *love* to see a reaction video of one of these bozos having to deal with a mentally ill woman driven to a psychotic episode after suffering a needlessly agonizing labor. It’s happened to one of my friends, though she was triggered by the hospital setting (someone who had an actual excuse to home birth but chose not to be selfish, in other words), it could very well happen to someone denied the pain relief they begged for.
It really chaps my ass that they bother with this ridiculous list when the NHS is dealing with so many problems: poor mothers, mothers who don’t speak English, teen mothers, mothers who victims of domestic violence, mothers without stable housing (imagine couch surfing with an infant), mothers with substance abuse issues. Giving birth in a dark room isn’t going to do jack shit to help these women.
Off topic, but New York Times columnist Nicholas Kristof has joined the lactivist fray on his facebook page by linking to the Pelotas, Brazil study. There is plenty of misinformation going on in the comments thread if anyone wants to go add a voice of reason.
When does the past end?”
For midwives, either immediately after a bad outcome or publishing of an official report condemnig their actions. Morecambe Bay Report was only two weeks ago and they are already ignoring it and moving on.
But if called out for their duplicity, they have Cathy Warwick’s (amended) statement to say that they were berated and reproached!
It’s incomprehensible to me that they woud say that to someone who lost a son due to their neglect. Maybe the past will end when they can give the Titcombe’s a healthy Joshua back and magically erase all the pain they needlessly caused that poor family. These midwives are just disgusting people.
You are not only one. We are legion.
I am Spartica… I mean Dr Amy!!!!!!
We are all AMY!
No, Annie, but you’re close!
Talk about yourself if you please. I am Dr Amy’s shoe. I refuse to be her sock as I’ve been called in the past.
But socks are fuzzy and warm ):
That’s it. Dr Amy is anything but. That’s why we have those brats… err, I mean loving mommies who drop by to swear that they’d never give birth in a hospital because Dr Amy is meeeen.
Pity that an old retired OB should care more about their children than those mommies themselves but… it goes with being warm and fuzzy!
Funny how these money grubbing docs keep insisting on giving a shit about child welfare.
I am Amy Number 7!
https://www.youtube.com/watch?v=QereR0CViMY
That’s what my brain auto-corrected it to as well!
Hash tags I’d like to see a twitter chat on #WeMidwivesWereWrong; #WeMidwivesAreSorry and #MorecambeBayNeverAgain – but I imagine that’ll come when the pigs at my mother-in-law’s hobby farm sprout wings and are seen overhead.
Stomach-turning!
Sheena Byrom: “Protecting normal birth is a midwife’s core function”
http://linkis.com/onlyfortheheartstrong.org/4AK0u
Disgusting, all of them. Including the President of the RCM. Hey, healthcare system over there, why won’t you alert yourself?
Wait, what? As opposed to protecting their patients?
The first question Sagefemme asked the midwives was “How do you feel about the report?” Are you kidding me??? Who the fuck cares how you feel?
“How does the midwife feel” is apparently one of the top ten tips for “better birth.” They don’t keep records about their actions except for their feelings about it.
I certainly didn’t see anything that sounded like “we need to clean house and establish regulations and codes of conduct to protect patients in the future” which is what I would expect the reaction of any ethical health care provider to be when faced with something this egregious.
If it were doctors saying things like this, they’d be accused of paternalism.
“But a healthy desire for normality can become sick and twisted within a dysfunctional system, like a family plagued by unhealthy obsessions and addictions” It’s funny how they find the way to blame the patient on the obsession with normal birth… Because clearly, they have to be mentally ill in one way or another, it can’t possibly be the midwife!
A little OT but I have now referred seven friends over the past 2+ years to your blog who were planning home births (we live in a very crunchy area). Six of them read through and chose hospital birth. The seventh went for the home birth and nearly died due to bleeding. She asked me again about your blog after her recovery (she and her baby were fine, due to an amazing stroke of luck) and has read through it and kicks herself for how she, a very educated woman, was misled. She and her husband are trying for #2 and will be doing a hospital birth. You may be one but you have helped more than you think.
Completely off topic, but I was playing with cdc wonder a little and did an analysis restricted to first live birth for women age 15-49 with birth weight of 1500-5000 grams, 39-41 weeks GA, vaginal delivery, restricting cause of death to the O and P series (basically conditions arising from birth or gestation, not including congenital malformations) in 2007-12 and got an in hospital mortality of 0.13/1000 and out of hospital of 1.41/1000. A relative risk of over 10x in this population which is extremely low risk in every way except for having no prior births. To be fair, I repeated it restricting out of hospital births to include those with some attendant, including other midwife but not other to remove accidental and unattended home births. That brought the rate down to 1.23 for the home birth group. So, ok, maybe more like 9x. Still impressive and suggesting that Dr. Tuteur is consistently underestimating the risk.
Where did you access the CDC data?
http://wonder.cdc.gov
It’s a great site. Doesn’t allow you to go into as much detail as I’d like and I haven’t figured out a way to merge the datasets from different periods, but very good source of information nonetheless.
Age 15-49 is not a low risk age group as a whole. Elderly primips, yikes.
why is having a baby over 35+ so much riskier than in your twenties? i tried looking it up and all i’ve found are lists of things more likely to happen but no reason given as to why. 35 year olds often don’t look much different to 25 year olds so what’s going on inside that’s so different? does you uterus start to weaken that early?
Stroke risk is one. It’s not the uterus getting older it’s the mother. Pregnancy isn’t just another kind of normal, it’s a long trek, with a difficult ending.
but why is there such a big difference between 30 and 35? lots of 35-40 years olds are fit as fleas but they are still more likely to miscarry, haemorrhage after delivery and have placenta issues than slightly younger women. It just seems like the likelihood of having health problems related to pregnancy accelerates much quicker than health problems in general.
I’m not a Dr. but am advanced maternal age. 40 is closer to menopause, so it stands to reason, that cycles, hormone levels, etc… Change. It has nothing to do with fitness, how much you exercise or how much kale you eat. 40 is advanced maternal age. And as an AMA new mom of twins, I think it’s very true.
As for the difference between 30 and 35, it’s not that dramatic of an increase. The difference between 30 and 40, or even 35 and 40, is pretty dramatic when it comes to risk of several complications. As we get older, our bodies really start to show the effect of our genes and lifestyle choices. Hypertension and diabetes start to pop up (not that young women can’t have these problems, but it’s much rarer). Egg quality decreases, and that may have something to do with pregnancy complications. And it’s just harder for our bodies, even of very healthy people who eat TONS of kale and whatnot, to bear up under the physical demands of pregnancy. The cardiovascular and metabolic demands are heavy. Hell, I know women who had their firsts in their late teens and their next in their mid twenties, and they tell me that the second was just harder. Way more aches and pains. Postpartum 19 year olds are bouncing around the next day while older women are… not. 🙂
I’m sure there are people here who can give you more thorough answers but that’s my version.
@disqus_crbTL8CYum:disqus, there are some relevant comments yonder
http://www.skepticalob.com/2015/01/omg-omg-omg-i-was-pressured-to-have-a-c-section-just-because-i-was-a-40-year-old-insulin-dependent-diabetic-with-pre-eclampsia-and-bloody-urine.html
But in any case, older is older–how many lines has on one’s face is irrelevant, 10 years is a big difference , and moreso as you examine the reproductive capacity of 35 vs 40 vs 25 vs 35
It’s a good point. I was afraid to restrict age too much because the numbers were going to get small really quickly. However, since the reviewer insisted ;-)…Restricting to ages 20-34 gives a neonatal mortality in hospital of 0.12/1000 and out of hospital of 1.39/1000 for first live births, restrictions otherwise as above. Out of morbid curiosity I ran the numbers for the extremes of age as well (<15-19 and 35+) and got 0.17 versus 1.53. Yow! (Though in fairness the last number was based on only 7 deaths and may be unstable.)
I’ve been cared for by UK midwives for two pregnancies, in three different NHS trusts, and I received excellent, risk-averse care. My midwives were supremely alert for the possibility of complications, and always referred me on when they had any concerns. I know there are plenty of midwives out there who don’t contribute to this sort of culture in any way, and they have absolutely nothing to be ashamed of. So why aren’t they standing up to join this discussion?
Is it because they’re too busy being decent midwives to join in twitter activism, or is it because they’re worried that admitting some midwives made serious clinical and ethical errors will put them at risk?
You wouldn’t see this sort of rank-closing from, say, teachers, and midwives in the UK are a similarly established and respected profession. But they do seem to have imported a sentiment of persecuted genius from their US sistren, and it’s not doing them any favours at all right now. Morecambe Bay happened, no amount of positive thinking will change that, but it doesn’t have to happen again.
Interesting that we also see our colleagues on this site calling themselves “Medwife” and “Crowned Medwife” – there remains a predominant culture in the political arm of midwifery that appears to scorn behaving like a health care professional.
The scorn should work the other way around.
Can the rational MWs here chime in and explain how they see the culture from the inside, and why the dangerous MWs aren’t thrown out of the club?
I can’t tell you what the culture is like from the inside, because I distanced myself from ACNM when it became apparent it didn’t represent or contribute to my practice. My professional experience has only been with other Medwives and I refuse to develop any type of relationship, professional or otherwise with HB CNMs in my area. I’d much rather hide away with a cup of coffee and a Green journal than attend a Midwifery conference with all it’s ideology. I’ll admit that I felt a bit defensive of Midwifery when I first started reading SOB and did a bit of “We’re not all like that.”, but the truth is, I don’t know where Midwifery stands anymore and I have no way of knowing of how many of us are ‘like that’. Perhaps being an SOB’er leaves me jaded, but I can’t defend my profession because I don’t know where the voice of Medwives stand.
I’ve spent a lot of time lately processing Morecambe, RCM Better Birth Campaign and ACNM Healthy Birth Initiative and having a bit of an identity crisis. I haven’t been very vocal on the last two SOB posts, because it all leaves me at a loss. Here we have the two largest Midwifery organizations representing Midwives and rather than addressing the ideology and rogue behavior as contributing to those deaths, they continue to promote their views of Healthy birth, unapologetically shift the blame from their ideologies or remain silent about the report.
http://www.skepticalob.com/2014/03/confessions-of-a-medwife.html
I fought the term Medwife for awhile, believing Midwifery to be a safe profession with a willingness to use interventions and collaboration to ensure healthy outcomes. When it became apparent that the voices of Midwifery placed more value on process than outcome, it seemed embracing the term Medwife allowed my professional practice and goals to be distanced from Midwifery.
As Bofa commented on that post,
“This is the beauty of it.
Those are the ones who thumb their noses at the “medwives.” In response, here is the medwife who accepts that title as a crown. Medwife – you say that if it’s a bad thing?” And so I took the crown and became the Crowned Medwife.
I’d like to contribute a bit more as to what options and challenges lay ahead to be the voice of Midwifery or change professions, but have two mothers in labor and have to run.
The post you linked to was one of the most meaningful ones here, I think. And I remember grinning when you took the crown, Your Majesty. You know, one of the duties coming with it is, under one name or another, Protector of the Realm. It feels good to know that to some, the realm is the safe outcome, first and foremost.
Thank you for your comment. We’re not here for the purpose of making one another feel better, but it means a lot. I wasn’t sure whether anyone understood my screen name pertaining to Bofa’s comment. My husband saw my screen name awhile ago and was appalled I would use “crowned” in my screen name. Obviously, he’s heard me talk about birth way too much that he attributed it a birth term and placing a value on vaginal birth.
I feel very sad about the direction that midwifery is heading. The CNM who saved my life after my first birth is no longer delivering babies. She simply could not deal with what she described as the “toxic” birth culture in which process was valued over outcome. She was tired of seeing mothers come through birth feeling broken because they couldn’t have that natural vaginal delivery. I have noted that the midwife who was my primary for both pregnancies has left the practice as well, which makes me think that there is a growing backlash against medwives. That this is a hospital-based practice with a highly ranked training program for nurse midwifery disturbs me greatly. I would no longer give a blanket recommendation for this practice.
I’ve never been averse to the term “medwife “, although it’s a shame that one needs the differentiation. I never viewed midwifery as taking care of only specific categories of pregnant women, but rather, in collaboration with doctors, caring for ALL women. It’s just that I can be autonomous as long as my patient remains within certain parameters.
I plan to answer this but I am at a GLORIOUS conference on women’s health and am busy sponging up information. Love it!
I live in a rather isolated area and work in a small practice with 2 other midwives and the OB who owns the practice. I am the newest, youngest midwife and the two older midwives have more woo-eye practice habits than I do. I try to keep my head down tbh. But I abso-freaking-lutely refuse to promote what they have suggested to patients in regard to herbal remedies, homeopathy, acupuncture, moxibustion, and being reluctant to induce with certain medical conditions. The inductions I do take any chance I get to do what I think is appropriate when they’re in front of me. The other stuff is almost never harmful, unless people are doing them to replace treatment- otherwise, party on with the placebo effect. But I treat it just as if someone was telling me about their religious beliefs.
It’s very tricky. And I have at least one former classmate who has gone entirely to he Dark Side. She’s spamming my news feed with doTerra bs and until the recent measles outbreak and outrage she would post anti-vax stuff. We went to the same program so I’m not really sure what happened. I guess she kept her true opinion under wraps until she could strike out on her own and pedal whatever bullshit struck her fancy.
Whatever, I practice safely, I try to keep my patients safe, and at this point I am building my seniority so that someday someone gives a shit what my opinion is 🙂
You’re right. The scorn should be the other way around, but it’s not. Am I traitor to my profession if I distance myself from the collegiality and values of its professional organization because it doesn’t represent me or is my profession a traitor to me by not holding CNMs to a standard of practice that is actually supportive of women and not by publishing guidelines for Normally, Healthy birth with practices which can be detrimental to women, infants and the safety of birth, all the while forming an allegiance with MANA? I’m wandering aimlessly somewhere between my title or education as a Midwife and my practice more in accordance with ACOG. Honestly, what does it make me? My title is Certified Nurse Midwife, but without a professional organization that actually represents profession, what does my title even mean?
How many times has it been asked here what has to be done to change Midwifery, with CNMs not necessarily exempt? How many times has it been asked when Midwives will call their ‘sisters’ to account. No one has ever had an answer. I surely don’t. I’m too introverted to take a public stand against ACNM and it would be detrimental to my practice where I receive a significant number of NCB referrals (and that means they receive Medwife care and keeps them away from Homebirth midwives). There is no organized voice for Medwives, only the option to professionally distance themselves. If anyone has any ideas, I’d like nothing more than a realistic plan to hold midwives to a standard their profession is purported to represent.
https://www.rcm.org.uk/learning-and-career/learning-and-research/ebm-articles/pain-and-epidural-use-in-normal-childbirth
:flings self off cliff:
Cannot deal with people who think that women are unworthy of pain relief of their choosing.
From the article: “Over recent decades, there has been a loss of ‘rites of passage’ meaning to childbirth, so that pain and stress are viewed negatively (Leap and Anderson, 2008)”
Well, they can fuck right off, too. Pain and stress are viewed negatively? Too right, they are. Tell me, oh learned academics, what are the positives to pain and stress in childbirth?
Pain and stress are viewed negatively when you break a leg, too. Doesn’t mean that people with broken bones have their need for acute pain relief belittled.
I don’t see how pain is relevant to the “rite of passage” of transitioning to postpartum parenthood. You get the same baby with or without an epidural, and those interventions increase the likelihood of a successful transition into a positive postpartum experience.
It seems like having a baby is a helluva rite of passage in and of itself.
So should adoptive parents go and get punched around a bit so they can experience the proper pain-filled ‘rite of passage’?
Right. The part of your life that is changing so enormously is that you have added a child to the family, not that you got violently mugged by your reproductive organs.
Hazing as a rite of passage into a frat is nowadays considered unacceptable.
But for being a parent, it’s still required for the initiation?
:gives kidney stones of proponents of “normal birth”: “Oh, what’s that? You’re screaming in pain? Just be relaxed and positive, feel the rushes of the stones slowly passing through your body! BTW make sure you don’t lie down, you can be in whatever position you want….except lying down. Because The Man would want you to lie down.”
You want to bond with that stone, don’t you!
Lithotripsy? No! Your body won’t make a stone it can’t pass, mama!
Oh, don’t remind me of the stone I passed on Yom Kippur in 1988. My pain was about 13 on the pain scale.
“Over recent decades, there has been a loss of ‘rites of passage’ meaning to childbirth,”
I have heard this rite of passage argument before and I find it so offensive. The idea that females are forever stuck in some sort of immature limbo because they missed the rite. Which brings to mind the question of the men. Does this mean that all men are still boys, because none of them have given birth?
The men are losing out on the traditional rite of pacing in the waiting room and handing out cigars. We don’t do it anymore, not like the old days when that was expected out of ya.
And why isn’t breaking your first bone a rite of passage then?
The arrogance there is just astonishing. We have blithe assertions about what ‘indigenous cultures’ think of pain (because they’re all the same) and about levels of fear felt in the past too. What all these women do have in common is that nobody ever thinks to ask their views on childbirth before presuming to speak for them to the rest of the world. Black women, brown women, women in history and those falling into more than one of these groups all share a hive mind, apparently. Just revolting.
The ethnicity I know best (as a foreigner in their small nation) were prone to smoking in pregnancy to try to keep their babies small. Sounds like they were pretty aware of the pain they would face..
Well, that’s one way to do it…doesn’t quite scream “platinum boobies” though.
If I knew that I had limited to no options to control my fertility, and that the consequences of a big baby would be excruciating pain at best and death at worst, I would consider that a very reasonable approach.
And I don’t understand the mindset that thinks the solution to women in the developing world without access to health care (including birth control) is to deny pain relief to women in the developed world. But then again, I never understood how demonizing formula in the developed world was supposed to help women in the developing world without access to clean water.
Apparently these writers have totally lost connection with their own ancestor’s experiences so they have to reference to mystical “indigenous cultures”. I’m familiar enough with folklore of my culture regarding childbirth, dominant message there is “Dear Goddess, please help me to come back alive from childbirth!” Also lots of sympathetic magic to help with birth (like, unbraiding hair, opening all doors and drawers in the house to help woman “open up” etc.) Seems like women were well aware of how dangerous this “natural” birth is.
That is truly mind boggling. Apparently, according to that author, the following developments are BAD things:
“A technorationalist society considers pain as either preventable or treatable…
The pain relief paradigm is dominant in maternity services…
Informed choice as an ethical imperative influences practitioners’ responses to maternal requests for pain relief in labour…”
In other words, there are more epidurals because people view pain as being preventable or treatable; that view is dominant in maternity services; and the fact that healthcare practitioners are now legally obligated to recognize that their patients are adults with the right to make decisions about their own healthcare means that when patients request pain relief, providers now tend to give it. Conclusion: ALL OF THIS IS BAD.
Oh
my god. Is that author a psychopath?!
Yes.
When I was admitted due to my severe preeclampsia I had the opportunity of hearing a woman down the hall (100 metres) laboring without an epidural. If I hear something like that on MY ward the nurse in charge will not be working the day after. He or she would be at a disciplinary hearing for not giving adequate pain relief.
How is childbirth pain different from any other type of pain is something that I still do not understand.
But do you know if the woman was refused an epidural ? There are some people who refuse epidurals, and there are some who cannot receive them for medical reasons (a minority). It is a choice whether to receive pain relief, although unfortunately some who refuse pain relief do so on misguided information.
I overheard she had refused pain relief. I am happy with that, I think that if you refuse treatment it is your right to do so. I would defend to death your right to refuse pain relief. That is not my point. The hospital offers epidurals to all women except the very very very few with a contraindication.
The thing is that woman was obviously in pain, and it sounded like A LOT of pain. I have never ever heard those shouts in my ward (not an OB), because we do use pain relief. If the matron in my ward hears a patient shouting with so much pain and the nurse is not running with a painkiller and calling the doctor, well, that nurse has a serious problem.
What happens if the patient refuses the painkiller?
Short answer: in other branches of medicine it never happens.
Long answer: in more than 10 years of practice it never ever happened to me that someone with such an amount of pain refused painkillers. Sometimes patients do refuse opioids. If they are in pain and complaining of pain we counsel them and explain thoroughly why we think they need opioids, and they usually accept treatment. I have never ever seen somebody in such pain that refuses morphine. Once one of my long term patients was in pain, I had prescribed painkillers and he was not taking them. The next week he turned up to his appointment and complained of pain again. I admitted my own lack of ability to treat pain without painkillers (he did not qualify for other pain treatment options). He started taking the painkillers. It might take a little bit of time but everybody accepts painkillers. And as I said nobody shouts like that in my ward.
I am the only person I know that has declined painkillers for severe pain outside of L&D, and I hang out with horse trainers, farriers, and farm workers. We have a lot of impact injuries.
I think you said that you worked on a palliative care service, correct? On your service, don’t you have more options than in L&D? Your non-pregnant patients don’t have to deal with worrying about the effects of opioids on the baby. From what I understand, if a woman does not get an epidural, the options for effective pain relief are really quite limited. For most laboring patients, I imagine there’s not a standing order for pain medications, right? And heck, we know that epidural coverage of the perineum is not great. If a patient doesn’t want an epidural and the RNs assess that the patient doesn’t want an epidural or other medication then there it is.
I think a commenter here (Dr Jay?) said that the OB ward must be a strange place for other physicians & nurses, as screaming is common.
Yes, I am pretty sure she did not want an epidural. As I said, the hospital has more than two anesthesiologists 24/7, and I overheard she had refused it. The thing is, why on earth someone refuses an epidural when she is in so much pain?
Because of the baby, everything will affect breastfeeding/make you need a CS/make you a BAD person and a BAD mother. Obviously I’m being intentionally simplistic about it, but this seems to be what most of it boils down to. Oh, and one I heard recently, “well it’s LABOUR! They don’t call it that because it’s easy!what do you expect?” So presumably, it’s also because you deserve it.
It does seem to come back to sex, doesn’t it? Dirty, dirty sex. You have sex? Well, these are the consequences! Even if you are married and in a stable relationship, you should still be punished with painful labor and ungrateful children.
Sez so in the Bible, don’t it? Don’t want to defy God’s plan for you, do you?
To be fair, ti’s possible that she refused pan relief in favor of “vocalization.” I had precipitous labor during my induction, and i vocalized PLENTY while waiting for the anethesiologist to get to me. I felt sorry for my hallmates.
What if the woman doesn’t want pain meds though? When I was admitted to a high risk room with high blood pressure, the patient in the room across the hall was carrying on. I commented that it was going to be a long night. The nurse said she was getting an epidural so that was a relief.
I didn’t think that I could have any pain medication since I was 9 cm when I arrived at the hospital. I was absolutely gobsmacked by how painful pushing was, and I doubt that I could replicate those guttural screams. I remember being shocked that those sounds were coming from me. I am sure that anyone on the ward could hear me.
Interesting, the author is male. I’m disappointed he’ll never have the chance to experience the wonderful rite of passage he thinks all women should be forced to have.
Maybe one day he will pass a kidney stone without medicine or medical intervention.
I’d pay money to see that… and hopefully someone will suggest he use the “working with pain” approach instead of the “pain relief” approach he spouts off about..
” inadequate service provision and an impoverished approach to labour pain rather than women’s preferences are contributing to the rise in epidurals”
Huh?
UK NCB heads tend to claim women want epidurals because they find being in CLUs so awful. That is, if you were somewhere nice with cascading care, one on one support, feeling safe etc, you wouldn’t need an epidural because you could cope with the pain. There are some women for whom this is true, but it’s wrong to apply it to everyone.
It’s true that women who give birth at home or in MLUs, with one to one support, do have higher satisfaction ratings with their care. Obviously they don’t have epidurals. But it’s a step too far to presume that the same can be applied across the population of birthing women. Women giving birth in MLUs and especially at home form a very self selecting group with particular views about labour that aren’t shared by the general cohort.
“there has been a loss of ‘rites of passage’ meaning to childbirth, so that pain and stress are viewed negatively ” When in the history of humanity have pain and stress been viewed as positive? Also, this idiot (because, sincerely I can’t find a better word to describe him) could consider that the “rite of passage” he talks about has more to do with the fact that you become a mother and not so much with pain. Having a child to care about, and the responsibility associated with it, is the rite of passage, wether the woman had a vaginal birth, c-section or decided to adopt the child. She became a mother, therefore her life changes forever. Pain has absolutely nothing to do with it.
And yes, women are afraid of childbirth because it is dangerous. Even I am a little afraid, and I see multiple childbirths every single day. My biggest fear (other than big complications) is that I go into labour early and don’t get the option of an epidural, since I will be on heparin during the pregnancy.
As I mentioned yesterday, in the initiation rites for a fraternity.
That’s all this is. It’s hazing – to be in our club, you have to go through the hazing rituals.
I suspect that roots of these rituals are into general initiation rites, as described in some cultures even today where young men have to prove that they can endure pain and stress. Which was quite logical if everyday life consists of dangerous affairs like hunting and fighting neighbor tribes where pain endurance is crucial. Do we have to hunt and fight nowadays? Why would be pain a necessary part of “rite of passage”?
Yes. Presumably the author also thinks ritual scarification, female circumcision, and circumcision of unanesthetized adolescent boys (http://www.npr.org/blogs/goatsandsoda/2014/08/27/343735766/a-botched-circumcision-calls-attention-to-kenyan-ritual ) are also wonderful rites of passage well worth preserving.
This drives me crazy. Medical professionals wouldn’t deny appropriate pain relief to someone in ANY other situation so why should labor be different. A great book to recommend to any woman concerned about getting an epidural is Epidural Without Guilt by Dr. Gilbert Grant. He does a great job of explaining the different types of pain relief, their safety, and the benefits and risks. I read it during my pregnancy and requested and was provided an epidural almost immediately after arriving at the hospital.
OT: http://adventuresofalabornurse.com/2015/02/26/when-to-call-the-doctor-or-midwife-for-delivery-in-ld/ a labor nurse friend of mine just posted this to facebook.. do you think this could be true? that they might cut you/use a vacuum just because they get impatient? i like to think that would never happen but maybe that is naive. do labour nurses often think they know more than they really do though? she also talks on another post about an ob that did a 4th degree epi on every single patient that delivered vaginally and was the only doctor they had to fetch ‘the gelpi’ for. that’s really scary. my friend has posted from this blog a few times and it’s quite good/funny and not majorly woo-ish from what I can tell..
Cuts 4th degree episiotomies? Sounds 100% made up to me.
4th degree includes complete severance of the anal sphincter and tearing of the rectum, creating a single, continuous orifice, right? It also requires extensive, time-consuming, and fussy repair.
yep.
Somehow I doubt there’s an OB that could just churn those out, on every patient, unnoticed. Never mind the likelihood of one that would want to.
Who would want to create a tedious, tricky repair job?
Repair job? Meh. A couple of sheets of seaweed.
I have done it once – on a bad shoulder dystocia (we were in minute 4) and every other maneuver was failing (including the original epis).
It is done, but so rarely not to be an issue
That sounds like a completely sensible and medically indicated. (Don’t have any kids yet, but if I was in that situation, I’d prefer a live baby and a good urogenital surgeon afterwards.)
maybe she just means bigger than average and can’t actually tell the difference. do you think it’s a myth that there are any doctors that still do them on everyone?
http://adventuresofalabornurse.com/2014/05/31/the-good-the-bad-and-the-ugly/ i found the post. hm, she says at first that she’s heard of physicians who do this and then talks as if she actually worked with them so idk
“I have heard of physicians who tell every single one of their patients that they had CPD or that their baby is breech so they can do a C-section. I have heard of physicians who gave every single patient having a vaginal delivery a 4th degree episiotomy. Literally. Every single one. It became like a game…how late could we call them to the delivery so that they wouldn’t have a chance to grab the scissors. Sometimes we’d hide the lidocaine and just pray that the baby would be delivered by the time more was brought to the room. More than once they were called so late they missed the delivery.”
Yeah total bullshit. Just as you say, first she says she’s “heard of” physicians who do this, and then she morphs into pretending that she works with these mythical doctors. OBs who lie to all their patients and tell them their babies are breech? How does that work exactly? The proof would be there upon delivery.
This lady’s blog is one big attempt at an attention grab.
The author deleted this page which got a lot of flak
http://adventuresofalabornurse.wordpress.com/2014/05/20/our-transition-from-an-ldrp-with-a-traditional-nursery-to-a-mother-baby-unit/
you can get the idea from the post here including going down to the comments
http://adventuresofalabornurse.com/2014/05/06/keeping-moms-and-babies-together/
The RN’s hospital closed their well baby nursery unit as part of the “Baby Friendly hospital initiative” and got a lot of flak in the comments. The blog post was supposed to demonstrate how 100% rooming in is good, but it really highlighted the dangers of it too-no options for a mom who does not want to room in.
Also “This is how I feel when my patient is complete, but I lie and say she’s 7 so that the doc will give her a chance to labor down”
http://adventuresofalabornurse.com/2014/04/02/this-is-labor-and-delivery/
does that matter much though? not to excuse lying but i thought you could be at 10 for a while and as long as the baby was tolerating it there was no rush to start pushing. i heard that if you wait a while the second stage can be shortened (‘labouring down’?) and i suspect that happened with my first.. that i was complete for some time before pushing ’cause he was pretty far down when they checked me and it took like five pushes to get him out.
A nurse should NEVER EVER lie about something like that. Heads would roll if I thought that was done to me. Say the patient is at -1 and complete and the nurse tells me she’s 7 and -1. I come and reassess in an hr or two and check myself, and I find she’s complete and -1. Then I might decide to let her labor down. By an hour or 2 later she’s unchanged. I think she’s been unchanged for one hour when in fact it’s been 3. That’s a different clinical situation and an ominous sign that I miss out on.
Apparently she is Shelly Lopez Gray, OB Clinical Nurse Coordinator at Texas Children’s Pavilion for Women. I wonder if they are aware what she is writing about them.
Yes, what a huge liability to them.
Hides the scissors?! So then if there is an emergency, the doctor would have to rip me with his/her hands?!
Hides the lidocaine?! So I have to undergo this without pain relief? thanks a lot Shelly!
Intentionally creates unassisted births!!? What if there is a shoulder dystocia or cord emergency?!
Wow! Such a huge risk. So unprofessional.
Lovely… I know several women who delivered there. All but new had a vaginal delivery (c/s was MRCS). No 4th degree tears. No 3rds either from what I recall.
There are some very old doctors that have done that in the past. I have heard the older residents at my hospital talk about the very few times the attending “cut” the time we usually give a woman to give birth because it was late and they knew it just wasn’t going to come out on it’s own. I personally have never experienced a situation like this (granted I have been practicing for a little under a year).
However, I do see how some nurses might view some situations as “the doctor getting impatient”. I remember one of the first times I was alone in the labour ward (my attending was asleep) and after 3 hours of pushing I called my superior for a vacuum. The woman had been all night in labour, hadn’t slept at all, had been pushing the 3h the protocols contemplate, and was exhausted. If we had waited could she have given birth on her own? Probably. Was the risk of a complication worth it? No way. You can see it both ways: we gave her the chance, followed the hospitals protocols, and did everything correctly, or, the resident got impatient after 3h, called the attending and used a vacuum.
And about the 4th degree tear epi, either this doctor is completely useless, or it is made up. The only possibility I can think of is the doctor doing an epi that then tore and prolonged to a 4th degree tear. But it is extremely rare, especially with a medio-lateral episiotomy, a lot more frequent with a medial one, it depends on which one they regularly do.
Obviously, nothing like what she describes in her article. Never in my life have I heard of an OB telling everyone their baby is breech to do an elective c-section or midwives hiding scissors from doctors. That is just plain crazy.
#WeMidwives (!!?!!?)
This is unbelievably immature and unprofessional. Is this a high school pep rally? Can you imagine a similar Twitter push of #WeObstetricians ? Hell no.
What I love is number two;
“Realising the benefits of midwifery-led continuity of carer with more access to this model of maternity care”
Oh that is fucking priceless. Of *course* the goal here is “realising the benefits of midwifery-led” care. I mean, what with all the dead babies, some of us might not realize how many benefits midwifery-led care brings! We need to realize it!
I looked for the “listening to your patient” part and couldn’t find it. My better birth involves being listened to and treated like a human being. These people disgust me.
Please tell me “carer” is a typo and not a newly minted word to replace “care giver”
Freudian slip. It’s widely used in disability care, to refer to the people who help with tasks of daily life and self-care.
And aged care
RCM…this doesn’t look good. It really, really doesn’t look good.
Telling people that things were normal when they weren’t normal killed people, trying to make things normal when they weren’t killed people.
Women don’t care about “normal” if their baby dies or is injured.
The RCM needs to come up with a statement-
What were the failings in Morecambe Bay
How did it happen
What lessons Morecambe Bay taught you
How you’re going to stop it happening again
Not
“We’re all going to move forward together in a spirit of positive collaboration”.
HOW ARE YOU GOING TO STOP THIS HAPPENING AGAIN?
CONCRETE ANSWERS PLEASE.
i assume you have a few obstetrician acquaintances or GPs who used to do obstetrics. what’s their general feeling about this? would they prefer it if obs were more in charge of maternity care? or do they like that they don’t usually deal with the uncomplicated (I suppose boring from a doctor perspective?) deliveries and rely on midwives to filter out the risky cases
Hmmm
It various.
My own GP colleagues in my workplace are all, like me, risk averse, and have serious reservations about midwife led care, birth centres with no onsite OB cover and homebirths.
The local obstetricians largely resent being treated as firefighters who only get called once the building is on flames and the bucket chain isn’t working…
My paediatric friends have a general feeling that the worst “bad baby” disasters they see are transports from
midwife led units or babies that have been discharged home 6 hrs after normal delivery having been assessed by midwives and who then turn out to have something awful (undiagnosed heart defect, sepsis, jaundice, dehydration etc) going on.
Generally speaking, the OBs and GPs I know have a lot of respect for Midwives who work within their competence and knowledge, and have no issues with midwives who appropriately manage their cases.
The Paediatricians on the other hand…they hardly ever have a nice word to say about midwives… and in fact will turn the air blue more often than not, when asked about midwives.
Of course, you do have to remember something…
there is a reason Doctors tend to be risk averse.
There is a saying that doctors and their partners have the most complicated pregnancies.
Few of us have experienced lovely straightforward normal pregnancies and births firsthand, and we’ve all seen disasters during medical school or post graduate training.
If you put all my medical colleagues and friends in a room we’d have all the common obstetric complications and most of the rare but serious ones covered.
Even the one person I can think of with the easy labour and straight forward birth…it was because she had cervical incompetence and had a nightmare of a pregnancy, Shirodkar suture and all!
“There is a saying that doctors and their partners have the most complicated pregnancies.”
Because almost all of us are primips in our 30s. NCB says that advanced maternal age and first births are not higher risk, but they are.
I imagine it’s hard to balance medical school and residency with a new baby. Honors college was exhausting enough with only the occasional baby-sitting of my little brother.
True, and some of us do stupid stuff like work 36 hrs straight when we’re 36 weeks pregnant or work a 12 hour shift 24 hours after being discharged from hospital with hyperemesis (um, yes, this was me), and other things likely to put up our BP, reduce placental blood flow, stress our kidneys and generally make our OBs shake their heads.
One of my family members is an OB. She had two vaginal uncomplicated deliveries in her 30s. Hospital births with both babies monitorized and epidurals. No problems at all.
When I read this, I compared the midwives to the new young firefighters that the FireCapt tells me about. They think they can handle every situation and the more dangerous and “exciting” the better. It seems that these midwives never grow out of that stage though. With time and expeience the firefighters become more like the risk averse obs. They we ould rather have a home owner panic and call 911 for a small fire that they probably could have put out with a fire extinguisher or respond to a false alarm than have to deal with a fully engulfed house with people trapped inside. Yes, they can put out the fire. The question is can they do it before anyone dies or is seriously injured?
“The Paediatricians on the other hand…they hardly ever have a nice word to say about midwives… and in fact will turn the air blue more often than not, when asked about midwives”
And there you have it. Proof that this is not a turf war.
Agreed. In fact, to make MORE MONEY (the claim that many CPMs make about evil doctors) Pediatricians should be encouraging more home births. ‘Cause, you know, damaged children need lots more (expensive billable ) medical care than healthy children. There you have it: Pediatricians support homebirth!
/sarcasm off
“Stay positive.” Oh, they can fuck off with their “stay positive” attitude. That’s know as ignoring problems in my book. Completely irresponsible.
It’s nearly dystopian. A bunch of babies died and they think the fix is calling it “born” instead of “delivered”? Who are these people?
Worse. They can comfort themselves that they’ve made some kind of a difference by changing a “delivered” to “born”.
That’s plain indifference and hubris mixed in one package.
1984 came 30 years late. Doubleplusungood
All of that ‘let’s stay positive’ and ‘let’s move on’ made me want to vomit. Can you imagine preventable deaths in any other profession where ‘let’s move on, and be sure to stay positive’ would be an acceptable response?
It’s like Monty Python – “Let’s stop with all this bickering about who killed who…”
OT: A new study to make moms who can’t/don’t want to breastfeed feel just awful about it. Yippee.
http://mobile.abc.net.au/news/2015-03-18/brazilian-study-finds-breastfed-babies-are-more-intelligent/6330234
Perspective:
The iq difference found (3.7 points) is within the margin of error on iq tests. It may be statistically interesting, but it is functionally meaningless. The other cited benefits to breastfeeding (higher educational attainment, etc.) Are benefits of higher socioeconomic status. Did the study adequately address confounding factors like SES in evaluating the effect of infant nutrition, or is it yet another piece of evidence of something we all know already, that wealth is an advantage?
Look at Table 3. It shows that IQ is highest for those breastfed between 6-11.9 months. The IQ drops back down to the levels of the other cohorts if breastfed for more than 12 months. Later on, the authors say: “The potential exception is mothers who breastfed for more than 12 months, who were generally poorer, less educated, and included a larger proportion of women with higher African ancestry than did the other groups.”
Right there is basically saying that socio-economic factor is the primary driver of IQ. Not breastfeeding.
Look at figure 1. Check out the IQ for those in the highest income tier versus lowest income tier- it’s about 15 points. Looking at the IQ differences between breastfeeding cohorts within the same income tier shows basically no difference at all.
http://www.thelancet.com/cms/attachment/2027251823/2045715061/gr1.sml
3.7 IQ points…
That doesn’t MEAN anything.
We’re not talking about preventing your child becoming the next Hawking by giving them formula, are we.
There is a functional difference between an IQ of 100 and 120, and 120 and 140, and 140 and 160… but not between 123 and 127.
Functionally if you want to improve your child’s intelligence, an hour spent reading together and learning about topics they find interesting twice a week will do more than breastfeeding.
I say this as someone who has always done quite well on standardised testing, and who was formula fed from about 3 months because my mother wanted less then 2 years between her children.
I think the fact that both my parents are very intelligent, we had a house full of books, I was taught to read when I was 3 and then let loose on the bookshelves to read anything I liked (not necessarily something I’m doing with my own child…I read some pretty age-inappropriate stuff) was more important than breast milk.
It doesn’t matter if 3.7 points of IQ makes a difference in real life. What matters is that this gap of 3.7 points is not even real, but due to confounding. Studies that remove confounding (e.g. the Belarus PROBIT study and the discordant sib study) do not support an IQ gap.
The authors did not correct for the most important confounder: parental IQ.
This is yet another flawed “me too” correlation study. It’s like the thousands of studies that showed that women on postmenopausal Hormone Replacement Therapy were healthier, lived longer, had less dementia and heart disease and in every way were better than women not on HRT. But the reason was that health conscious women were the ones who elected for HRT, because that was the medical recommendation at the time. But when they finally *randomized* women to HRT they found that HRT actually caused heart attacks, strokes, and breast cancer.
I can tell you this: Every single weak observational study of this type is going to find a IQ gap, even if the authors attempt to control for income etc. It’s because breastfeeding is the medical recommendation and rich women, on the whole, find it easier to breastfeed because they get more support. Why do we keep publishing these weak “me too” studies? We already have much stronger studies (the discordant sib studies and the *randomized* Belarus PROBIT study) that do NOT show IQ differences.
Ugh. I heard about this on the radio this morning. After mentioning all the “benefits” this study found, they found a pediatrician who explained that women who don’t breastfeed (in Canada) are younger, poorer, and single (no support). He said we have to stop giving them an “out” in terms of formula and push breastfeeding.
Because breast milk overcomes all socio-economic disadvantages. Right.
Because the answer for poor women is fewer options and less support. Yes. Let’s try that.
“Here is an obvious confounder that explains the correlation. Therefore, causation.” WTF.
The webmd headline is even more infuriating and trollish. It also has a quote that basically says what you wrote but with a totally straight face.
“And Erik Mortensen, author of an accompanying journal editorial who’s with the department of public health at the University of Copenhagen in Denmark, said the study only shows an association between breast-feeding and IQ, not proof of cause and effect.
But the link is very strong, Mortensen said. “It may not be a causal effect, but in my judgment, the overall evidence from other studies and the Brazilian study suggests that the effects are causal,” he said.”
How the hell can webmd publish something so nonsensical???
http://www.m.webmd.com/a-to-z-guides/news/20150317/breast-fed-babies-may-be-smarter-richer-adults-study-suggests
Stop giving them an out? Yes, what’s clearly needed here is that we start forcing mothers to do what we want with their breasts.
Also, the quotes at the end of that article are hilarious.
How convenient that the best way to improve the health of poor babies is for their mothers, women with no power or influence, to modify their behaviour. It’s a good thing all the blame can be placed there, otherwise we might have to actually spend some money to tackle health inequality. Berating poor mothers though, that’s cheap!
Jerk. Sorry, that’s all there is to that. I don’t think I’ve ever called anyone a name over the internet, but it’s all that came to mind.
It’s a much nicer word than the one that came to mind when I heard it.
Was it Jack Newman, perchance?
From the CBC, yesterday. I’d be interested to learn if Jack Newman was the pediatrician to whom you are referring. He’s the go-to for journos on breastfeeding in Canada. I’ve never heard him be that big of a jerk on the air. http://www.cbc.ca/news/canada/manitoba/breastfed-babies-earn-more-money-score-higher-on-iq-tests-as-adults-1.2998982
That’s the one. It was Jack Newman and the quote that set me off was:
“It doesn’t help that doctor, that pediatrician, when the mother comes and says ‘my nipples are sore, what do I do?’ and the only answer they have is well, just give the baby formula,” said Newman.
I wish I could find the broadcast I heard. The voiceover was slightly different and it really sounded to me like he was telling doctors to discourage formula in younger, poorer mothers because they’ll just take the easy way out. I’ll try and find it when I get home tonight.
Well to be fair. A very nice LC told with my son that really the only way to stop the pain was to just give him a bottle. He was a barracuda baby and she commiserated with me that she had a baby like that too. She didn’t say it a negative way. She was just actually being honest that there wasn’t anything else we could do. He had tremendous suction and when she first came to help and attempted to unlatch him she said “Oh, I see.” He remained on a breastfeeding level 0 nipple the entire time he was bottle feed and only brand of bottle had a slow enough flow to not drown him. When I started him on a sippy cup a lady told me “You know they make different level sippy cups.” Yeah, they do and he was using a beginning level cup, but he still got choked because well he was a barracuda baby.
Mine too. The LC looked at one of my nipples and immediately recoiled and said pump on that side. They did not heal for three months. We went quickly to bottles and never changed nipples size. She is one and still chokes often.
Mmmmmmmm let me think about it… What would I prefer….. An IQ 3.7 points lower or no IQ at all because of a dead baby… Mmmmm…. Difficult choice….
Thank God our neonatologists thought a lower IQ was better.