Cathy Warwick, Sheena Byrom and other UK midwives give a master class on shirking responsibility

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It looks like I’m not the only one shocked by the response of UK midwives to the Morecambe Bay Report that places the blame for the preventable deaths of 11 babies and 1 mother squarely on midwives and their pursuit of “normal birth.”

According to the author of the report, Dr. Bill Kirkup:

All showed evidence of the same problems of poor clinical competence, insufficient recognition of risk, inappropriate pursuit of normal childbirth and failures of team-working.

In fact:

The midwives at Furness general were so cavalier they became known as “the musketeers”.

In an interview with reporter Shaun Lintern in yesterday’s Health Service Journal, Dr. Kirkup expressed his disappointment with the response (or, more accurately, the lack of response) from professional bodies. He singled out midwives in particular:

…[He] had also been “concerned” by some comments online which he described as “defensive.”

This included blogs by midwives suggesting the report was anti-midwives or against normal birth, while on social media relatives of those who suffered poor care at Morecambe Bay had been accused of “midwife bashing” and “retrospective negativity.”

This is a direct reference to last weeks’ Twitter chat held by WeMidwives that I wrote about in Being a UK midwife means you never have to say you’re sorry.

Indeed, midwifery leaders like Cathy Warwick and Sheena Byrom and their colleagues have been holding an impromptu master class on shirking responsibility, such as the Twitter response when Lintern tweeted highlights of the Kirkup interview and Sheena Byrom disparaged them as concerned with “blame.”

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But Byrom is hardly alone in her desperate efforts to avoid accountability both for the specific tragedies at Morecambe Bay and for the midwifery philosophy of promoting normal birth that led to these tragedies (and others).

What methods have UK midwives used?

1. Ignoring the report

The report has been greeted in the midwifery community with the sound of silence. Cathy Warwick of the Royal College of Midwives has perfected the art of using a lot of words to say absolutely nothing. In  posts on her blog, such as this, she has issued meaningless platitudes and resolutely refused to discuss the core issues in the report.

2. Self-pity

Monday’s piece by an anonymous midwife in The Guardian (I loved being a midwife but bullying, stress and fear made me resign) is a sickening example of how midwives think everything is about themselves and their feelings, patients be damned. See the midwife turn the poor outcome* of a baby at her hands because she failed to recognize the severity of fetal distress into a tale of HER suffering:

The fetal heart is bad – but not bad enough to act. You continue this dance for hours until suddenly the heart trace is terrible – this baby is in real trouble. You press the emergency bell and the world runs into the room. You roll the woman this way and that, attach name bands and tape up earrings, you hold her hand as she is anaesthetised and whisper that the baby will be out soon. You knew something was wrong, but you didn’t have the words and no one listened.

Apparently the fetal heart rate was bad enough to act, but the midwife lacked the clinical competence to recognize it. She “didn’t have the words”??!! What does that even mean? How hard is it tell someone, ” the fetal heart rate indicates this baby is in distress”? Not hard at all, but the midwife didn’t do it.

3. Decrying a culture of “fear”

This is the meme of the moment in midwifery. Midwives are wailing about being held to standards, subject to scrutiny, and forced to use checklists.  What fear are they fighting. They’re fighting the fear of preventable maternal and neonatal deaths, the very things that these measures are designed to prevent.

This stunningly immoral and reflects a preoccupation with midwives’ “experience” over patients health and wellbeing.

4. Insisting that it is critical to “avoid blame”

This is the classic maneuver of anyone who fears accountability, but there are some situations in which blame is not merely appropriate, but absolutely necessary for the well being of all.

Imagine a drunk driver who killed a small child in an accident that occurred precisely because he was drunk. What if he told the judge that he should be allowed to go on his merry way because he didn’t intend the child should die, and therefore it is critical to “avoid blame”? We’d be rightly appalled.

The same principle applies to midwives who didn’t mean for babies and mothers to die preventable deaths because they were too committed to “normal birth” to call for interventions. They were to blame. Their philosophy of promoting “normal birth” is deadly and it is appropriate that we blame it and change it.

5. Insisting that problems can only be solved by “positivity” not negativity

That is just stupidity.

6. Banishing the deaths at Morecambe Bay to the “past”

Deaths due to drunk driving, faulty pharmaceuticals, and even intentional murder are all in the past, too. That doesn’t mean would shouldn’t look at them, learn from them, and hold those responsible for them to account.

7. Bullying on social media

Dr. Kirkup specifically noted the bullying that James Titcombe has been subjected to by midwives who think their professional autonomy is more important than whether other people’s babies live or die. He may not even be aware that WeMidwives chose to forward their “concerns” to his employer, the Care Quality Commission. What were they “concerned” about? He quoted me, whom they despise and fear (rightly so, since I intend to hold them to account). It is obviously pointless to bully me, so they tried to bully him.

and, most importantly,

8. Refusing to apologize

How hard is it to say, “We’re sorry. We allowed our preference for ‘normal birth’ to interfere with our ethical obligation to protect the health and well being of mothers and babies.”?

Apparently it’s very hard because it would require acknowledging the central moral and empirical defect at the heart of contemporary midwifery culture, the obsession with “normal birth.” Midwives have convinced themselves that normal birth isn’t merely better for them, it’s better for their patients. Acknowledging the many preventable deaths that followed ineluctably from this deadly philosophy would mean a wholesale attitude readjustment. Instead of viewing themselves as “guardians of normal birth” they’d be relegated to what they are in reality, mid-level maternity providers who are legally and ethical required to call high level providers like obstetricians, pediatricians and anesthesiologists even when it means sacrificing autonomy.

Unfortunately, for midwives, self-justification and preservation of their own autonomy takes precedence.

I consider myself a very cynical person, but even I am shocked by the brazen behavior of UK midwives. Not only do they feel no remorse for the preventable deaths at the hands of their colleagues, they feel free to flaunt their lack of remorse on social media. Not only do they refuse to be held accountable, they feel free to criticize anyone who dares hold them accountable. Not only do they refuse to recognize the full breadth of human suffering that took place at Morecambe Bay, they feel free to compound that suffering by chastising and bullying the sufferers.

To Cathy Warwick, Sheena Byrom and other UK midwifery leaders I say this:

Have you no shame??!!

*Edited 3/25/15 10 PM from “died” to “poor outcome” to reflect the fact that the midwife does not disclose what happened to the baby.

  • Angie

    My daughter’s son died six days after an horrendous mismanaged delivery. Countless times my daughter told the midwife she was having regular painful contractions, the midwife said she wasn’t. Countless times she told the midwife she labours quickly, midwife said she didn’t, apparently midwives aren’t obliged to read the handheld maternity notes. My daughter began pushing, the midwife said no you aren’t and left her on an antenatal ward where she delivered her baby, too late for intervention, too late for pain relief, too late to save the baby. My daughter arrived that morning to be induced with a perfect healthy baby in utero and six days later carried her baby to the morgue. Are they sorry? Only sorry that we have had the audacity to insist on a an investigation free of conflicts of interest. If the smallest amount of the massive effort they have used to cover up had been directed at the labour and delivery I wouldn’t be typing this and I wouldn’t be visiting the grave of my Grandson every day. Shame? They don’t know the meaning of the word.

    • Medwife

      How horrible. I’m sorry you and your family are going through this, especially knowing it didn’t have to happen.

  • Ludhiana SEO
  • Hannah

    News on the NHS England maternity review:

    http://www.england.nhs.uk/2015/03/26/chair-mr-announced/

    • Anj Fabian

      James Titcombe, Morecambe Bay parent and CQC adviser on safety”

      Good.

  • toofargone

    I am not sure if anyone has already answered this but a report doesn’t do much. Is anything going to happen as a result of the report. Are there any legal requirements now? If the Joint Commission cited a hospital for some major violations that gravely endangered lives and resulted in deaths that would be one heck of an action plan that would have to be written. I just don’t understand the silence. The body that represents UK midwives should be making a statement, but I suppose they are with that whole “normal birth” campaign going on.

  • Lana Muniz

    OT: My latest piece at babymed:

    Homebirth midwives “value the art of letting go.” Letting go of what, exactly? The lives of babies born at homebirths. We know this because it’s written in the MANA Statement of Values and Ethics right on their website,

    “F. We value the art of letting go and acknowledge death and loss as possible
    outcomes of pregnancy and birth.”

    http://www.babymed.com/blogs/lana-muniz/homebirth-midwives-and-art-of-letting-go

    • Allie P

      THE ART OF DEATH? THE ART?!?!?!?!?!?! Is this a bad Neil Gaiman novel?

      I don’t understand. it’s like opposite day.

      • Lana Muniz

        I’ve been sick with anger over this. Women planning homebirths have no idea what these midwives really stand for.

    • Dr Kitty

      They are possible outcomes.
      “Letting go” is appropriate when you have done all that is humanly possible to prevent those outcomes (and yes, sometimes there won’t be much you can do) and it still happens.
      It’s not your first go to emotion if things turn out badly.

      I recently listened to an amazingly powerful case presentation by a nurse, who was present when a cancer patient suffered a terminal haemorrhage.

      He had a massive tumour which ate into one of his arteries and he bled to death in her arms. It was not preventable, it was not treatable and it was something they both knew might happen and for which he had been prepared. The plan had always been that if it happened he wanted to die with someone else present, and as peacefully as possible.

      She still, years later, has tears in her eyes talking about it, expressing guilt she couldn’t do more, a sense of powerlessness that all she could do was hold and comfort him. She described how she worried for weeks that the police would turn up at her door and ask her why she hadn’t called an ambulance, why she had just let him die, why she hadn’t tried to resuscitate him.

      That’s how another professionals feels, about a completely inevitable, unavoidable death, when she actually did everything exactly right.

      So…the MANA statement reads as especially sociopathic.

      • The Bofa on the Sofa

        The biggest problem comes in the question of what constitutes “unavoidable.” We hear it all the time from HB babies that died from congenital defects, and the view is, oh there is nothing that can be done.

        However, I’ve mentioned this before, there used to be a bit on Dr Radio (Sirius/XM 81) where there was a comment that there are more adults alive today with congenital defects than there are children. Why? Because actual health care professionals aren’t content with “there’s nothing we can do” and are always trying to figure out if there is something that could be done better to prevent it.

        Sometimes, the answer is no, but the goal is to make that the temporary state of affairs, and, hopefully, in the future, you can make that a yes.

        Are congenital defects a death sentence? Not necessarily. But you have to deal with them effectively, and not just throw up your hands.

  • KarenJJ

    With regards to (3), with 11 preventable baby deaths and one preventable death of a mother in one district, I’d say patients have PLENTY to fear from this style of midwifery. Telling women not to fear midwives and birth isn’t going to make the deaths disappear and everything hunky-dory in midwifery.

    • They’re taught that fear towards established medical care is natural since science is so unnatural; homeopathic care? Natural. Possibility of neonatal death? Natural.

  • Bugsy

    OT: damn anti-vaxxers.

    I’m 7+4 today following a frozen embryo transfer last month. My husband just informed me that one of his coworkers has mumps. No, I don’t know if it’s an anti-vaxxer. I know that mumps immunity following MMR appears to be a bit lower than measles. However, I have read that there’s an increased risk of miscarriage in the first trimester. That’s what scares the crap out of me.

    I had my MMR titres checked last month; the immunity to mumps was never uploaded to the system. (I thankfully am immune to both measles and rubella.) I can’t speak to the clinic until tomorrow.

    So f****** mad. I’ve already been dealing with a subchorionic hemorrhage and 2 ER visits. Never mind the difficulties I had in even getting pregnant. Now THIS to worry about?

    So unfair.

    • araikwao

      So sorry to hear of the situation – keep us posted

    • Amazed

      Very unfair. Damn anti-vaxxers, indeed.
      Keeping my fingers crossed.

    • I’m so sorry, that’s terribly unfair. We’re rooting for you. <3

      • Bugsy

        Love the doggy. 🙂

    • Mishimoo

      That is so unfair!! Thinking of you, really hope that everything works out well.

    • demodocus’ spouse

      Good luck for you and the new little one. It is wicked unfair.

    • Dr Kitty

      Congratulations on the pregnancy.
      Hoping your titres are where you want them to be.

    • Cobalt

      Congrats, and I am sorry about the completely unnecessary and avoidable stress that anti-vaxxers create for the vulnerable. I hope you get reassuring news and an excellent outcome.

    • Bugsy

      UPDATE: I am immune to mumps, thankfully. My husband is also getting his titres checked, since our son has only had his first MMR.

      However, the direct supervisor (who shares a desk) with the coworker with mumps is also a dad. He has a 2-week-old daughter at home. Rightly so, he’s terrified.

      • Mishimoo

        Argh!! I am so glad that you’re immune, but have so much frustration for that new dad + his partner. Really hope the bub hasn’t caught mumps!!

      • Daleth

        I would seriously fire that worker for coming to work with mumps.

  • lilin

    “you didn’t have the words”

    Well then it’s great that you resigned, wasn’t it? You weren’t able to do a job that was critical to people’s lives! It doesn’t matter if you “loved being a midwife”! You weren’t competent!

    • Therese

      See, the way I read it was that the midwife knew something was wrong, but couldn’t get anyone else to intervene since on paper it didn’t seem bad enough. What else is the midwife supposed to do if the hospital has a policy that X, Y, and Z needs to happen before a doctor will come in and do a c-section and so far only X and Y has happened? Maybe I am misunderstanding the situation in the UK, but that seems to be what she alleges is occurring.

      • Medwife

        She had someone to call, the GP, she just didn’t want to call him, as I read it. Do they not have the power to call for someone to do a c/s before the baby is actively going down the drain? It was a weird story. Bad, but not bad enough to act. When you have a Cat II strip (what the US nomenclature is for “not good, but not necessarily instant c/s), there are interventions to do which if not successful lead you to call for help. What’s the big mystery?

        • Roadstergal

          Would it have been reasonable to have called in a GP for a second opinion if the trace wasn’t looking right? That is, there’s a step between ‘pressing the alarm button’ and ‘wait and see’ that’s ‘This doesn’t look right to me, tell me what you think’?

          • Medwife

            Yes! It would have been totally the right thing to do. Maybe the GP would have looked at the info and patient and not thought about it too hard, but said that bad was bad enough, off to the OR. And the midwife would have felt she had gotten her patient an “unnecessarean”. In retrospect we see that the patient was getting sectioned either emergently with a compromised baby, or more calmly with a healthy baby.

          • Hannah

            I think the difference in terminology is causing confusion, here. An SHO (senior house officer) is a hospital employed doctor, to begin with unspecialised and then at the very beginning of their specialist training, further up there hierarchy are registrars and consultants being the highest grade of hospital doctor. In this context there are two kinds of SHOs: one kind on an specialist Obs/Gynae training track, the other on a GP training track, with a rotation in Obs/Gynae. She’s saying that the SHO on duty/call, is in the latter category and the box being ticked is presumably their ongoing training in a little bit of obstetrics. There are no actual GPs involved.

          • araikwao

            Oops, sorry, think I more or less duplicated your point above..

          • Therese

            So the registrars are doctors? She says she tried to get the attention of the registrars but they just told her to contact the SHO. So does that mean basically that the doctors told her to let the doctor in training deal with it? It really sounds like, if her story is true, that other people definitely dropped the ball here.

          • Hannah

            They’re all qualified doctors, they’re just different degrees of seniority.

          • Therese

            So she went to a higher up doctor and he told her to consult a lower doctor? Would that be a follow the chain of command thing or more of a “I’m too busy go bug someone else” kind of thing?

          • Guesteleh

            Can we all agree that this was shit writing? Why didn’t the editors, you know, edit the damned thing or ask for a rewrite?

          • Hannah

            I don’t think that section is particularly poorly written, it just presumes a level of knowledge of the UK medical system and hierarchy. The next paragraph describes the stillborn baby having been dead for “days” and “macerated.” Clearly the trace would have been more than a bit iffy, if that were the case.

            I think what’s throwing people for a loop is mainly the juxtaposition of some legitimate and important concerns (low levels of staffing and resourcing making it difficult to get a senior response when difficulties emerge, and to provide the level of compassionate care you would want in the stillbirth situation, for example) with the bookends about being “the guardian of normal birth.” People wonder where that fits in with more proactive and responsive care, not less.

            On reflection I think what she actually wants is for people to expeditiously take those situations off her hands so she can get on with “being the guardian of normal birth.” I suppose from a patient perspective it at least beats starting from the position that every birth should be a normal birth, jealously guarding them and repelling medical help. If it were rephrased as “woman centred care” rather than normal “birth” it might even be the same thing, but I think she presumes they’re pretty much the same thing.

          • Hannah

            Sorry, that went a bit wrong. The quotes should have been around “normal birth” not just “birth,” and the next bit should read “it might even be a laudable thing.”

          • Montserrat Blanco

            It is the normal chain of command. If the SHO dismisses your concerns and you still feel there is something wrong normal people would call the registrar again and even the consultant. It means you might hear something you do not want, but what is that compared to a healthy patient????

          • Dr Kitty

            To be clear:
            In the UK Drs specialise a lot later. You can’t go straight from medical school into your chosen speciality. You have 2 foundation years (roughly equivalent to internship and first year residency) doing a bit of everything, before opting for a training programme.

            In UK obstetrics you have SHOs and Regs and Consultants
            The SHOs will be mixture of Foundation Drs (first year residents), GP trainees (equivalent to 2nd or 3rd year residents- they will have done AT LEAST 2 years of hospital medicine), and ST1,2,3 OBGyn trainees (equivalent to 2nd, 3rd and 4th year OB Gyn residents).

            Regs will be ST 4,5,6,7,8 OBGyn trainees. I.e.
            2 years of general medicine skills and up to 8 years of specialist OBgyn training, plus post grad exams. They would be 4th year residents and junior attendings in the USA.

            Consultants will have had 10 years of postgraduate training in OBGYN.

            So…
            The MW was asked to call the junior doctor because it wasn’t bad enough to call the Reg outright. That’s SOP.
            That “GP trainee” she was being snotty about will have had 5 years of medical school with at least 3 months undergraduate OBGyn experience, plus 2 years of general medical and surgical training in hospital, plus possibly up to another 18months of subspecialty training in hospitals (GP trainees usually get A&E, psych, paeds, OBGyn and general medicine placements).

            To be a GP you have 2 foundation years another 18 months of hospital medicine and 18 months of GP practice, and exams, before you qualify as a GP.

            In the UK ALL doctors who are not fully qualified GPs or Consultants are “junior doctors” or “doctors in training”. SHOS and Regs are considered junior doctors in training, even though in many other countries they would not be considered in that light.

            The midwife wasn’t being told to call the medical student or intern or some random warm body… she was being asked to appropriately use the existing chain of command.

            Don’t forget- midwifery is a 3 year degree.

            I hope that helps.

          • Ash

            Thanks for the clarification.

            Do midwifery led units have no physicians in house? Under what circumstances do they consult with a physician–only to discuss transfer?

            In a consultant led unit, what physicians are usually in house? Is it usually a Sho or a registrar during nights or is a consultant required to be in house 24/7?

          • Dr Kitty

            It depends on the size of the unit.
            As an example- the consultant led unit where I worked delivers about 2700 babies a year. It had two OB theatres and 10 delivery rooms in the delivery suite.

            Monday-Friday 9-5 there was a Consultant, a Reg and an SHO just for delivery suite.

            5pm-9pm a Regs and 2 SHOS covered delivery suite, gynae ward, antenatal and post natal wards between them, with consutant on call from home. Weekends 9am-9pm was the same, with the consultant coming in for a ward round morning and evening, on call from home the rest of the time.

            9pm-9am 7 days a week one Reg and one SHO covered gynae ward, postnatal, antenatal and delivery suite, with consultant on call from home.

            The bigger tertiary hospital has onsite consultant cover 24/7.

            Stand alone midwifery led units HAVE NO OBSTETRICIANS OF ANY GRADE ON SITE. They are supposed to transfer at the first sign of trouble.

            Along-side MLUs, which are often on a different foor or in a different wing of the hospital to the consultant led unit, will either transfer the patient out or ask an OB (SHO, Reg or consultant- depending on the problem) to go and assess the patient in their unit- depending on the situation.

            For example, a Reg might go to the MLU within the same building to do a forceps delivery, rather than try and transfer the woman to another floor of the building in the middle of pushing.

          • Medwife

            When it comes down to it, if I needed a surgeon, either intra or post partum, and I couldn’t get my OB there, I’d take just about any doc’s help. All of them have done more c/s and hysters than I have.

          • Montserrat Blanco

            It is what normal people working at hospitals do. As I said, when in doubt they call you, you go, look at everything and make a decision. It is easier to work like that.

        • Therese

          Oh, I read it that she did call the GP, but he did nothing to follow up on it, since it wasn’t bad enough. That’s how I interpreted “they tell you to find the senior house officer but he is a GP trainee and here to tick a box.” So in other words, she did tick the box by contacting him but that’s all it amounted to be since he didn’t do anything. But I could be wrong, since it’s not very clear.

          • Montserrat Blanco

            As I understand it she did not contact the SHO. In any case when I was a trainee and the nurses were not happy with my view they were more than happy to make me call the consultant.

          • Therese

            It just doesn’t seem like the plain reading of her account. “They tell you to find the senior house officer but he is a GP trainee and here to tick a box. The fetal heart is bad – but not bad enough to act.” The way that the sentence about the fetal heart rate not being bad enough immediately follows the sentence about the SHO just being there to tick a box, to me says that is what he told her. He ticked off his box by looking at the chart and saying it wasn’t bad enough. Otherwise, why even throw in the part about the SHO just being there to tick off a box? This midwife went to the higher ups to tell them she was concerned about this patient so I am kind of baffled that the take away would be she was trying to prevent her patient from getting an unnecessarian. If that was her concern, why go bother the higher ups at all to tell them something was wrong?

          • Therese

            Also, I think the tense would have been different had she refused to notify the doctor. She would have said something more like, “They tell you to find the senior house officer but he is a GP trainee and he would have just ticked a box.” But the way she continues speaking in the present tense when describing the doctor, rather than switching to the conditional, to me implies that she did contact the GP, rather than just speculate on what would have happened had she contacted him.

          • Amazed

            She did her best to make the text dramatic, with herself being this misunderstood heroine. It’s just a standard method of building up the tension. “He’s here to tick a box” means “there was no use to go to him because he would have just ticked a box.” I work with texts and that’s what it looks like to me. Plus, she might not have felt comfortable with an outright lie. She might have been scared of libel or something and that might be the reason why she used such vague language. But it fits with the rest of the piece which screams about poor little her. As to “I don’t have the words”, I read it as a blatant attempt to hide the fact that she was horrified at seeing just how abundant the shit hitting the fan was. The shit that SHE let hit the fan. Of course she couldn’t find the words! No one likes to realize that they have harmed another human being.

            EDIT: Oh, it’s all in past tense. Then, I have to agree with the posters above to some extent. “You knew that something was wrong but you didn’t have the words and no one listened”. She had no idea what was going on, so she “didn’t have the words”. The rest of it is again an attempt to get us to sympathize with her big, warm heart and cry for HER. Not working for me.

          • araikwao

            My understanding of that was the SHO is doing the rotation to tick a box in his training. I took it to mean she didn’t call him because she didn’t expect him to care.

          • Amazed

            Could be it. After all, midwives are the only ones who care!

          • Mariana Baca

            Yeah, that is how I read it, too. But it doesn’t sound like she contacted him. The people “ticking the box” are admin people, and it is the simple presence of the GP trainee that ticks the box. the phrasing, “They tell you to…but…” implies that the midwife is not following the standard recommended procedure.

          • demodocus’ spouse

            my dad as a respiratory therapist certainly went over the head of new/trainee docs if he felt they were missing something serious.

          • Therese

            It sounds like she did contact doctors in a more senior position and they were the ones that told her to go discuss it with the trainee.

        • KarenJJ

          Also where does the mother stand in all this? Does she get information about her and her baby’s condition and the chance to make a decision, or does it not work that way in the UK?

          I had indications that labour wasn’t going all that great (no dilation and no baby descended and some meconium) but the monitoring showed baby was coping well enough for the time being. I was given the option to continue if I wanted, or go straight to a c-section. I opted for the c-section. I’m glad I didn’t wait around until it was a dire emergency.

          • Montserrat Blanco

            Yes it does work like that in the UK… If the midwives tell the doctor.

            I am not an OB but take my ward. We see patients every day once. If everything is fine, that is it. If something un expected comes up the nurse is the first one to know and has to notify us. If the nurse doesn’t say anything to us… We simply don’t know until the next ward round, 24 hours later. For the record, mines are great and they always call if necessary. That way we are able to avoid most of emergency buttons. It is strange in my field that someone deteriorates quickly, so it is always better to tell the doc and avoid a potentially awful situation.

        • Dr Kitty

          My reading of it was that she had a Cat II strip.
          She called the SHO, who agreed it was a Cat Ii strip.
          They did all the things you do to try and improve things.
          It became a Cat III strip and proceeded to CS.

          My reading is that she seems a bit confused. She appears to be trying to make two points.

          A) she had a bad feeling that things wouldn’t turn out great, but the strip wasn’t bad enough to make anyone act immediately just based on her concerns. She’s annoyed that her intuition and experience was trumped by the data.

          B) there wasn’t anything that could be done to prevent the CS, no matter how hard everyone tried, and she somehow felt that there should have been a way to keep the birth normal, if only she had been listened to.

          IF the care provided after the recognition of the Cat II strip was appropriate, then there was nothing wrong with what happened. It was just one of those things…

          So no, I don’t get the point she was trying to make.

      • Montserrat Blanco

        When you work at a hospital this happens quite a lot. Sometimes my nurses feel there is something wrong with one of our patients. They tell me. Sometimes they even say: look, I feel something is wrong with that patient, but I do not know what it is. I ALWAYS go, talk to the patient, examine the patient, sometimes run a few tests… And sometimes everything is normal and going well and we all forget about it. I have NEVER complained to a nurse for calling me and I go to see the patient 98% of the times. If I refuse to go, that one is on me, because they can write on their notes: Dr. Blanco says over the phone she is not coming, and then whatever happens to the patient would be my responsibility. I Never had a single problem. I don´t know who she worked with or where but that type of “fear” about “what the doctor is going to say” is at best childish and at worst a complete and total lie. I have never worked on such an enviroment. And yes, sometimes they have called me at 3 am and I know it was just to make me get out of bed and go to see a patient that had nothing. I have not complained even on that situation because, as I said, had I not gone, that one is on me.

        • aliciaspinnet

          I’ve worked with training interns, and one thing I’ve always made a point of telling them is “If a nurse says that they’re worried about a patient, then the patient is probably sick”. Because in my experience as a doctor that’s usually the case. It’s similar to the concept of the end-of-the-bedogram – once you have enough experience you can tell that a patient is unwell at a glance, even if vital signs/tests don’t back you up yet. Call it clinical gestalt, or just a gut feeling, but it’s pretty powerful. It’s the reason why I’m wary of an over reliance on protocols such as ADDS scores – I find people start ignoring their instincts in favour of what the protocols say.

          It sounds like it’s a bit ambiguous whether the doctor was informed or not. If she didn’t inform the doctor because she didn’t know what to say, then I would suggest “I’m really worried about this patient”, repeated as many times as necessary.

          • Therese

            Yeah, I think you guys are really reading the “didn’t have the words” way too literally. I think it’s clear she meant, didn’t have the right words to make the higher ups take the situation as seriously as she was taking it, not that she literally didn’t know how to say, “I’m worried about this patient.”

          • Montserrat Blanco

            No, we have the experience working on different hospitals, units, working enviroments, that tells us that a) she didn’t call the SHO or b) she didn’t escalate those fears to the consultant as EVERY nurse I have worked with would have done in that situation. When you are a young trainee doctor the nurses do not believe what you say IF it does not agree with what they are seeing.

          • Amazed

            Was the trainee GP really this high and mighty? I haven’t seen a trainee, in any field, who isn’t eager to check and recheck out of fear of failure when someone does as much as hint that there might be a problem.

            The animosity I see from this midwife reflects the turf war midwives fight against doctors, in my eyes. Since the GP trainee is the enemy, she sees him as high and mighty. That’s what these women fear most, it seems – to be taken as something less than doctor equals. And of course, they see fantoms everywhere.

          • Therese

            Well, if the trainee was being overworked, which I hear is the case in some UK hospitals and isn’t there pressure on doctors to reduce the number of c-sections they perform, to save the NHS money? It doesn’t seem outlandish that those two things could result in a doctor saying, “It’s not bad enough to do a c-section yet.”

          • Amazed

            And yet she didn’t say so. Interesting. She didn’t say, “he ticked a box”, she only did some general whining of how no one listened to her non-worded knowledge.

            A doctor might say so. A trainee, not so likely. First, they aren’t part of the hospital payment policy. Second, while they’re in training, they’re probably scared shitless of every deviation from normal because they recognize how little experience they have. A trainee is much more likely to raise a fuss over a slight deviation than “tick his box”. Of course, with the narrative that aims to present her as the only person with a heart there, he cannot be there for anything else.

          • Therese

            She didn’t say “he ticked a box” because her entire scenario is being told in the present tense, so it wouldn’t make sense to switch to past tense just for the one encounter with the junior doctor.

          • Amazed

            So what? She could have written it in present tense. Her attitude just woozes all over the garbage she wrote – “I am so sensitive, I am the only person who cares, ain’t I wonderful? The world is so cruel to my tender soul.”

          • Therese

            Well, maybe she is all that, I don’t really know, but if we just go by what is written down in black and white, it sounds like she did plenty to try to notify the higher ups. She could be lying to try and come off sounding like a martyr, I don’t know, but just going by what is said in her text, I’m just not coming away with the conclusion that she was trying to prevent her patient from getting a c-section. Now it is possible that was her goal, but you’d have to make assumptions that’s not supported by the text to reach that conclusion.

          • Amy Tuteur, MD

            Did she notify her own supervisor or department head?

            When nurses or midwives disagree with a doctor’s decision, they have many potential options. They can go up their own department hierarchy to get a more senior nurse or midwife to intervene with the doctor or the doctor’s superiors. They go can over the doctor and directly to his/her superiors with their concerns. They could reach out to the obstetricians in the hospital. They could call the president of the hospital or the chief legal counsel.

            And, of course, she could always have pressed the emergency button, which is what she eventually did.

            She is trying to avoid accountability for her own mistake (not recognizing the severity of the fetal distress) by blaming one other individual (who was hardly the most skilled person around), while there were many others she could have consulted in person or by phone.

          • Therese

            She went to the “sister in charge” which I assumed was the lingo for the head midwife? She consulted registrars (plural) so that means multiple doctors. She said that this continued for hours, so I take that to mean she attempted to consult with multiple people over the entire course that this was playing out. Pushing the emergency button after everyone above you has told you that there is no emergency sounds like it would create a “boy who cried wolf” scenario, if you did it every time you had a concern about a patient that you felt was being brushed off. I mean, really, the fetal heart rate is a little concerning but everyone tells you that it isn’t to the point to justify a c-section and somehow pressing the emergency button will change their minds? “Oh, well, since you pressed the button, now we have to do a c-section!”?

          • Therese

            Also, Dr. Amy, why do you claim the baby in this scenario died? I don’t see where it says what the outcome was. I might just be missing it.

          • Amy Tuteur, MD

            I was confused on that point as were a number of readers of the piece. She does not explicitly say what happened to the baby, but moves on to discuss how hard another patient’s stillbirth was for her. I didn’t realize until later that those were too different stories.

            It’s interesting to me that she insisted on anonymity in telling her story. Why does she need to be anonymous if she has retired? Is it because the stories she is telling aren’t actually true? Is it because there was a terrible outcome in the first case and she doesn’t want to be held liable for it? Her refusal to identify herself diminishes her credibility, but has no impact on the fact that the piece is self-involved and self-pitying.

          • Therese

            Yes, true, the more I read it trying to analyze just what she did or didn’t do, the more the self-pitying tone starts to grate on me.

          • SporkParade

            Here’s where I’m confused. My baby went into fetal distress. The midwife called the OB on-call for Pitocin at the first sign of trouble, and an entire crew to apply fundal pressure during the second stage. By the time things got really bad, all it took to get him out was an episiotomy. Is it just me, or did this midwife just sit on her hands doing squat until it was too late?

          • Montserrat Blanco

            I have worked in the NHS and although I had to follow recommendations about what to do and how to do it and various hospital policies (as in ANY job, by the way) I was NEVER EVER told to not follow my clinical judgement in order to get a number of hospital stay/expensive medication/procedures low. It sounds unbelievable to me.

            If as a nurse you are afraid of what a doctor will say, well, yes, you have a problem. I do not feel afraid about what my nurses will say about something. Patient wellbeing worries me much more.

          • Dr Kitty

            Not in my experience, particularly in maternity.
            You were told- if it looks dicey, call the Reg, if the midwife is worried, call the reg, if you just have a bad feeling and you don’t know why- call the reg. I had LOVELY Regs, who were only too happy to be called to something that turned out to be normal, rather than a complete sh*tstorm.

            There was NEVER a suggestion that a general drive to lower CS rate in the institution should impact individual care.

          • Daleth

            “That’s what these women fear most, it seems – to be taken as something less than doctor equals.”

            If they want to be considered the equals of doctors, may I suggest medical school?

          • theadequatemother

            but all she would have had to say was, “I’m worried about this patient.” I always take the worries of our nurses seriously. What was probably going on was too much ego…a fear that someone would think she was “silly” or “crying wolf” or “nervous” or “incompetent.”

          • Montserrat Blanco

            Exactly!!!!

      • moto_librarian

        “I am supposed to the guardian of normal birth.”

        If this is her mindset, I’m glad her ass is out. All she did was bitch and moan about risk management and forms. If she was that worried, she had options. It sounds to me like she is bemoaning the fact that a section was needed. She also complains about how midwives are being vilified after the Morecombe Bay report. Given the RCNM isn’t doing a damned thing to make sure that these preventable deaths stop happening, I don’t really care about her feelings.

        • Daleth

          I know, exactly. No healthcare provider should ever be “the guardian of XYZ procedure” as opposed to the guardian OF THEIR PATIENTS.

  • Dr Kitty

    I was recently at two multidisciplinary education days.
    One was on palliative care with palliative care nurses and doctors, GPs and district nurses. It was quite clear that there was mutal professional respect, everyone was on the same page- we all wanted our patients to have a good death in their preferred place, while recognising that sometimes emergencies or social circumstances would occur the would scupper these plans. We all knew that sometimes symptom control would be inadequate at home, or a panicked relative would call 999 and CPR would be done against a patient’s wishes, and we were all trying to come up with strategies to prevent that happening.

    The other was on Obstetric problems, and was for GPs, with presentations by midwives and obstetricians.
    It became VERY clear that there were two competing agendas (one of risk recognition, risk reduction and pro-active management of risk, with interventions seen as useful) and one of “lovely natural birth, which is best for most women” where interventions were undesirable and “the medical model” was to be avoided.
    I, like most GPs present, felt a bit stuck in the middle, and as if we were being asked to pick sides.

    Contrasting the two events was very telling.

    • Amazed

      Currently having my time of month, I see nothing lovely and natural about it. And labour is supposed to be worse! Lovely? Natural? Arsenic is as natural as they come.

      What would those loonies prescribe against period pains? Because the only thing that have helped me so far were meds and zumba. One of them comes from the Big Bad Pharma and the others have something like 20 or 30 years of existence, unlike the thousands of years women have been having their period.

      What comes next into midwife-y book of natural?

      Dr Kitty, was this before or after the oh so negative report came out?

      • namaste863

        Hear hear! Mother Nature can take he monthly gift and shove it. Try Sodium Naproxen. I’ve never found anything that works as well on menstrual cramps.

        Oh, and “So is Arsenic” is my stock issue response whenever my woo steeped relations try to get me to jump on the “All natural” bandwagon.

        • Amazed

          Zumba works great for me but I always have meds at hand, just in case. Years of Mother Nature’s monthly gift had made me fearful. Fear is good!

          Natural DOESN’T equal better! There are many natural substances that I would not dream of putting in my mouth or bloodstream, or anything.

          • namaste863

            Be afraid. Be very afraid.

        • Mel

          I recommend telling people how Toxicodendron radicans has changed my life. To give people a fighting chance, I try and emphasize the first two syllables of the scientific name when I use it, then switch to T. radicans for fun.

          Once I’ve got them on the hook, I drop the common name “poison ivy” and explain I hate being itchy.

          • Amazed

            Ah you’re evil! So delightfully evil!

          • namaste863

            That works, too. God knows there’s plenty of it where I live.

          • The Bofa on the Sofa

            “the ortho-quinone product obtained upon oxidation of urushiol”

        • LibrarianSarah

          I prefer “so is poison ivy; try rubbing it on your genitals.”

          • namaste863

            Good one!

        • Montserrat Blanco

          Have a baby, most of the period pains are gone after that! You will have other bunch of problems though

          • Roadstergal

            That’s exactly what my dad told me when I was a teenager in agony with period pain – that my mom had the same, and it only went away when she had my oldest sister. Fortunately, hormonal contraception had the same effect!

          • Dr Kitty

            Sadly didn’t work for me. That’s endometriosis for you.

            Mirena IUS stopped my periods completely, which was excellent.

            Failing that, I’m on a fun combo of Diclofenac, paracetamol, tranexamic acid (and some opioids in the evenings, at weekends and on days when I don’t work).

            I’m someone who went back to work 48hrs after a laparoscopy and laser resection of endometriosis and adhesions, with only paracetamol required for analgesia, and yet 4 drugs are required for cramps.

            My period pain is not to be trifled with, and has been worse than ovarian cyst rupture and post op pain at times.

          • Montserrat Blanco

            No way! I am sorry you go through that.

          • Bugsy

            Mine, too. I did have around a year of slightly less pain following my son’s birth…but an HSG at that time caused the cramps to become even worse than ever. I live off of the BCP when not pregnant. It’s a pretty crappy way to try to get pregnant, though.

            My cramps sound just like yours. I was 7 cm dilated before my contractions even began to approach my menstrual cramps. Endo hasn’t been officially diagnosed – I’ve never had a lap – but coupled with my infertility, it’s what my docs suspect.

        • Mishimoo

          Sodium Naproxen doesn’t do anything for me, but Mefenamic acid takes the pain down a notch or two. (Which is greatly appreciated – my period pain is worse than my labours and it feels like I have a baby crowning for 3-5 days, depending on severity)

      • Sue

        Yep – that’s another physiological process that can HURT, in its most natural state. Menstruation is not an illness, so you are not allowed to complain about the pain or take pain-killers – cos your uterus knows how and when to contract!

        • Amazed

          Nature got it all wrong with me. All the brain cells meant for the whole me – she gave them to the head leaving none for the uterus! My uterus is stupid, that’s why I don’t trust it and I do my best to relieve it. Poor thing didn’t choose stupidity.

      • Poogles

        “What would those loonies prescribe against period pains?”

        Menstrual cups or cloth menstrual pads – the claim is that there are “toxins” and “chemicals” in commerical tampons and pads, and that is what causes the cramping. I kid you not.

        • Wut.

          TMI: I’ve had burning on my outer labia from plastic sanitary pads, but it wasn’t anywhere related to menstrual cramps, and it only happened once, probably when my skin was especially sensitive from allergies or whatever.

          While menstrual cups and cloth pads are great for the environment and saves money in the long run, making that ridiculous claim will only turn people off of them because they’re looping them in with their stupid homeopathic nonsense.

          I wish I had trouble believing that anyone could be so stupid.

          • Cobalt

            “I wish I had trouble believing that anyone could be so stupid.”

            Any one person, sure. I’d believe in any one person doing just about anything. What really gets me is that there’s SO MANY. And the wackier the add-on claims are, the more people double down into it.

          • Ughhh. Yes, exactly.

        • Mishimoo

          Anion pads are also the in-thing with a subsect of woo believers.

          • araikwao

            ???

          • Mishimoo

            From the creators of the magical anti-EMF card, Love Moon anion pads cure everything from period pain to prostate issues and they only cost $110 (aud, not including delivery) for a box of 237, but you must change them every 3 hours.

          • araikwao

            Prostate issues? Do men wear them, or do they get enough magic from their partner using one?!

          • Mishimoo

            It goes something like this:
            The Government/Big Pharma is so concerned about life-changing uses the anion strips that we’ve patented have, that they’re said that they can only be used in sanitary pads because people think they’re gross and won’t ever take anything in them seriously. We’re not allowed to use them in anything else because they are too much of a threat!! We’re not allowed to tell you this, but some of our customers have had miraculous results from wearing the anion pantiliners in their shoes to fix their prostate, or extracting the anion strip from the pantiliner/pads and using it in other ways. For example: putting the strip in their waterbottle to ionise their water, putting the strip in their mouth at the start of a sore throat, putting it on wounds, etc. (basically, it’s a panacea sold by people using large scientific words and based on fear + ignorance.)

          • D/

            Damn, those anions are powerful stuff! How in the world did I not know about this?! In fact after watching their video demonstration I’m thinking a pantiliner on the forehead might even strengthen mental abilities … Or maybe a maxipad?
            http://www.lovemoonsanitarypad.com/benefitsofanion.htm

            In Love Moon’s defense that price is actually a steal considering it’s the anion harvesting process from mountain forests, waterfalls and beaches that drives up the cost, and churning out up to 6070 anions per cubic centimeter would certainly not be sustainable for more than 3 hours.

            Anyway thanks for the laugh-til-I-cried stress relief … I definitely needed it 🙂

          • Mishimoo

            You’re welcome! The tachyon shield effect of the card/stickers from the same company has become a bit of an in-joke between my brother and I, even though the company has since removed that claim from their website.

      • Ugh. Barf.

        I’m 28 and have been having my period for about 20 blasted years. They’ve always been terrible, especially as I got older and developed endometriosis.

        I’ve broken bones, a blood infection, and dealt with broken teeth and endured the pain with a little meditation and cursing; menstrual cramps aren’t an endurable pain even for me. The fact that people have the audacity to recommend stretching or aromatherapy or such nonsense when someone is curled in a ball retching and passing out because it feels like a cheese grater is raking down their insides pisses me off.

        On the upside, premenstrual psychosis might be a valid legal defense should one of us ever snap and punch one of those woo cretins in the throat.

        • Amazed

          I am not this bad, thanks God, but it IS very painful. And a friend of mine once ended up in the ER because of it! She’s the one who suffers all the thing you describe. Mine is a walk in the park in comparison and was so even before I discovered zumba.

          Woo cretins, indeed!

          • Poor lamb. ): I’ve never ended up in the ER but can imagine it getting that bad for people. Hopefully they gave her something for pain outside of well wishes and supplements. *eyeroll*

      • demodocus’ spouse

        Those aren’t menstral pains, dear, they’re surges. You’ve been listening to society again. {sarcasm}

  • toni

    Ugh, sack the lot of them and start over. A health care provider’s job is to protect health and reduce suffering. It is *not* to promote ideologies.

    • Roadstergal

      I have lost every ounce of respect I might have had for UK midwives. And yes, I’m sure they’re not “all like that,” but this is the _leadership_.

      • toni

        I didn’t mean sack every midwife just to clarify. That wouldn’t really be feasible or safe. I meant replace the higher ups who set the tone and eventually they could stamp out the woo.

  • CanDoc

    Just, wow. And yet, completely unsurprising. This is exactly to be expected from a group who sees themselves as the counterculture oppressed soldiers fighting for salvation for all… from fear and from eevil doctors with their eeevil interventions. And their machiavellian view that some babies “aren’t meant to live” with a completely callous disregard of the devastated families left in their wake is entirely consistent with the kinds of things they say: If you say “The fetal heart is bad – but not bad enough to act” then end up with a dead or damaged baby… then clearly you misread the fetal heart, rather than the alternate explanation that this baby could never have survived.
    I’m disgusted but not at all surprised.

  • The Computer Ate My Nym

    Re point #4: I actually do think that there are situations where avoiding blame is appropriate. The root cause of the problem and the reason that the mistake was made may be more important than the specific person who made the mistake. For example, the infamous “cut off the wrong foot” problem: Of course the surgeon should be sure which foot they are supposed to operate on, but instituting protocols to double check the issue prior to starting surgery are more likely to result in that never happening again than simply penalizing the person who made the mistake. It’s best to make it easy to do the right thing and harder to make a mistake.

    That being said, if you have, in the same example, a surgeon who ignores the protocol and refuses to double check the surgical site because they feel that their instinct on which foot should go is better than any testing on the issue, that person is dangerous and should be not only blamed for the mistake, but probably discharged from practice. Because no amount of engineering to make mistakes harder will work if someone deliberately bypasses the safety mechanisms.

    In short, I think there is a role for “avoiding blame” but I think the midwives are badly abusing the concept.

    • Tosca

      Agree totally. I also think there’s an appropriate time to say “Those (bad events) were in the past, we need to move on”.

      That is when
      1. The events and contributing factors that led up to Those Bad Events have been thoroughly examined, and the causes determined
      2. The people most implicated in the causes of Those Bad Events have been appropriately dealt with; retrained, demoted, on probation, sacked, prosecuted, whatever.
      3. Systems have been put in place to ensure that the conditions either don’t recur, or are nipped in the bud
      4. Those affected by Those Bad Events have received appropriate recompense.

      Only one of those things have happened.

      Mr. Titcombe fought for justice for his son when he only THOUGHT he had died because of incompetence and arrogance. Now he KNOWS it, and they think he’s going to stop before heads roll?

      • Medwife

        So maybe it’s time to stop harping on Semelweiss and the initial rejection of germ theory?

  • Alexicographer

    Any midwife, or care provider of any sort really, who would tell a parent who lost a child (to a preventable death!) that they need to “move on” or “look ahead not back” or “get over it” — not as an “in the moment” (we all might say something stupid) but as something they would stand by and not retract and apologize for ever having said, needs a new career, one that does not involve responsibility for the safety or well-being of fetuses, babies, or children. Full stop.

    • toni

      Yes, losing a child is the absolute worst thing that can happen to a person. No one who isn’t a callous a-hole could say those things to a loss parent. I hope she has an epiphany and realises what being so deep into this ‘normal childbirth’ dogma has done to her heart.

  • yentavegan

    I have a theory why the midwives in question feel no remorse or responsibility for these deaths. I am almost too ashamed to write this because this theory goes against the accumulative knowledge of modernity. My theory? These midwives believe that infants who do not survive “normal” birth are not meant to live.

    • jhr

      A bit neo-Darwinian, no? How about other modern “interventions” like chemo-therapy, or antibiotics, or even eyeglasses. That’s trusting nature without including the present stage of nature’s evolution of the human brain to create mechanisms to sustain life and improve it’s quality…

    • ArmyChick

      Seems like the percentage of sociopaths in midwifery is pretty high.

    • toni

      I agree that is what it is deep down. They do slip and give us little glimmers of that attitude occasionally.

      • toni

        just like anti-vaxxers.

    • Mel

      I think the reaction has two parts.
      Part one is an unshakeable (and blatantly terrifying) belief in their skill set being strong enough to deliver any child and mother safely.

      Part two is the conclusion that if something bad happens to a mother and/or child under their care, the mother/child MUST then be “not meant to live”.

      Army Chick hits it on the head: This is pathological psychopathy.

    • Melissa

      That is pretty much on the nose. Related, if a woman can’t get pregnant or birth a baby naturally it means she isn’t meant to be a mother. I’ve heard both things mentioned before in conversations about health policy, specifically the idea that by limiting access to pain relief in childbirth we could decrease child abuse deaths later on. Luckily we ignored that particular idea in our final work, but it was chilling to hear out loud.

    • Medwife

      I think if they thought they were killing babies with their incompetence, there’s no way they could keep working. They have to justify it somehow. Maybe it’s the system’s fault for low staffing, or “everybody loses a few” (you have to work to avoid reality here- no, NOT everyone just loses a few healthy babies of healthy women), or it was meant to be.

  • Lancelot Gobbo

    Much as physicians have become cynical about the low threshold for a patient to start a lawsuit, it has had a profound effect on the way we practice. Defensive medicine is sometimes wasteful and expensive, but it does tend to avoid rare and unlikely things being overlooked. I’m afraid midwives will have to undergo the same kind of trial before they pay proper attention to minimising risk. Making midwifery all about gratifying their own need to see the world as one where pink unicorns and rainbows await every inadequately monitored vaginal birth (isn’t that what ‘defending normal birth’ must mean when you ignore fetal distress?) is missing the whole point of their trade: deliver the baby safely with best possible outcome for babe and mother.
    They need to be scared that substandard practice will be punished. It’s the stick rather than the carrot, but it has a chance of bringing them up to par. Curiously, I was delivered in the back bedroom at home by an NHS district midwife in 1958. She became my godmother and a good friend. She would have been horrified by this dangerous reversal of who midwifery is designed to serve.

    • Amy Tuteur, MD

      I’m beginning to wonder whether this attitude is related to the fact that midwives aren’t required to become nurses first. Once you’ve actually seen what can go wrong with the human body, it’s hard to pretend that any human organ systems work “perfectly.”

      • Lancelot Gobbo

        In the UK they are nurses first, who go on to do their midwifery, so while that might explain things in the US, it gives no excuse for the Morecombe Bay Murderers.

        • attitude devant

          I’m fairly certain that you are mistaken there. That USED to be the case but now you can get a ‘midwifery degree’ which does not involve training as a nurse first.
          Alternatively you can train as a nurse and then do an abbreviated midwifery program. (BTW, I get my info from nhscareers.nhs.uk.)

          • Lancelot Gobbo

            You might be right. I left the UK in 1985.

      • attitude devant

        I puzzle over this attitude among UK midwives and this is the only explanation that makes sense. No one with medical/nursing training can easily swallow the idea that birth is perfect. Once you’ve seen how badly things can go, you have more respect for the profound changes in physiology that occur with pregnancy and birth. The miracle is that it doesn’t go more wrong more often.

      • toni

        I think the midwives of Byrom’s generation would have had to be trained as nurses first.. I think it is a relatively new way of doing things to solely study pregnancy and birth.

        • Dr Kitty

          The midwives of Byroms generation were nurses in the 1970s and 1980s.
          Medicine and nursing have changed immeasurably since then.
          The nursing they will have learnt is very different to nursing as it is now practised and taught. They may have kept their midwifery skills up to date, but I doubt they have kept their nursing skills up to date in the same way.

    • Daleth

      “Defensive medicine is sometimes wasteful and expensive, but it does tend to avoid rare and unlikely things being overlooked.”

      Yes. In other words, it saves lives.

    • The Computer Ate My Nym

      In the US, non-CNM midwives avoid the problem of malpractice and having to practice defensively by simply refusing to carry malpractice insurance and declaring bankruptcy if they are sued so that there is no way for the parents or the child who is harmed to obtain adequate redress. I’m not sure what the NHS is thinking to put up with that risk in their system, but apparently they’re willing to for now, possibly due to the right wing fetish for saving money today, even when it means a high cost in human suffering and payouts for that suffering tomorrow.

      • MWguest

        The state of Wisconsin is poised to add this risk to their system by enacting a law that would allow LMs to be reimbursed by Medicaid. Currently in Wisconsin, LMs can attend breech, twins, VBAC, they are not required to carry malpractice insurance, nor are they required to have any collaborative agreement with a physician.

        The nurse-midwives are afraid to voice their opposition (this directive is being handed to them by the ACNM national office) because coming out against other midwives would be “too confusing” for the state legislature and the general public.

        OK – so we should allow lay midwives free reign in the land of out-of-hospital birth – AND allow Medicaid reimbursement for their services? I’m so tired of this.

        “SERVICES
        PROVIDED BY CERTIFIED PROFESSIONAL MIDWIVES Governor: Reduce funding for
        MA benefits by $174,800(-$73,000 GPR and -$101,800 FED) in 2015-16 and
        by $524,300 (-$219,400 GPR and -$304,900 FED) in 2016-17
        to reflect estimates of net savings that would result by providing MA
        coverage for services provided by certified professional midwives. Add
        licensed midwife services provided by certified professional midwives
        licensed under state law to the statutory list of services covered under
        the state’s MA program. Require DHS to submit an amendment to the
        state’s MA plan to the U.S. Department of Health and Human Services to
        permit reimbursement of services provided by a certified professional
        midwife. Specify that this provision would take effect beginning on
        January 1, 2016, provided that the state receives federal approval of
        the amendment to its state MA plan.”

        • Ash

          Can you link me to the exact proposed bill and section? I really need to write to my elected officials about this. Thank you.

          • MWguest

            It’s in the biennium budget bill.

            http://www.doa.state.wi.us/Divisions/Budget-and-Finance/Biennial-Budget/201517-Executive-Budget/%E2%80%8B

            Senate Bill 21 (This is a 1839 pg document):
            https://docs.legis.wisconsin.gov/2015/related/proposals/sb21.pdf

            And thank you. This issue needs some attention.

          • MWguest

            Maybe the state legislators need to hear how much it will cost in Medicaid dollars to have one or more of these babies hospitalized in the NICU.

            The proposed savings of reimbursing LMs by Medicaid is approximately $700,000 over two years. Pretty sure NICU charges can hit that number in a pretty short period of time.

          • PrimaryCareDoc

            Yes. One NICU baby will cost them over $1 million.

          • Sr27

            My cousin is a NICU nurse, and she says she sees bad homebirth transfers once a quarter. I can only imagine those numbers would be worse if midwives were being paid from Medicaid and therefore were more homebirths.

        • The Computer Ate My Nym

          Wisconsin is suffering from a governor who is making a number of fiscally bad decisions. He’s a Republican. I’m not surprised that he thinks that the cheap in the short run unqualified midwives are a good idea.

          Minnesota, with its tax-and-spend Democratic governor, is doing much better.

          • MWguest

            Are we discussing politics or midwifery? I try to stay away from politics online, because I just don’t have the time to go down that rabbit hole. If you want to talk about midwifery in Minnesota, a little known fact is that unlicensed practice of midwifery is legal just like Utah and Oregon.

            FUN FACT: Mr Jesse Ventura was governor when voluntary licensure for lay midwives was enacted in MN.

          • The Computer Ate My Nym

            I apologize if I got too far into the politics, but I do think it’s connected. “Fiscal conservatives” tend to be attracted to using CPMs because they charge less and they don’t necessarily think through the long term consequences of their positions. It’s a false economy and the places that implement it suffer, both economically and with poorer health.

          • MWguest

            You don’t have to apologize – it’s just that lots of very unproductive conversations can get started that way.

            Yes – I agree it’s somewhat driven by fiscal conservatism – but I also think it could be an item thrown into the budget as a personal favor – considering that $700,000 is a miniscule percentage of the biennial budget.

            And sure, Dayton is a democrat – but the midwifery laws in MN aren’t very good either.

  • Cobalt

    Number 4 has a grammar issue in the bold text. Otherwise, this is painfully accurate. These problems should not exist.

    • Amy Tuteur, MD

      Thanks! Fixed it.

      • Lancelot Gobbo

        Replied to wrong comment – sorry!