Ideas have consequences.
Bad ideas have deadly consequences.
Today’s report on the deaths more than a dozen babies and mothers at a UK hospital is a catalog of horrors.
According to The Guardian:
Frontline staff were responsible for “inappropriate and unsafe care” and the response to potentially fatal incidents by the trust hierarchy was “grossly deficient, with repeated failure to investigate properly and learn lessons”.
Kirkup [the author of the report] said this “lethal mix” of factors had led to 20 instances of significant or major failures of care at Furness general hospital, associated with three maternal deaths and the deaths of 16 babies at or shortly after birth.
“Different clinical care in these cases would have been expected to prevent the outcome in one maternal death and the deaths of 11 babies.
In 2008 alone there were 5 deaths:
A baby was damaged due to a shortage of oxygen during labour, while another died from an unrecognised infection.
“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,” Kirkup said. (my emphasis)
And most damning of all:
The midwives at Furness general were so cavalier they became known as “the musketeers”.
Those midwives are directly responsible for the deaths and should be held responsible to the full extent of the law. But the individual midwives are just the proximate cause. The real cause is radicalization of midwifery that values process above outcome, and midwife autonomy above all else.
Outcome, whether mothers and babies live or die, is the MOST important goal in obstetrics. It’s not the only goal, of course; safe care can and should be accompanied by compassionate, comfortable care. But is the sine qua non of all maternity care.
Midwives have forgotten that. Instead they have elevated process, specifically process that is good for them, above the health and even the lives of mothers and babies.
The goal of many midwives has become unmedicated vaginal birth, and professional autonomy.
The deadly results are not restricted to Morecambe Bay. The relentless promotion of “normal birth” has led to bad outcomes and soaring liability costs, now accounting for 20% of total obstetric spending.
I’ve written about these issues relentlessly and repeatedly over the years:
Promoting normal birth is killing babies and mothers
Midwife: UK deaths result of failing to meet the needs of … midwives?
New document on British maternity services is fundamentally unethical
In the UK, babies continue to die on the altar of vaginal birth
Government report: UK midwives put the lives of mothers and babies at risk
#FightFear: the hateful truth at the heart of UK midwifery
When UK midwives put the lives of mothers and babies at risk, the solution is not more homebirths
Who radicalized midwifery?
Biological essentialists.
They are fond of catch phrases like “trust birth,” “pregnancy is not a disease,” and #FightFear They insist that obstetrics has “pathologized” childbirth and they can display a shocking and callous fatalism by dismissing deaths with the dictum that “some babies are not meant to live.” Such views lead inevitable to the “poor clinical competence, insufficient recognition of risk, inappropriate pursuit of normal childbirth” highlighted in the report.
Feminist anti-rationalists
They dismiss science as a male form of “authoritative knowledge” on the understanding that there are “other ways of knowing” like “intuition.” Many are post modernists who believe that reality is radically subjective, that rationality is unnecessary and that “including the non-rational is sensible midwifery.”
Midwifery theorists
Consider Normal Childbirth: Evidence and Debate by Professor Soo Downe who dismisses the importance of scientific evidence in guiding clinical care:
The implication of the new subatomic physics was that certainty was replaced by probability, or the notion of tendencies rather than absolutes: ‘we can never predict an atomic event with certainty; we can only predict the likelihood of its happening’… This directly contradicts the mechanistic model we explored above, and it implies that a subject such as normal birth needs to be looked at as a whole rather than its parts…”
When we turn to the implications of this paradigm shift for our understanding of health, it becomes clear that the benefit or harm of an intervention for an individual can only be established with reasonable certainty by identifying and taking into account all the relevant “noise”. This includes environment, carer, attitudes, skills and beliefs, and the expectation of the woman and her family. Similarly, the appraisal of research and evidence needs to consider the concept of attitudes and roles of researchers and how these may have framed or influenced the process of generating evidence…
Not only is this NOT a justification for ignoring scientific evidence; it is utter nonsense that betrays a fundamental ignorance of physics.
The philosophy of “normal birth”
The definition of normal birth is simple and straightforward: If a midwife can do it, she calls it normal. If she lacks the skill to provide the needed care, she insists that the birth is not normal even if it results in a healthy mother and a healthy baby. “Normal birth” and “midwives” are interchangeable. In other words, “normal birth” is nothing more than a marketing term designed to promote full employment for midwives.
Midwifery leaders
Cathy Warwick, leader of the Royal College of Midwives, has not yet met a major problem that can’t be fixed by promoting increased midwife autonomy through homebirth and free standing midwife led units. Too bad for babies and mothers that Cathy Warwick believes the central problem in contemporary maternity care is meeting the needs of midwives, mothers and babies be damned.
The deaths at Morecambe Bay, and the subsequent coverup, are the inevitable consequences of a maternity system whose gatekeepers are biological essentialists, feminist anti-rationalists, believers in nonsensical theories, promoters of process over outcome, who appear to think that their primary responsibility is to themselves and not their patients.
The UK National Health System made a Faustian bargain with midwives to install them as gatekeepers in exchange for the promise of saving money; midwives are less expensive than obstetricians. It turns out that dead and injured babies cost a lot of money, though, not to mention the fact that allowing preventable perinatal and maternal deaths is fundamentally unethical.
The NHS needs to reorganize midwifery care to place obstetricians in control of patient care and midwives as their assistants. The radicalization of midwives, which provides the theoretical justification for placing their needs ahead of patient needs, means they can no longer be trusted to act independently.
The result is babies and mothers who didn’t have to die, shattered families, grieving parents and massive liability payments.
Horror, indeed.
Addendum
A direct quote from the report:
[M]idwifery care in the unit became strongly influenced by a small number of dominant individuals whose over-zealous pursuit of the natural childbirth approach led at times to inappropriate and unsafe care. One interviewee told us that “there were a group of midwives who thought that normal childbirth was the… be all and end all… at any cost… yeah, it does sound awful, but I think it’s true – you have a normal delivery at any cost”.2 Another interviewee “… was aware that there were certain midwives that would push past boundaries”.3 A third told us that there were “… a couple of senior people who believed that in all sincerity they were processing the agenda as dictated at the time… to uphold normality… there’ve been one or two influential figures who’ve perpetrated that… sort of approach and… there’s nobody challenging…”.4 Whilst natural childbirth is a beneficial and worthwhile objective in women at low risk of obstetric complications, we heard that midwives took over the risk assessment process without in many cases discussing intended care with obstetricians, and we found repeated instances of women inappropriately classified as being at low risk and managed incorrectly. We also heard distressing accounts of middle-grade obstetricians being strongly discouraged from intervening (or even assessing patients) when it was clear that problems had developed in labour that required obstetric care. We heard that some midwives would “keep other people away, ‘well, we don’t need to tell the doctors, we don’t need to tell our colleagues, we don’t need to tell anybody else that this woman is in the unit, because she’s normal’”.5 Over time, we believe that these incorrect and damaging practices spread to other midwives in the unit, probably quite widely. Obstetricians working in the unit were well-placed to observe these lapses from proper standards, and it is clear that they did, but seemingly lacked the determination to challenge these practices. This in turn represents a failure to maintain professional standards on their part.
The Guardian published a good article related to this today, Eliane Glaser’s “The cult of natural childbirth has gone too far”:
http://www.theguardian.com/commentisfree/2015/mar/05/natural-childbirth-report-midwife-musketeers-morcambe-bay
I left a comment that was just posted.
From the comments to the Guardian article, this golden snippet –
“the midwives split quite neatly into two groups: the “nurses additionally trained as midwives” who were very good, and the “midwives trained by wannabe witches to bring down the filthy patriarchy and avoid anything like an obstetrician”, who were frighteningly bad.”
Haha that’s a great quote, although I am hesitant to say that all direct entry midwives are bad and all nurse trained midwives are good, or better. As with many things, a lot of this is individual clinical decisions and whether they are based on your personal views, or on evidence. Both groups are susceptible to the same pitfalls I think
Yes. My experience is that the nurse trained midwives were better on average, and the only poor care I’ve had has been from direct entry. But I’ve also had superb care from direct entry, and it’s possible the nurse trained midwives were better at least partially due ti being more experienced- they’re older on average.
Yeh, the difficulty as well is the quality of the training on the midwifery courses locally, as bad lecturers and mentors will create poor new midwives (bad as in strong ideological leanings, not listening to students, bullying) and often NQMs apply to the trust in which they trained, which can lead to these pockets of similar (ideologically) midwives
I’ve got two questions:
1) Would it be so bad for satellite Maternity Units to employ an onsite Ob or to have an Ob nearby on call to help with risk assessments? I just don’t see how a Midwife with a three year degree can compare to an Ob with not only a medical degree but a specialist degree that focuses on ‘when shit hits the fan during labour’.
I’m pregnant with my second and have the choice between a satellite Maternity Unit or the hospital. My first was an induction for being overdue so had to be done at a hospital but other than that went smoothly so I’m a bit more open to a Maternity Unit. BUT I’ve been raised around nurses, I can remember when my sister was working in an Emergency Department and she was talking about a Golden Hour: the quicker you can get to the hospital, the better. Now, maybe this is just pregnancy hormones making me anxious but I can’t stop myself doing the math. If I’m at the Maternity Unit and I start to hemorrhage (no predicting it): At least 15 minutes for the ambulance to get there, 10 minutes for the paramedics to stabilize me and then at least 20 minutes to get to the nearest hospital. 45 minutes. How much blood can a hemorrhaging woman lose in 45 minutes? Compared to 5 minutes to get me in an Operating Room if I birth at hospital. And I’ve had people surprised that I feel safer and more relaxed birthing at a hospital than I would at home (yes, I’ve actually had one woman tell me that just doesn’t get it)>
Question #2: Can those moronic Musketeer ‘midwives’ get charged with murder or manslaughter? They deserve to go to jail.
MLUs not attached to hospitals should (and usually do) have very high standards for which women are suitable for their service, and also strong conditions for transfer. Midwives do not, you’re right, have the same level of training as an obstetrician but they do have extensive training in what constitutes a normal labour and birth and where their scope of practice ends (I mean, they should, in the above case they ignored that which is the issue) and when to transfer our before something goes wrong. In the case of haemorrhage which as you say is not predictable, midwives are able to administer uterotonics (usually syntocinon, ergometrine) and are also able to set up an IV and infusions. So, by the time the paramedics arrive the patient should be stable, often the haemorrhage will have stopped and the placenta will be delivered, although the transfer would still take place and the obstetricians at the hospital would assess for the next steps.
All midwives in a local area are required to attend mandatory drills and skills training, where emergency procedures are practiced so that everyone knows what to do and when, and all community midwives carry adult and newborn resuscitation equipment and drugs to manage pph. Yes things do still go wrong, and more than is acceptable, often the mistakes are made due to midwives not doing what they should have…due to ideology, or mistakes, or lack of care.
and the midwives can be prosecuted, it depends on if the CPS decides to bring a case, which usually depends on the findings of the hospital and NMC investigations. The NMC will likely sanction these midwives, up to potentially striking them off the register.
There is the option of corporate manslaughter…but I can’t see it happening.
A couple of the Catch Of The Day cases (student midwifery board) showed an reluctance to transfer from a birth center and the reasoning was absurd. A multipara who had been laboring and wanted to get the birth over with asked for her waters to be broken. The midwife declined saying that if there was meconium in the waters, they’d have to transfer.
Another woman was laboring and had burned through every pain management strategy the midwives had and asked to transfer for pain relief (epidural) and the midwives used the distract (You are doing so well, don’t give up now!), delay (It would take soooo much time to transfer and a further wait for an epidural.). They didn’t make it to outright refusal.
The woman with a seizure disorder (controlled) who showed up at the birth center in labor and wasn’t transferred immediately. The midwives did call and consult before proceeding, but what could they have done if she did seize? Call for transport?
Yeh I do agree that some of those cases are questionable, if I remember correctly the lady with the seizure disorder had actually been informed she wasn’t suitable for care in the MLU but showed up anyway, in that instance you would advise transfer but if she refused you have to provide care. They did the right thing by contacting the hospital and speaking to the co-ordinator and SOM, you’d hope that either the lady would consent to transfer or the hospital would send support…but that’s up to the labour ward co-ordinator.
the other cases are ideological, rather than using best practice…which is not how things should work, but also ARM isn’t necessarily required either, and it increases the risk of infection so wouldn’t be done as a matter of course, if labour was significantly longer than it should be (shown on partogram) then transfer should be offered as augmentation would likely be required. Same with pain relief, if a woman is not coping and needs more pain relief then you should listen, however if you are a significant distance from the hospital then the time to get there might be worse than just supporting the woman through the last part of labour. I may be wrong, but I think a hospital transfer for pain relief may not be classed as urgent for the ambulance service so time might be longer than in an emergency
IMO- if you have a multip who has prolonged labour, there is a REASON why the labour is prolonged, and if you aren’t willing to AROM or transfer for augmentation or further assessment, you aren’t doing your job properly.
“There might be mec” is not a reason not to rupture membranes. It isn’t like mec inside an intact amniotic isn’t a problem, you just don’t know about it!
If there is mec you should want to see it!
That was just…stupidity.
Yeh I agree, not entirely sure that AROM should ever be performed at an MLU or at home, because it’s an indication that the labour is no longer progressing normally and as such falls out of the scope of practice of the midwife alone (i.e. needs doctor review). Often midwives may work in multiple areas (so hospital delivery suite, community, MLU) and where on DS it becomes somewhat normal for a midwife to decide to ARM w/o a doctor asking them to, it shouldn’t be a midwife’s decision and as such shouldn’t be done in a midwife-led setting, if I were attending a lady and felt that AROM was required, I would transfer because it’s no longer normal. That lady may go on to have a lovely natural birth (if she is happy with that, and has the right level of pain relief for her) but than can happen in a hospital too. Basically, while the care that takes place after transfer may be the same as if she hadn’t transferred, you should still transfer if things aren’t normal.
That said, transfer is a woman’s choice, and not sure what happens when mum refuses, which does occasionally happen with militant NCBers
That’s pretty bad. You live in Oregon, don’t you? That is scary hubris.
Do you ever hire anyone to do anything that can do a half ass job (for whatever reason, to save money), with the hope that a better trained person can always come in and save the day? A painter? A plumber? A car mechanic? An accountant? Someone to safely deliver your child? Why not just hire the better trained person?
‘we can never predict an atomic event with certainty; we can only predict the likelihood of its happening’…
While the above is technically true I fail to see what events on the atomic level have to do with evidenced based obstetrics. I’m pretty sure she has no idea what the phrase she’s parroting actually *means*.
Still trying to wrap my head around Cathy Warwick’s nonsensical response. Lady, this is YOUR responsibility! Stop prevaricating and ovary up!
She won’t. She doesn’t need to. The NHS is a giant political football so whatever the Government says, the Opposition will say the opposite. We have an election coming up which will muddy the waters even further.
Oh man. I really did not enjoy reading this post last night as I was staying in an NHS hospital waiting for surgery this morning :/
Get better soon!
I wish you a speedy recovery!
Hope everything goes well and that you recover quickly.
50 years ago I was delivered in England by a doctor at home. He came by on his bicycle to see how the midwife was managing my mother’s labor. Not well. I was delivered by forceps at home by a doc. Sounds like the system has not improved.
Are you crazy? These days, he rides a Segway.
The system of prenatal care and birthing is not always the culprit, as you could see from my country’s example. I’m from Latvia, ex-Soviet country currently in EU. We have comparatively high neonatal death rate, and nobody can say for sure why (WHO pointed this out lately that we need to gather data about procedures and practices more thoroughly because currently it’s not being done). And our system? Much better if compared with others. First, our midwives are at least in CNM level, so no lay midwives at all (doulas are becoming more popular recently, but they are clearly support personnel and don’t try to play medical professionals). Second, you can get all prenatal care, birth in hospital and some postnatal care for free – government funds it. Third, you can get prenatal care either from OB/GYN (default option), GP or midwife – in latter there are additional consultations with OB/GYN too. Freestanding birthing centers are not very common as well as homebirths (they are expensive because not funded by government), whereas in hospital default L&D caregivers are midwives but there are always OB/GYNs present who can make serious medical interventions if necessary. Sounds like everything should be great, but it isn’t. Some maternal and neonatal deaths can be blamed by poor social situation (recently 3 deaths were reported for mothers who birthed at home unassisted and didn’t get any prenatal care at all – but it’s rather because they didn’t care to get help not that they were some kind of UCB adepts) but it doesn’t explain them all. Maybe low salaries of medical personnel and resulting decrease of their availability and qualification (many young professionals migrate to Western Europe)? Soviet heritage of poor attitude, substandard care and such? (You wouldn’t believe standard birthing and postnatal care practices in Soviet era which most of our mothers had to go through) One aspect that scares me most – our government really believes that WHO recommendation of 10-15% C-section rate and has allocated funds for hospitals as such, and as a result hospitals try do decline medically assigned C-sections as much as possible (they are paid for by government, whereas elective C-sections paid by patients who often can’t afford them). Probably it’s combination of all aforementioned, but as a pregnant woman I’m not very happy about this situation.
I don’t blame you for being unhappy. I hope all goes smoothly for your birth.
My cousin’s mother is a pediatric epidemiologist in Lithuania. Her husband is the equivalent of uh..a game warden? A forestry worker? He doesn’t chop down trees but he helps manage the forest. He earns more money than she does. He has a side business of carpentry and he builds furniture, and that job earns at least twice as much as his wife makes and much more than his “real” job makes. They’ve never been able to visit the US together when their kids weren’t working in the summer in the US because they have well paying jobs (well, HE earns a decent amount) and a high chance of defection. Only SHE had a chance of earning a decent amount in the US, after spending dough to get appropriate training in the US and testing to get a license to practice medicine here. At the time, the kids could earn more in a summer as wait staff than they could earn in a year in Lithuania so they would try and work every summer break they had. Even now, 10+ years of trying to visit the US as a couple and they are still not allowed to do so. They are so crappily paid that LIthuania feels the risk of them absconding if they go together is too high. “We won’t pay our medical professionals a working wage, and we’ll damn well make sure they can’t leave our borders in order to earn enough to live on!”
The Maternity Risk manager was also their Union Official!
“We were particularly concerned at the conflicts of
interest surrounding the position of maternity risk manager, who was also a supervisor of midwives:
we believe that she was part of the close-knit midwifery group of ‘musketeers’ and, as a former union official had continued to act in a staff representative role supporting
individual midwives. She was central to deciding whether and how incidents would be investigated,
often by herself: “If there was any sort of serious incident or an incident where staff needed support or
I needed to start an investigation I would go to that site as soon as possible.”19 This inherent blurring
of roles was graphically illustrated in a letter following a medication error in 2007 to the midwife
concerned: “Jeanette Parkinson [Maternity Risk Manager] was present at the meeting yesterday
evening (10/1/07) and explained that she was there as your representative.”
I’m sure it was recently announced that the system of supervision of midwives is going to be changed, exactly because of this sort of situation. Supervisors of Midwives were responsible both to investigate midwives’ failings and to support their professional development, and somebody finally recognised the conflict of interest. Trying to combine the roles of supervisor and union official is definitely pushing it, though . . .
(Here’s the NMC article on the changes to midwifery supervision, if anyone’s interested: http://www.nmc-uk.org/media/Latest-news/Nursing-and-midwifery-regulator-calls-for-supervision-to-be-removed-from-its-legislation/ )
From the report:
” there was a growing move amongst
midwives to pursue normal childbirth ‘at any cost’”
whew. chills the marrow
It goes on…
“Third, midwifery care in the unit became strongly influenced by a small number of dominant individuals whose over-zealous pursuit of the natural childbirth approach led at times to inappropriate and unsafe care. One interviewee told us that “there were a group of midwives who thought that normal childbirth was the… be all and end all… at any cost… yeah, it does sound awful, but I think it’s true – you have a normal delivery at any cost”. Another interviewee “… was aware that
there were certain midwives that would push past boundaries”
Chilling indeed.
“at any cost” – Too bad you thought my job was to care for you and get the best outcome possible for you and your baby. I’m just here to make sure the kid came out your vagina…so sorry the baby died, but at least you didn’t you have pain medication or a c-section. I’m sure with some counseling you will get over your baby’s death and after all it was probably for the best as babies that can’t survive VB are inferior and you might have had trouble BF. Just think you could have ended up with a c-section and formula fed infant.
OT, because we totally need more evidence that at least one doula out there is a birth hobbyist…
http://www.mothering.com/forum/19-i-m-pregnant/1476170-25-weeks-complete-placenta-previa.html#post18552170
In a discussion about coping with placenta previa, I suggested that maybe a doula would be helpful for some things – I sure as heck could have used one, and another poster chimes in to say that her doula wouldn’t have agreed to do the things I described (help with pumping, be a runner between the NICU and c-section recovery, general hand holding, reality checking, and emotional support while in hospital) because “that’s family’s responsibility.”
How unbelievably depressing is that? It would be one thing to say it’s not your strong point, or that another doula would be better suited, or almost anything besides, basically, “if it’s not going to be fun for me, you’d better sign your family up.” My family’s awesome, but me being out of commission tied up a lot of other people’s free time, and the end result was that I was pretty much on my own in the hospital. My husband almost didn’t make the c-section because he had to wait at home until the babysitter got there.
So yeah. That doula. She sucks.
So, family should be obligated to do the not fun stuff (presumably for free) and I should pay someone to hold my hand, spritz some essentials oils around and tell me I’m a birth goddess? Seems legit.
Um, what does she think a doula’s job is?
My thought exactly: What does a doula do then?
And here’s the education requirements for the BC international educated midwifery bridging program: http://cmrc-ccosf.ca/files/pdf/MMBP/MMBP-Midwifery-Elig-Req-2012.pdf
Am I misunderstanding this, or does this list of requirements actually allow an experienced CPM from the US to move to BC and practice?
I asked the program director that very question – she says likely not, but it is not black and white. I suspect that the CPM who would be candidates to enter the bridging program would be interested in meeting our local standards (which exist and midwives are held accountable), so many would not be interested in pursuing a licence here. However, I teach the midwife student occasionally, and there are some students who enter the program because they “want to make homebirth more available” and are deep in the woo. My current student however it awesome and is not woo-driven at all, and I look forward to working with her as a colleague because she truly only want to look after low risk women.
Chilling indeed. Note in BC there is a 4 year bachelor of midwifery program – I do not see any requirement for entrants in the program to have had a nursing background prior to entry. http://midwifery.ubc.ca/ Sadly – I do not think that a similar scandal would be beyond imagination here…
I think our system has the advantage of nurses being involved with the midwife patients. The nurses are trained differently, and are not afraid to comment when things don’t follow the standards. It is a little be harder to have the same culture the midwives were able to create over there. We also try very hard to keep the lines of communication open, but I will admit that when I am on call, I am not afraid to ask a midwife if they “want my help” when things are deviating, the nurses also don’t always wait for the midwife to ask for me, they can call as well. I think it is the attraction for some patients and midwives to choose homebirth, because no one is looking over their shoulders like we do in the hospital.
The link to midwifery.ubc.ca is depressingly relevant.
The sidebar links to info about a visiting UK midwife:
““What has always fascinated me is the sense that the process of
childbirth is far more than just getting a baby out. It is something
that links us back through all our ancestors, and into the future, and
we are all (mother, father, baby) irrevocably marked by it. It is also
one of the few experiences left in society which, when undertaken
physiologically, is ultimately unpredictable and uncontrollable and, as a consequence, deeply emotional. It takes all those who experience it authentically to the very edge of their capacity to cope, and it says to them, you can do this – and if you can do this, you can do anything. Getting it right is therefore profoundly important for the wellbeing of families, and for future generations.While I have always believed this intuitively, recent exciting evidence from epigenetics seems to suggest
that there is biological evidence for the impact of labour and birth on way genes might be expressed for the child, and for their adulthood, and then their own children in the future. So, for all these reasons, the normal birth agenda is really important to me.” – Dr. Soo Downe”
Well now I need a shower and not in the good way.
I’ve always believed intuitively that people doing a job should get on with doing it the best way they can, putting their own beliefs and values aside if necessary in order to meet required standards. If their values and the required standards clash irreconcilably, they leave.
So these people are using the cloak of a hospital and the respectability that goes with that to practise their birth junkie crap. Disgraceful.
More epigenetics pseudoscience. Sigh.
I believe intuitively that she should eff off. That’s very important to me.
Why yes, it is unpredictable and deeply emotional. That’s why they were hired, to protect people from the unpredictable parts. Not to stand there and observe nature taking its course, like a priestess ensuring the ritual is done correctly.
Oh god NO! Links us back through all our ancestors? Not in the least.
What awful mysticistic tripe.
I think it is far more than getting the baby out as well. It is still far more than getting the baby out if you have every intervention going and a highly medicalised birth – I had two. I can get very mystical about the birth of a live baby however it comes out. Can’t quite see the point of a good birth/ dead baby though. or suffering for the sake of it.
“Unpredictable and uncontrollable” are things I normally associate with natural disasters and wild animals. Why exactly should I think they are a good thing when it comes to giving birth?
Those are words I associate with domestic abuse.
Ick.
The disturbing thing is that she’s so close to right so often. The births of our children do mark us irrevocably. The experience is deeply emotional. Children can be a link to the future. It is important to the wellbeing of families to get this right (by which a sane person would think that you should minimize injury and prioritize safety, and Dr. Soo Downe evidently means commune with your ancestors). The exact method by which you give birth has nothing to do with any of that.
I seriously hope these midwives aka the Muskateers lose their jobs and never go near a patient again. I wouldn’t let these heartless incompetents near an animal. Even vets “intervene” more than these midwives i.e. painkillers, cesaerans etc.
They are cowboys…they only thing missing is the spurs on their boots.
The dumbing down of midwifery
It seems that it is the parents who had to fight for an investigation into deaths that could have been avoided. This investigation should have happened anyway. What kind of health care professional didn’t recognise that one of the babies had difficulty breathing and should have been on anti-biotics. Shouldn’t the pediatrician have spotted this infection?
That’s the issue. A paediatrician would have, but the midwives didn’t call a paediatrician, or any other doctor to see him until it was too late.
Midwives do postnatal checks for well babies and only ask doctors to see if there is a problem…I think you can see the obvious flaw there…
The parents’ reaction:
http://www.independent.co.uk/news/uk/home-news/morecambe-bay-report-bereaved-families-of-babies-who-died-saddened-but-vindicated-by-damning-findings-10083617.html
Waiting for the inevitable gofundme for these mental giants.
I suspect that the most prominent feature of the response from midwives and natural childbirth advocates will be deafening silence.
After reading the report, I can’t fathom anything other than deafening silence. Disgraceful. The only appropriate response could be to acknowledge the danger in ideological isolationist practice with a stepwise plan and guidelines outlining midwifery management with guidelines and value of Obstetric involvement. I’m not holding my breath.
I, for one, REALLY want to know their response to both the avoidable deaths, as well as the cover up.
They claim to have morals. I’d like to see them.
Their response to the deaths? Maybe “some babies are just meant to die”, or even “babies die in hospital too”. Straight from the radical-NCB handbook.
Wait – it’s actually in the report:
“This was most graphically illustrated by the comment made to us by an interviewee as
she left the room that “sometimes bad things happen in maternity – people just have to accept it” ”
Astounding.
ヽ༼ ಠ益ಠ ༽ﾉ
That’s what you say to someone who lost a loved one in a completely unavoidable freak accident, or when a healthy woman has an unexplainable miscarriage. The flippant attitude of these freaks just makes my blood boil.
I’d be willing to bet that many of them will talk like this in the face of parents who have just lost their newborns due to their incompetence, and the saddest thing is that most of those victims will continue to advocate for them.
The report says “there was a growing move amongst
midwives to pursue normal childbirth ‘at any cost’”
It’s hard for them to respond to that in any way other than to agree, surely.
Now that a national investigation by the NHS into maternity care in England has been initiated, what is the likelihood the US will proactively evaluate CPM licensing and poor outcomes directly linked to the same tenets linked to catastrophic outcomes in the UK…isolated practice, unwillingness to apply risk-out criteria, failure to identify opportunities for intervention and a dangerous culture of cover-ups and protecting their own? The parallels in the report are strikingly similar to the dangers of CPMs in the US. Would the US HHS, ACOG or ACNM be willing to initiate such a campaign now that the UK has succintly identified the factors contributing to a needless increase in perinatal morbidity?
If ACOG says it, no one who matters will listen. I don’t think HHS would take an interest. CPM licensing is a state matter, and currently the only loud voices on the matter are pro licensing, though groups like Not Buried Twice are at least getting another voice out there.
ACNM is the only group that could say it and make it stick, and currently their leadership is not interested in doing so. I suspect a lot of their membership would be, however, if asked.
I’m going with nothing will happen to the CPM in the US. I found myself the other day explaining how lame the CPM credential was on facebook to a friend that is usually quiet rational and smart.
Our system here is so different that most people just don’t understand it all. The only reason I know is because I was thinking about trying for a VBAC and found Dr. Amy.
Unfortunately, I don’t see anything happening here until it becomes more popular and more babies and/or moms die.
I doubt it.
The ACNM is more interested in “sisterhood” than whether babies live or die. State politicians have no incentive to regulate CPMs because their supporters are often one issue voters while the average voter couldn’t care less about homebirth.
The midwives at Morecambe seemed more interested in “sisterhood” too and mothers and babies suffered the consequences. ACNM take notice. Proactive management trumps a root-cause analysis.
If this is the result of midwifery socialisation in a system where midwives specialise after nursing training, how much more isolated will midwifery practice be as training moves more into a separate stream, as is currently happening in Australia?
Labor ward staff already have their own culture, but most midwives currently in our system are trained as nurses, just as specialised doctors and allied health staff are trained as generalists first, and specialise later.
Can anyone reassure me that straight midwifery training without general clinical training will make better midwives?
I can’t imagine how straight midwifery training without a nursing background or experience could produce a well rounded provider with adequate critical thinking skills. As the population of childbearing women becomes older, unhealthier and has multiple chronic illnesses, I cannot begin to understand how a midwife without a nursing background could evaluate the significance or its contribution to maternal-child risks. Worse yet is throwing these midwifery students together in a culture of NCB without nursing experience in management of truly critical situations and it sounds like a recipe for disaster.
I’m against it too, because for many women this is often the first time that women are having very regular contact with medical professionals. Amongst women I know there have here have been a bunch of underlying conditions and immune system issues picked up during pregnancy (eg celiac, Graves disease etc). Someone with no general training on the human body could very easily miss some of the odd things going on.
Exactly. In addition, take for example something as basic to nursing as fluid volume management. Without a thorough understanding of cardiovascular and renal physiology in the nongravid patient, add in complex changes or pregnancy, birth and comorbidities of chronic HTN, preeclampsia or PPH and I just don’t know how it can be a safe model of training. An RN with general nursing experience on Med/Surg caring for a patient with renal disease or right sided heart failure makes for a better precursor to Midwifery practice than any nonnursing midwifery student.
I think that learning to do assessments is a huge part too. The old school nurses that trained me always said you want to be observing always, even just walking into a patient’s room. If the only thing on your mind and agenda is the excitement of pregnancy and birth and the only training you have centers solely on those things, it’s very short sided care that you will offer.
Wish I could upvote your comment, but don’t have a Disqus account. At times, Midwifery promotes the concept of Holistic care, but has entirely too much focus on the pregnancy and psyche with so little on the medical needs as a whole. You cannot claim to provide holistic care when you aren’t caring for the person as a whole and only as an event.
You are right. Having worked with both CNMs and non-nurse midwives, I see a huge knowledge gap in non-nurse midwives compared to CNM’s.
I haven’t worked with CMs so can’t compare. However, as clinical adjunct for student NP’s, the difference between experienced nurses and novice nurses pursuing graduate education in terms of critical thinking skills and clinical observation is profound. This observations holds true even for RNs never having practiced in a women’s health field and are now in the midst of a women’s health practicum.
For sure. Lack of experience is huge and sometimes it seems that sometimes non-nurse midwives lack even basic knowledge in anatomy and physiology.
I’m in my senior year of BSN school and recently shadowed on a high risk labor and delivery unit. (I’m interested in perinatal and neonatal health.) One day was more than enough to convince me that I need at least 2 years of med/surg before I pursue any kind of specialty nursing. I cannot imagine being able to do right by my patients otherwise.
I’ve seen new nursing grads go straight into L&D and ICU. They need LONG orientations with good mentoring, even more so than a med-surg RN. It looks like a struggle.
Yes. I know it’s done and can produce a good nurse, but I am pretty sure that is not the path for me. It would give me a lot more stress than I need in my life and I learn better with more processing time.
Yeah, imagine if doctors only ever studied their specialised field. Straight from bachelor’s degree to learning exclusively about orthopaedics or kidneys or whatever
This does concern me. Bear in mind that a lot of UK midwives have trained as nurses, most of the older ones, but as time passes their number will reduce.
I really don’t think it will. I’m a huge fan of general training and then specialisation in a field (Nurse-practitioner level). It’s expected for ophthalmics, why not obstetrics?
I think, while
there is definitely reasons to say that nursing or other health care
experience is a benefit it depends on whether you regard midwifery as a
professional group of it’s own (and the comments here seem to indicate
that and look at it’s failings) or whether it’s regarded as specialty,
which is post-training and not a separate group to the broader
professional grouping of nurses or doctors.
The things that need
to be considered if the entry criteria is rigorous and that they still encourage students in with previous nursing/medical training as preferential candidates, if training is sufficient and does it cover that
understanding of basic physiology and management of common conditions as well as specialist knowledge and more importantly where the limits of practice are and what safe practice is, and the system, it needs to be collaborative and coordinated with each profession/specialty working together for the patient. If those things are there, it could possibly work.
If those aren’t met, it’s going to be bad. In this case, even with supposedly a system in place it was horrific. Focus on one thing, above all else, even safety. Gross mismanagement of services and lack of objectivity of managers. Disconnected services, and staff, even obstetricians delivering patients that clearly needed more advanced services (they say they would deliver severely premature babies there knowing that the specialist services were not available at the hospital so emergency transfers were needed), training an issue, they claimed they didn’t know a cardinal sign a baby was having a problem, when other experts say it’s something they certainly should have known. Poor systems for investigating events, it kept in house and cases treated as “isolated incidences” despite being sentinel events. I’d think you’d really, really would want to be careful there, because it’s a realistic concern that with changes to training it could be disastrous.
I’d love to say that I’m shocked but I’m not. What I am is disgusted. The NHS is paid for by these patients taxes…..so the mothers and fathers taxes are paying the nurses wages. It’s disgraceful that women are being advised into home births with little or no painkillers or even birthing centres with no chance of an epidural. Even if there are no complications I can’t believe that women have have to beg nurses for epidurals in the hospital itself!
SINCE WHEN IS THE MIDWIFE RESPONSIBLE FOR DECIDING IF A PATIENT NEEDS A PAINKILLER?
I’ve heard women complain of being denied epidurals to midwives refusing to hand out bottles of formula. I really hope this report forces the Government to get rid of birthing certres, where hilariously midwives are even claiming that they are “safer” than hospitals(!), home births and get back to the Old days where labour and delivery are consultant led.
YOU CAN’T PUT A PRICE ON A HUMAN LIFE.
“midwives are even claiming that they are “safer” than hospitals(!)”
Oh gawd yes, my friend has been fully convinced by the midwives that the order of safety is home > birthing center > hospital. The Birthplace Study – well, not the study itself, but the summary of what the layfolk took from it – was widely circulated amongst her peers as evidence in favor of this paradigm.
The question is, “How can that be?”
Seriously, how can it be safer at home than in the hospital? That doesn’t even make sense.
It only makes sense if you believe that complications are caused by interventions and/or bad thoughts.
But why assume being in a hospital causes “bad thoughts”?
It’s the whole failing of the NCB, based on the presumption that the hospital is evil, and therefore you can conclude that the hospital is evil.
No, no, deciding to go to the hospital is a bad thought, because wanting to go means you think something might go wrong!
They also claim the home has fewer germs than the hospital! Ha, not my house I’m sure. After I had my DD someone came in a wiped down my room and bath in hospital everyday…That does not happen in my house!!
When I ask, I hear a lot about ‘infections’ – seriously, like setting foot in the hospital is an automatic massive exposure to MRSA, whooping cough, and other sorts of generic cooties. Secondarily, it exposes you to cut-happy OBs and their knives, and ‘those’ sorts of midwives who will induce you the moment they see you. Trying to get many conversations boiled down to the essence, there.
It feels, to me, like it’s just a general sense of ‘hospitals are icky’ and anything that supports that feeling is taken to heart.
It’s a good thing I’m unlikely to ever have children, and thus ever have to deal with a midwife,because if my child was hungry, and a person were to stand between that child and food for woo reasons, I would very possibly punch them. I am not a violent person, but that is unfathomable.
Oh honey. They usually don’t stand between your hungry baby and food themselves. They get you to do it.
The hospital LC who came in when my son was born was a classic. She had it down. She started off by asking if I had a nursing bra, and asking to see it. Then she asked if I’d had any advice, and made sure to tell me that anything my mother said would probably be wrong, because women my mother’s age had been told a lot of misinformation. (NB: The LC was about the same age as my mother.) After inspecting my underwear and insulting my mom, she went on to discuss how, if I gave my son a bottle, I might consequently never, ever be able to breast feed him. She told me we were clearly headed for difficulties – my milk wasn’t in yet, which was a bad sign, and I was going to get plugged ducts and mastitis – and adding to our difficulties by, oh, feeding the baby (like sensible people!) would probably doom us completely.
Fortunately (ironically) for my son, he was mildly jaundiced, which made the more medical staff insist that he eat something, and the something was formula, and we all came around fine in the end.
That LC was far more helpful than the one who showed up after my daughter was born. That one took two minutes to determine she couldn’t sell me anything, and left.
This is clearly a system that is not working in way too many sites in the NHS. And yet, I am constantly getting propaganda from ACNM (that I’m supposed to use to bolster my image!) about how wonderful the UK maternity system is and how we should have one just like it in the US. There is never acknowledgment of the rising number of perinatal deaths in some of these units. I would never be comfortable working in such a way as to have so much antagonism between midwives and OBs. It’s not safe. Obviously.
It’s very good in many ways. But there are also a lot of issues. There are things the US could learn from the UK, definitely, but the reverse is also true. Woo heads tend not to get this.
The American CPM is admired by some in the UK, Canada and Australia.
I find this horrifying because there is little to admire about the CPM. Apparently the ability to go where you want, do what you want and have no one hold you accountable sounds great to some people.
It’s a system that allows for a lot of income and no quality control. Bad news in general, especially horrible when life and health are at stake.
Like what? not being obtuse just wondering what you think the US system could learn from UK’s.. or did you mean regarding healthcare in general not maternity/newborn care
Caring for everyone across the lifespan would be a really good start. The UK does have a lower maternal mortality rate, though perinatal mortality is worse.
Both really. The US would do well to emulate the UK’s universal care provisions- there seem to be more women doing without prenatal care on your side of the pond, and we don’t have women who are effectively forced into homebirth for cost reasons as you sometimes do. The recent extensions in government funded care for pregnant women in the US don’t seem to have solved these problems. Then the UK could learn from whatever it is that makes your stillbirth rate better than ours, and could tackle the culture of epidural denial that exists. I’m far from convinced it even saves the NHS money anyway.
I’m not sure why the stillbirth rate would be higher in there than here. From reading this site I do know that stillbirth risk increases with post dates…If midwives are leading the care perhaps they are letting women go too far postdates rather than inducing when it needed??? (inducing is considered bad bad bad in NCB land, but really common in US hospitals) Can midwives induce labor in the UK??
Our system isn’t perfect, but wow when I read stuff like this…It scares me that this could be where our system is headed for my daughter.
I thought it’s been mentioned here that there were also fewer ultrasounds in the UK than in the US? And that UK women weren’t all automatically tested for GD and GBS? That alone would seem to have an impact…
For induction, I’ve heard second-hand that the NCB-type UK midwives are really against it.
The ‘standard’ ultrasound schedule is one dating scan at 12 weeks and one anomaly scan at 20 weeks, this schedule is increased if there is increased risk (multiple pregnancies have more as standard) and if antenatal findings suggest abnormality. All women with a family history of diabetes are offered a GTT at 20 weeks, as well as any women who present with glucose in their urine on 2 occasions antenatally. GBS is not routinely screened for, the NHS says it costs too much, but if it is present in a previous pregnancy then antibiotics are offered during labour. The postnatal newborn exam is carried out by either a paediatrician or a midwife who has done extra training and qualified to do it, and observations on the baby are routinely done both at home, in birth centres and in hospital.
Inductions are only performed in hospitals, some midwives are against it, but most delivery suite midwives are used to dealing with high risk pregnancies and as such work within those limits. Inductions are ordered by doctors, but the medications and observations are administered by midwives, the standard induction is usually a vaginal pessary (10mg dinoprostone) I think they usually try that twice, before beginning induction with synto/pitocin.
My money is on women, especially older women, going postdates, and with minimal NSTs and ultrasounds. I don’t think they routinely screen for thyroid disorders which is something the majority of American providers do. Not screening for diabetes is not going to help either. But I don’t really know enough about the system to do more than guess.
yes, i don’t know what the actual guidelines are but in practice you won’t be induced until 42 weeks unless they detect something scary going on with the baby.
I don’t know why either, but we should try and find out. Induction is usually offered at either term plus 10 or term plus 12, depending on the relevant Trust, sometimes earlier if there’s a particular reason eg older mother. So postdates might explain some of it, but my understanding is that we also have a poor stillbirth rate prior to 40 weeks as well. This is particularly significant given that virtually all women in the UK have antenatal care.
well that sounds better than 42 weeks but why not dead on 41. Aren’t all babies ready by then? my auntie wasn’t induced until 42+3 six years ago in Dorset. baby was fine but 11lbs(!) http://www.nhs.uk/conditions/pregnancy-and-baby/pages/induction-labour.aspx#close
http://www.nhs.uk/planners/pregnancycareplanner/documents/nice_induction_of_labour.pdf
looks like 42 weeks is still standard..
I don’t think it is. I’m not sure why they list 42 weeks there, but in every discussion I’ve ever seen online about this, people mention induction being offered as standard before then. Maybe some Trusts leave it that late, I don’t know? Mine doesn’t. But yes, as the EMCS rate is lower when induction is offered at 41 weeks, and obviously so is the stillbirth rate, there’s a good case for moving it forward to then.
They did used to leave it longer than 42 weeks though, a lot. My aunt was allowed to go to 17 days overdue 20 years ago, having had three ten pounders already! Outrageous. The baby was almost 12 pounds and there was shoulder dystocia. Luckily they were both ok, after a fashion.
The official guidance is that all women should be induced or sectioned BY T+10.
T+12 is just some Trusts hoping to save costs in the expectation that a significant proportion of women will go into spontaneous labour in those two days. It is not a clinical decision based on patient’s best interest.
The sad truth is that this nonsense is more common than people realise.
NZ and Australia are examples of where midwifery is now pushed as the solution to everything obstetric.
Hospitals believe they can save money so they blindly push the normal birth barrow. The boards get sucked in by advocacy groups and are too scared to stand up to them for fear of being deemed politically incorrect or ‘anti-women’.
On the point of why didn’t obstetricians complain: They do, until they are blue in the face. They are simply shot down as misogynist, old fashioned or ‘non-collaborative’ and excluded from further decision making as ‘trouble makers.’
One of the major advantages of midwives is supposed to be that they listen to their patients. On some level, the implicit tradeoff of having a midwife is having a less trained care provider versus one who will have more time to spend with you and pay more attention to your needs. Yet these midwives seem to be repeatedly blowing off women’s needs for everything from pain control to intensive interventions. So what’s the point? Get rid of the whole classification if they can’t serve their purpose and go back to OBs as the only care providers.
I agree, and find it fascinating that they’ve created this dichotomy of “midwives = listeners; OBs = refusing to listen.” Why is there the assumption that just because one is a doctor, he/she doesn’t care about the patient’s feelings or concerns? The OB I had during my pregnancy was fantastic, spending as much time with me as I needed…and I was an overly anxious first-time mother. I realize that not all are like her, but the dichotomy that the NCB movement has created ticks me off.
”They are simply shot down as misogynist, old fashioned or ‘non-collaborative'”
This!
I gave birth in January here in the UK and I found the midwives’ lack of empathy appalling. After 24 hours of agony I was offered a hot bath, codeine and paracetamol and told that “labour is pain” and that it was going to get a lot more painful, pethidine was presented as a safe alternative to an epidural, and the gas and air tube was shoved in my mouth, probably to shut me up – I’m convinced it is available for that sole purpose.When I got to the final stage what were supposed to be encouragements turned into insults when I was told that I was incapable of giving birth and that I didn’t want the baby out. I asked to be seen by a consultant and after warning me of the doctor’s brutality they finally gave in and I was so relieved to finally be treated like a human being in a moment of complete vulnerability and to be given the reassurance I needed. In the end, as I was thanking the consultant for delivering my baby one of the midwives admitted that she and her colleagues had let me down. I’m sorry for the abundance of unnecessary details but what I want to highlight is the inadequate attitude that these people can have – at Morecambe Bay the midwives weren’t in speaking terms with the consultants because they “made them feel irrelevant”. It’s time the NHS started to save money by getting rid of this medieval so-called profession whose existence increases the number of complications, incidents and complaints, and treated birthing women’s pain with respect and the appropriate medication, not with hot baths and paracetamol.
I’d call that abusive. Have you complained?
Not yet, I’m having a hard time accepting some parts of this utterly humiliating experience. Oh and yes, the midwife did try to talk me out of having an epidural and then played the whole “anaesthetist isn’t here it could be an hour it could be 2 who knows” game. What I find even more infuriating is that you can only have an epidural when you’re 5-8cm dilated, and they only check the dilation every 4 hours. I plan to complain as soon as I feel comfortable enough to talk to someone about the whole thing – a senior midwife, the most vicious, made me feel guilty for having an assisted delivery because of the “cascade of interventions” I brought upon myself by opting for an epidural and told me that my baby probably had a “banging headache” after the forceps delivery. It took me a good few weeks to start to overcome the guilt, and this website certainly helped, so thanks Dr. Amy.
God Almighty! I hope your report rings quite a few bells
I’m sorry you were treated so crappily. From what I’ve read re: epidural/forceps link from physician commenters on this site the epidural most likely did not cause the need to use forceps. Having a baby in a dodgy position or a big head for your pelvis that required forceps probably caused you to be in such pain that you needed the epidural. So the two interventions are linked but not for the reason the midwife told you. And a forceps delivery without anaesthesia is horrible.
and a 5-8cm rule is ridiculous. they’ve just picked the narrowest but still plausible sounding window to keep even more women away from the good stuff. such bs.
Don’t understand the whole epidural ‘window’ still being used in practice (although in this scenario, it is clearly based on ideology and not in the needs of the woman). In no other arena do health care providers use ideology or outdated information to quantify the extent of an individual’s pain. My rule of thumb is if you’re having regular contraction with increasing intensity and I can’t see the baby’s head, your window is open. Does a lot for a woman not to feel judged on her individual response to pain or her fear of the window of opportunity closing, takes the numbers game out of it as well.
I work with some older nurses who have the “4cm rule” stuck in their heads. I have to argue it out from time to time as I have the same “rule” you do 🙂
Does anyone even get admitted before 4cm? I mean apart from women whose waters have ruptured or are in for inductions. I ask because I went in to triage with regular ctx but only 2cm so they sent me home (so embarrassing lol) I went to an ob appt 7 hours later and I was 4 (ctx only a tiny bit worse i thought) and he told me I could go straight to L&D. I figured 4 was the threshold.
I was admitted at 3cm with regular and close contractions + intact membranes, but I was around 90% effaced.
Yup. Not frequently but when we have someone with regular contractions that just won’t quit and are painful enough that she needs pain medication, and she’s full term. And we have staffing and a bed 🙂 although really we’re not going to send someone away in active distress. We might keep someone “for observation” overnight and see if she makes cervical change. Long story short: Yes we do.
I wonder if we are working in the same institution. It is generational for those of us who were at the bedside when epidurals were first coming into use to have the 4 cm rule drilled into our heads. It was made to seem the world would end if an epidural was placed before 4cm. Now that we know better, it’s a hard practice to change for RNs, OBs and Anesthesiologists alike. I make a point with RN at bedside to reassure mothers that if she desires an epidural at any point, just ask, no exam needed. Comes with some eye rolling with RNs my age, not at all from younger RNs. Considering many of the older RNs (my age) are some of my dearest friends, the eye rolling is in jest as we all struggle at times to embrace changes and I never have a worry that a mother never waits any longer than the time it takes anesthesia to arrive from the time she requests one. Younger anesthesiologists will place at any request, a few of the seasoned will question the neccesity of an early epidural but never at the bedside. No one goes without an epidural once requested, but sometimes it takes a little reminding that the world won’t end just because she’s only 2cm.
Wasn’t there a recent paper saying there were no additional risks to giving pain relief before 4cm vs after?
I would encourage you to complain when you feel ready. My first birth included some of the same elements as yours, although I wasn’t given the epidural, and I felt better for complaining. I also think it led to me receiving better care next time round.
Please complain, when you feel able to.
Your GP might be helpful- I help patients work on complaint letters fairly frequently.
Maternity services see every delivery that results in a healthy mum and baby as a good outcome. If you don’t tell them that you experienced unsatisfactory, rude and disrespectful care they will not accept that it happened. Filling out anonymous patient satisfaction surveys won’t help.
The midwife will be able to frame it as you not being “a coper” and succumbing to a cascade of interventions. You need to be able to re-frame it as a woman who was in pain and requesting help, who was denied effective treatment and made to feel ashamed and humiliated that things didn’t follow an ideal script. Something that was out of your control.
Be angry. Name names. Make it clear that you would NOT recommend the hospital to friends and family. Ask for a formal written apology from your midwife, not just from a manager. State clearly that you want a record of your complaint filed in this midwife’s HR record.
Stating that you are prepared to complain directly to the NMC over failings in your care is a nuclear option you can use if you don’t get satisfaction.
Ask for concrete evidence of how they plan to prevent this happening in the future to other women, not just empty assurance that “lessons have been learnt”.
Be the squeaky wheel.
Yes, please, please, please complain! Remember you only have a year to do it though. My daughter went through a similar experience and I have failed to persuade her to complain. She is an anxious person at the best of times and the idea of reliving her experience by filing a complaint makes her even more anxious.
That’s exactly what I’m dreading, but I know I have to do it, otherwise I won’t be able to move on. Thanks for your advice.
Thank you so much for your advice and all the useful info.
I am so sorry that happened 🙁 I also encourage you to complain, sadly midwifery is one profession where some of the providers are incredibly rude and lack empathy, I’d recommend going through your GP as Dr Kitty suggested or seeking advice from PALS at the hospital. The level of care was far below standard, and that comment about the baby having a headache and it being your fault was outrageous. Note that in my year of midwifery training (I left due to mental health issues and bullying by mentors) we were told that sometimes babies can be uncomfortable from a long or difficult birth, but we were told this so we knew to be extra gentle not so we could guilt trip new mothers.
I am so very sorry that this happened to you. It is not evidence-based care to limit an epidural to such a small window. Studies show that administering them earlier or later do not increase the risk of c-section. I also cannot believe that the midwife would tell you that your baby likely had a headache from forceps delivery, especially given that their poor care was the real culprit. I hope you can make a formal complaint, and that someone listens.
That sounds like a nightmare. Fear of this very thing happening is what turned me away from using a midwife…I just got the impression that they would be all “You don’t need pain medication” and “Here, bite on this stick.” No, thank you.
I’m so sorry you had such an awful time..hope you are recovering well in both mind and body, and congratulations on your baby
The midwives weren’t in speaking terms with the consultants? They didn’t like feeling irrelevant? That is disgusting and at a moment of utter vulnerability, nonetheless. This model of care and NCB hubris failed you and falls nothing short of vicious and inhumane. I sincerely hope you and your baby are doing well now, despite what you were put threw. It seems the NHS is listening now and reporting your experience will be heard. It won’t change what you went through, but it may make a difference in the care others receive in the future.
Like I said when I first heard that quote, the midwife who identifies a complication in a timely manner, calls the consultant, provides a good description of the situation and assists the consultant in solving it isn’t irrelevant at all. The one who delays or blocks the consultant from providing help, or hides problems? Yep, irrelevant.
I’ve added an additional quote directly from the report; it is utterly chilling.
I want to know more about why the OBs didn’t step up and attempt to put an nd to this. That suggests deeper issues than radicalized midwives such as a deep cultural pblem and likely organizational issues (hierarchy etc) that are preventing a culture of safety.
Yes, it was not midwives alone–there were failures from all stakeholders–OBs/pediatricians (paediatricians, I suppose, in the UK!)/midwives.
I’m not sure that it is appropriate to blame the obstetricians and pediatricians for not complaining loudly enough; they were complaining. There was a culture within the hospital and shared by everyone overseeing the hospital that these deaths were to be ignored and that no one should or would be disciplined. How exactly could the obstetricians and pediatricians make headway against that?
Ultimately it was the parents who were able to get the attention of journalists and the journalists publicized the deaths. Only then, in the face of relentless public criticism, was a real investigation undertaken.
I suspect that the hospital administration was under pressure to ignore the issue because midwives are cheaper* than OBs and they were being told to cut costs at all…costs. This is not a problem unique to the NHS: I’m struggling with a similar issue at a hospital in the US. I expect that pretty much everyone in medicine is being pressured to keep costs down, even when doing so puts patients at risk.
We need a major paradigm shift in how we think of medical costs in the world. In the past, medical costs have been seen as a sort of dead loss to the economy, not producing anything. Thus, increased medical costs are seen as a disaster. I think we need to revise this way of thinking and simply admit that medical costs will and SHOULD increase over time. Embrace the high cost of medicine. In return we’ll get longer, healthier lives. It seems to me a good tradeoff.
*Well, if you ignore the increase in malpractice costs they are.
You took the words right out of my mouth. As soon as $$ is a factor, it’s amazing how many other factors can be completely overlooked.
But the trouble is, ultimately this is more mythologizing. Fully trained midwives are only cheaper than Consultant grade OBs. OB registrars are comparatively ‘cheap’, SHOs even cheaper. Also there seems to be a bottomless pit of funds to build and maintain more and more off site ‘birthing centres’. Funny, that.
Midwives may not actually be cheaper than OBs, especially after the malpractice payouts are factored in, but I’m almost certain that the NHS’s motive for promoting midwife care is the impression that it is cheaper. The current British government doesn’t seem stacked full of feminists, woo filled or otherwise. Though I can well believe that it’s a false economy, even looking just at the salary costs.
A valid point. Though it must be stated that it was the current government that pushed NICE to recommend MRCS.
In fact, when I lived in NZ about 20 years ago, there was no mechanism by which complaints could be filed against physicians at the licensing board. It was known by many MDs that one GYN thought that cervical cancer was best left alone. He did a “study” in which he just ‘watched’ patients with abnormal Paps until they became metastatic cancers. Despite many, many doctors under him knowing of this, he wasn’t stopped until his patients started dying and women started complaining to each other and the press. TCG, RN
Perhaps they were registering their concern via what looked like a channel to the appropriate authorities but was in fact a very short pipe with a cap just out of sight.
One way to ensure no issues is to set up a process where no issues can be identified. People get the release of sharing their concerns, no risk of any of those concerns actually being heard wherer they could make a difference, and certainly way cheaper than identifying and resolving them.
It certainly happens in the corporate world, I’m sorry to hear it may be happening where lives are at stake.
The article in the Guardian mentions senior Obstetricans writing a letter to management expressing their concerns, but without any action being taken.
The sad thing was that there WERE investigations, by the hospital, the Trust and the CQC…and no underlying themes were found. Everything was treated as happening in isolation, and it wasn’t seen in the context of systemic failures with a culture of hubris within a cavalier midwifery team.
I think the NMC is currently investigating six or seven midwives. It is highly likely that there will be sanctions and probably at least one person will be struck off.
Call me cynical but I will believe that when I see it. There was a midwife in my healthboard area who was directly responsible for the death of a baby, she deliberately delayed a transfer because she “thought she could handle it”. There was a big stoosh about her being made accountable and then nothing. Not a whisper about what happened next.
Well since the GMC has struck off one doctor, suspended another with conditions and given a third formal advice, with several more under ongoing investigation, the NMC will find it very difficult if they don’t impose similar or stronger sanctions, as the report is clear that midwives were directly responsible for much of the inappropriate care.
You can’t ask for independence and clinical lead responsibility and then say “oh but the OB is REALLY in charge, sanction them!” If it all goes wrong.
I wonder whether the cult of relentless positivity that infects so much business thinking also took hold in this environment. In that space, putting things together would be regarded as focussing on the negative (‘look how well we did here! Never mind that dodgy outcome over there!’). Further, it might be that concerns are all filtered past one spot in the office, to be reviewed and further discussion up ‘managed’ so that the boss gets a positive view of how things are going.
That kind of behaviour can lead to oversights that cause rockets to fall out of the sky, and could well lead to the kind of issues that seem to happen here.
“The implication of the new subatomic physics was that certainty was
replaced by probability, or the notion of tendencies rather than
absolutes: ‘we can never predict an atomic event with certainty; we can
only predict the likelihood of its happening’
And that only holds true at SUBATOMIC levels. Last I looked, babies were much larger than quarks.
Yet another abuser of quantum physics in the service of woo.
Oh I disagree. The concept of things being an issue of probability applies to everything in life. I live my entire life by the concept.
However, the “implications” of it in my life bear absolutely no relationship to the blathering nonsense she spews in the second paragraph that is quoted.
That things are best described as probabilities doesn’t mean it’s a frickin free-for-all and anything goes. There’s a whole field of study called “Statistics” that teaches us how to interpret things like this in a rational manner, and it is nothing like the crap she is peddling.
That was my exact thought: A probabilistic rather than deterministic view of the universe in no way means that ordinary things are beyond our control or unknowable. It certainly doesn’t absolve anyone of the responsibility for doing her job to the best of her ability! It’s just more quantum nonsense. “Modern physics exists, and I think it sounds cool but don’t actually understand it, therefore, magic.”
My clinical work is almost all about probability (with some human understanding and reassurance thrown in). That means that things that are more likely to be associated with certain clinical signs are – well – more likely.
Exactly. All that happens when you work in a probabilistic world is that instead of saying “If I do X then Y will happen” what you say is “If I do X I maximize the probability that Y will happen” (see Sue’s comment below)
And then you do the smart thing and play the probabilities, because that’s the optimal strategy.
Schrodinger’s box: If you have no fetal monitoring, then the baby is both alive and dead until it comes out.
“Because we eschewed appropriate monitoring, we have no evidence that the baby was not alive when it was in you. You must have done something wrong in the birth process to collapse the waveform.”
So let me see if I can work this out…
Proponents of homebirth in the States routinely point to the UK and the Netherlands as “proof” that homebirth is safe and that midwifery should be the standard of care. Yet the Netherlands is working hard to determine why properly screened, low-risk women still have a perinatal death rate 2-3 times higher than their hospital cohort, and midwives in the UK seem to be taking their cues from their under-trained lay counterparts in the United States.
Hint: You might want to come up with a more compelling argument for why the midwifery model of care is superior to obstetric care.
“You might want to come up with a compelling argument for why the midwifery model of care is superior to obstetric care.”
Therein lies the entirety of the dangers of NCB ideology, this claim of all natural and the Midwifery model as a superior mode of care. Midwifery and NCB ideology have fused into a dangerous model that promotes Midwifery as the ideal model of care. It has moved further and further from the Obstetric oversight, recognition of the significance of risk or willingness to intervene; where value of process is placed over outcome and this rogue determination of autonomous practice. When midwives began to believe their model of care as superior to the Obstetrical model was the moment Midwifery began to fail themselves and more importantly, the women they serve.
I only made it to the 14th page of the report earlier today and even at at that point, it became blatantly obvious that the chancre of NCB on Midwifery is the root of dangerous practice and poor outcomes. I don’t even know how to respond to how sickening it is to have interventions and consultants at hand in hospital-based care and to ignore it’s value or accessibility, all in the name of NCB ideology and at the expense of mothers and babies.
You know that I am a huge advocate for CNMs (they delivered both of my kids), but privileging normal birth is becoming far too common in this group as well. I have seen some disturbing changes in the web page of the CNM group that I used that strongly suggest the growing influence of woo. I can also see that several of the better (I.e., medwives), have left. This is a bad state of affairs.
I got into this discussion a couple months ago and a friend put forth the argument that since a certain percentage of hospital births are “freebies” numbers-wise because they’re c-sections, if you took those out of the data set would hospitals still have an advantage in terms of the numbers. (…??) She asserted that hospital patients receive totally different management than homebirth patients and so you can’t compare the two groups. Um, yeah, you totally can compare two different groups that received different treatment protocols. That is the basis of many a clinical trial. But I got tired of arguing with her total lack of comprehension of statistics or medicine.
I am given to believe that since the experience is so wonderful and awesome for those patients for whom it goes well, that is what makes midwifery awesome, and those who end up with bad outcomes are… what, collateral damage? Whereas doctors manage everything like it might go pear-shaped quickly, and it’s not fun to be managed like you’re a disaster waiting to happen, but it does typically prevent things from going REALLY pear-shaped. I mean, it sounds good to be a midwifery patient as long as you firmly believe you’ll stay in the good group. Ask any homebirth loss mom how well that worked out for her.
I didn’t mean “given to believe” to say that I actually believe that… I think that sentence got away from me, and I can’t edit my post. I meant that is the understanding I have of the beliefs of others, not that I agree with those beliefs.
You know when I have my children in dangerous place I watch them like crazy (Stay close to them, hold their hands, or literally just hold them, make sure they can’t get out the stroller, etc.). Most smart people try to avoid bag things happening. Acting like OB’s are bad because they know bad things can happen and they actively try to avoid those bad things … is crazy reasoning to me. “Most accidents are freak accidents.”
I think it’s kind of this “You don’t want to live in fear” mentality. Acting like something can go wrong at birth ruins the experience. Combined with a dose of magical thinking, that you will attract the outcome you desire.
I’m not too, too worried that if my daughter runs out into the street on our very quiet street she will get hit by a car, but I still don’t intend to make a habit of letting her do it by herself until she’s older. If I’m ruining her experience of the street, at least she is still alive, and that’s what counts.
There’s a study out there that showed people who worry live longer!! A dead or damaged baby would definitely ruin the experience for me.
I have a friend in the UK who was forced to labor naturally. She popped several vessels in her eye that could have left her blind and her son almost died (two true knots, wrapped three times around the neck). It took her months to be allowed to have a c-section with her second.
Whatever else might be said of a public health system, I’m glad I was able to go straight to an MFM who cared more about getting my children out safely than about how to cut costs.
If you go on UK mothering forums you will hear tale after tale of women being forced not only to labor instead of getting a c-section that they needed or wanted, but being forced to labor without pain medication despite repeatedly asking the midwives to get them an epidural.
Apparently there is a culture among midwives there of being so opposed to epidurals that they will tell laboring mothers that the anesthesiologist has been called when he hasn’t, and that he’s running late, for hours… until the midwife can say oops, it’s too late for an epidural now.
Yeah. I have heard some great horror stories from several others. When even a T1 mother (automatic high risk, MFM involved ‘oh no missy, no regular OB for you’ as I was told in the US) can’t ask for a c-section and risks her already precarious eyesight?
She had to change doctors to get permission for a c-sec on the second.
That happened to me. I have actually also had some stunningly good midwife care too, indeed the majority of it over my two pregnancies and births has been at least good and sometimes magnificent. My recent EMCS and live baby was achieved because a midwife picked up on a problem in what should have been a low risk VB, averting tragedy. But the culture of epidural denial and forced NCB definitely exists.
Meanwhile, people like Hannah Dahlen write about the greater use of Caesarean birth in Australian private hospitals (compared with public hospitals) as if having that choice is a bad thing.
I wonder though if it cuts both ways sometimes.
A well known local ob here (now retired) had a high c-section rate. Every woman I know who went to him had a section; and in every case he sent them home from what would have been their last appointment for the pregnancy to pick up their bag so he could whip the baby out that afternoon, as it was ‘urgent’.
Now this happened in say, 10 women over five years, and among the birthing mums not going to him, the c-section rate was lower. Way lower.
All babies and mums were great, no one had any complaints, but I do wonder how many of those sections were urgent given the pattern I saw forming among my fit, healthy, early thirties, appropriate weight cohort.
Were all my friends who were his patients given a real choice? Given the outcomes, I suppose it doesn’t matter, but when ‘choice’ is the subject I do wonder.
All babies and mums were great, none had any complaint.
You do not know what they talked about during their appointments, and there are a lot of women that are not willing to talk about their obstetric history with everybody. A CS at term is usually safer for the baby, maybe those women did not want any risks at all for their babies.
If you really want a C-section, perhaps for reasons you don’t want publicly known, who better to go to than the doctor renowned for being quick to do C-sections and having good outcomes with them?
Quite. If I thought, for any reason, that I had a moderate to high probability of ending up with a c-section I would rather have an obstetrician who does one a day rather than one a month.
From my own experience of being pregnant, women discuss their obstetricians. If a particular obstetrician has a very high c-section rate, this tends to be known, and women who are very invested in natural birth will avoid that particular obstetrican, and vice versa. My own obstetrician had an extremely high c-section rate, but his area of practice was specifically multiple births and certain other types of high-risk pregnancies. Locally, he is the go-to doctor for twins and especially higher order multiples, but is shunned by those in search of water births.
Sure, that’s the worst case scenario in their minds. C-sections create unloved children who will grow up to be serial killing autists due to the lack of vagina-touching and immediate skin to skin contact.
As far as I know you can’t request an OB here in the UK as prenatal care is provided by midwives unless there is an issue. For example, gestational diabetes, high BP etc, all sorts of maternal or fetal health concerns. OB’s deal with women and attend births that have additional needs or complications. A patient with a healthy, uncomplicated pregnancy may never see an OB the entire time. While I agree with Dr Amy that the push for homebirth and stand alone midwifery units is based on misinterpreted science I think the UK system isn’t too bad. The midwives here have a university degree, are fully trained and at the first sign of any issues you are referred straight to the OB and the care is a team effort. There doesn’t seem to be the same OB-midwife divide! However, from talking to friends in midwifery there does seem to be a higher level of ‘woo’ in midwifery compared to other medical disciplines (aromatherapy, homeopathy etc). I do think it’s a good system – see a midwife until additional expertise is req – but the dogma of ‘natural birth’ is leading to dodgy reccomendations!
The things I hear from my UK friend definitely gives me the sense that the midwives are trying to steer women away from hospitals and Obs. I hear all of it second-hand, but it’s a lot of ‘cut-happy Obs’ and ‘unnecessareans’ and ‘hospitals are really risky and you get tons of infections there.’
Are VBACs a situation where you see an Ob?
http://www.skepticalob.com/2012/05/how-does-your-midwife-really-feels.html
About midwifery students in the UK. I have no problem with seeking out a midwife who is university trained and delivers in hospitals. What I have a huge problem with is said midwife refusing pain relief to laboring patients all in the name of ideology.
What good is “university trained in hospitals” if they are still going to be about ideology? What good does it do to have advanced medical training if they are going to not use it?
And when a midwife says, “We can just transfer in case of an emergency” it means nothing if they don’t acknowledge that they are in an emergent situation. So the uneducated don’t transfer because they don’t know any better, but the more educated don’t transfer because they think they know better than they do because of their education.
This is why homebirth CNMs in the US are just as bad as CPMs. Despite having the extra training, they are stuck in the ideology and that is what makes them incompetent.
Except that report contradicts your claim that “at the first sign of any issues you are referred straight to the OB and the care is a team effort.”
Maybe in many hospitals it works. It clearly didn’t at this hospital.
True. I’m just going by the my experience and that of friends and family. I had excellent midwifery care in the UK and Ireland and I think the system of seeing a midwife until you have the need of an OB is great when done properly. My midwives didnt care what my choices were as long as everyone was safe and healthy. When discussing options at an appt a fab midwife said to me ‘why would it matter to me if you have an epidural or not, it’s your choice’ – love that! Sadly, not all of them are like that and the dangerous natural ideology persists. What is really scary is that our politicians are buying it and making recomendations on the back of it.
Actually, no, you CAN request obstetric led care in the UK, even if you are low risk, it just isn’t pushed as an option.
I have several patients who, while remaining low risk, have had such negative experiences with midwives in previous pregnancies that they have requested OB led care. To date such a request of mine has never been declined.
You also have the option of private maternity care, if you have a spare 5k lying around…
…And you live in or near London. There is NO private, OB led maternity care available in England, Scotland or Wales, not sure about NI. If you are really lucky you might find an OB/Gyn who will take you on as a private patient. I found one, 24 years ago but there are none in my area now.
NI has a weird (very weird) system.
The OBs who work privately all also work in the NHS.
So, you pay your 3-5k and you have all your antenatal appointments in person with the OB in the private clinic.
Then you have your baby in the NHS hospital, with midwives, but your OB will be phoned as soon as you arrive, and all decisions about your care will go through your OB, and your own OB will do your CS or delivery.
I saw my OB as a private patient the first time, but for free, because he’s a family friend. This time, as he’s retiring midway through my pregnancy, and we’re going for ERCS, I’m going NHS.
I’m not low risk, or a good candidate for a VBAC, so I’m going to get frequent third trimester scans and lots of other stuff that most people won’t.
Did they outline what they intend to do about it? Are they planning to do the re-org Dr. Amy suggests above, with OBs at the top and midwives as assistants?
I don’t know much about the healthcare system in the UK. Are women able to request an OB instead of a midwife?
Yes. But no-one will tell you that unless you ask, and you will still labour with midwives as your attendants.
NICE does support MRCS though…so there is that.