Dear Baroness Cumberlege: UK midwifery has become a sisterhood of deadly enablers

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Dear Baroness Cumberlege,

Congratulations on your appointment as Chair of the maternity review mandated in the wake of publication of the Morecambe Bay Report. It is a weighty responsibility to have the task of protecting the UK’s mothers and babies from poor clinical care, refusal to address devastatingly poor outcomes, and a tendency for officials at every level to champion each other rather than the babies, mothers and families they are obligated to serve.

I cannot say that I am surprised by the findings of the Morecambe Bay Report. From my blog across the pond I’ve been following midwifery in the US and other countries for nearly a decade. I’ve detailed the progressive radicalization of British midwifery in theory and in practice. The hideous outcomes at Morecambe Bay (where 16 babies and 3 mothers died over a 9 year period) to the newly revealed horror at Royal Oldham/ North Manchester General Hospitals (where an appalling 7 babies and 3 mothers died in just 8 months!) are the inevitable result of a policy where UK midwives consider themselves “guardians of normal birth” instead of guardians of the lives and health of mothers and babies.

I understand how a group of providers can become more concerned about their own self-interest than patient well being as UK midwives have done. What I do not understand is how the NHS has allowed UK midwifery to become a sisterhood of deadly enablers who feel free (on social media no less!) to harass loss parents, make light of their suffering, ignore dead babies and dead mothers, and complain that not enough attention is being paid to their feelings.

I suspect that observing this type of behavior, which will probably not be addressed in the maternity review, might give you some insight into what those who desperate to secure quality midwifery care for their themselves and their loved ones are up against.

I’d like to share with you what happened on just one day, on just one social media platform, as a group of midwives attacked an obstetrician and a loss father.

How did this come to my attention? I was the cause of the attack.

A Professor of Obstetrics alerted a loss father (in his role as patient safety advocate) and myself to a midwifery practice boasting about a successful homebirth after 3 C-sections.

Can you spot the problem? According to the midwives (and journalist/professional natural childbirth advocate Milli Hill) who parachuted in for the attack, the problem was not the terribly risky homebirth. The problem was that a Professor of Obstetrics had dared to correspond with me and they didn’t approve … they didn’t approve at all. You can find the beginning of the Twitter conversation here (UK midwives foolishly continue their bullying on Twitter).

Hill captures their criticism succinctly:

Tweet 4-6-15 3

YOU should explain why you are tweeting with Amy Tutuer [sic]

That’s how I came to be part of the Twitter conversation, and what I observed may interest you in your forthcoming task.

I observed a group of midwives that has become a sisterhood of deadly enablers, ignoring deaths of their patients, incapable of tolerating criticism or even listening to it, patrolling social media to keep obstetricians and loss parents in line, and cheering each other on by encouraging outright dismissal of any criticism.

For example, midwife Sheena Byrom, as is her wont, started tweeting the conversation to NHS accompanied by (yet another!) thinly veiled threat to report the loss father’s failure to toe the midwifery line to your maternity review.

Tweet 4-9-15 1

That’s when I copied you in so you could see the bullying in action.

In the 100+ tweets that passed back and forth over the course of the day yesterday, I did not see even a single one from a midwife acknowledging the appalling litany of maternal and perinatal deaths at the hands of UK midwives. The same dangerous midwifery culture that leads to praise of homebirth after 3 C-section also leads to shirking any responsibility in maternity deaths, and the privileging of process over outcome that the obstetrics professor, the loss father, and I are working hard to confront.

Instead I saw this:

Tweet 4-9-15 3

And this:

Tweet 4-9-15 2

And this:

Tweet 4-9-15 4

I do not understand how midwives can be so brazen as to behave this way in a public forum, and I fear that the same vicious response to criticism is what mothers and fathers face in attempting to hold midwives to account. It is almost as if they believe themselves to be untouchable; they act as if it does not matter what they do, whom they harm, and what tragedies they cause, because as long as they ignore criticism and stick together they can avoid being held to account.

Baroness Cumberlege, in addition to being an obstetrician, I am a mother of four children, now grown. There is nothing more precious to me than these children (and their father) and I cannot imagine the horror of losing a child because of a midwife’s fealty to normal birth above all else, and THEN have to endure contemptuous dismissal of my loss by midwives who promote the philosophy that led to the death of my child.

The task ahead of you is enormous, and I beg your indulgence in intruding on your time, but it is important that you are aware of the vicious behavior of UK midwives on social media, which, I fear, is symptomatic of the behavior that has led to so many preventable deaths.

Sincerely,
Amy B. Tuteur, MD

  • SuperGDZ

    Isn’t Cumberlege thoroughly in the midwife camp? I understand that she was the political force behind midwife-led care and “normal” birth. And there’s this –

    http://www.iolanthe.org/Trustees.cfm

  • sdsures

    I live in Greater Manchester. Boy, am I glad that that’s not my hospital!

    • Sarah

      Same!

      • sdsures

        I’m in Walkden. 🙂

        • Sarah

          South Manchester here.

  • Amy Tuteur, MD
    • Amy Tuteur, MD

      Fortunately, I’m not similarly constrained.

      • fiftyfifty1

        Yes. Thank goodness somebody can stand up to those bullies. Because it looks like UK OBs can’t. Seems that it’s just you and Mr. Titcombe with guts enough to speak out.

    • Life Tip

      “And even if we were perfect, it might still sometimes be better to take a bit of risk to allow nature to take its course.”

      Oh really?

    • sdsures

      “The link (click here) was to a mother’s post about her successful home vaginal birth after three Caesareans (HVBA3C). The recipients were James Titcombe whose son Joshua died in Morecambe Bay NHS Trust, led the campaign for a public enquiry, and was vindicated by the Kirkup Report (clickhere).”

      A “successful HVBA3C…[whose son died]”.

      Successful?

      Successful???

      How dare they?

  • Dr. W

    If the hospital I work at lost 7 babies and 3 mothers in under a year, the state health dept would just be living at our facility. If our OB dept had the reaction of, “no biggie”, they would all be drug tested and fired.

    • Neya

      Talk about nut cases… There many problems with hospitals. Many medical professionals are not properly trained – even after years of training. What is the logic of thinking that less (no more training) will make birthing safer?

      • Well, you see, these women have vaginas. Logic dictates that they are masters of birth, seeing as though they have the parts necessary for it.

        You know, the same way that having bowel movements qualifies me to conduct home colonoscopies and attend the colonoscopies of others.

        Trust the anus!

  • Bugsy

    Completely off-topic: the Coursera class on Vaccines that turned me from somewhat anti-vax to strongly pro-vax has a session starting next week: https://www.coursera.org/course/vaccines?hc_location=ufi

    Needless to say, I highly recommend it!

  • Anj Fabian

    I read the list of the proposed committee members.

    Guess who isn’t invited to participate?

    I snickered when I saw that over a week ago. Twitter all you like, ladies. You aren’t going to be on the committee. You won’t be helping to make decisions. You won’t be determining policy.

    Now go away before I taunt you a second time!

  • Brix

    Fantastic letter. I’m appalled at the midwives’ arrogance. Not only in what they say but in how publicly they feel free to say it. Unbelievable. I’m glad that I live here, where I can choose my own healthcare provider when I give birth.

  • lilin

    It’s a wonderful system – people have to EXPLAIN why they talk to you. Midwives are CONCERNED about the LIAISON and your INFLUENCE.

    Notice they don’t have to explain anything. They don’t have to explain why you’re a terrible person. They don’t have to explain why people shouldn’t talk to you. They don’t have to explain anything. They have declared you bad and that’s that and everyone else has to prove to them that it’s okay to talk to that awful, awful Amy Tuteur!

  • demodocus’ spouse

    The lion picture is an interesting choice. Did you know that male lions sometimes kill cubs that are not their own when they take over a pride?

    • The Computer Ate My Nym

      Also the lions are going out to kill something. While this is totally appropriate lion behavior, it wouldn’t be the image I’d want associated with my midwife or OB. And male lions are lazy butts who usually just wait for the female lions to do the work and then steal the food.

      • MLE

        Damn it, comments like these are why it sucks to sign in to upvote.

    • sdsures

      Not sometimes. All the time, when new males take over a pride, they kill cubs that are under a year or so old, in order to bring the females into estrus so they can bear the new male’s young instead of nurturing a rival’s offspring.

  • Cartman36

    Don’t these midwives have attorneys advising them that speaking with a loss parent, especially in a public forum, is a bad idea?

    • Cobalt

      Maybe they have Certified Professional Attorneys who take a very “hands off” approach?

      • Cartman36

        LOL!

      • Daleth

        Hi-larious!

      • rh1985

        with a Google University degree?

      • Mad Hatter

        Or a Direct Entry Attorney!

      • Petanque

        Only Natural Litigation is allowed!

  • Bravo! There’s a cultural problem – it runs deep and short of being called out full-stop, will not change. Maternity care providers need to have a profound connection to what their purpose is (the health and well being of mothers and babies), and need to put whatever other goals may be as entirely secondary to that primary purpose. They need to understand and work together as part of a care team – one that places those with the most skills and qualifications as the lead on that team. There needs to be shared decision making (with patients who have had their right to informed consent respected) and a relentless commitment to continual improvement. This girls club thing is really unhealthy!

  • LibrarianSarah

    Sorry but Baroness Cumberlege might just be the most British two words since the invention of Benedict Cumberbatch. I feel like she should be a character on Downton Abbey.

    • Roadstergal

      I thought it sounded like the most made-up British name since Sir Bradley Wiggins.

      • Daleth

        Or Bandersnatch Cumberbund. Or whatever that actor’s name is.

    • The Computer Ate My Nym

      Upper class British no less.

      • LibrarianSarah

        Quite so. But at the same time it wouldn’t surprise me if her neighbors called her a “strumpet” for having an affair with a cockney chimney sweep.

        …I really need to get out more.

        • The Computer Ate My Nym

          As long as she is seriously and sincerely not amused by the mess that’s being made of low risk OB care in the NHS.

  • I’m reminded of corrupt police in the States having the run of their town and brazenly threatening anyone who dares ruin the sweet thing they have going.

  • Amy M

    Slightly OT: I skimmed some of the other birth stories on that one-to-one site (Where the successful homebirth after 3 Csections story is)—there are a TON (relatively) of high-risk homebirths in there. The mothers who wrote the stories even admit that they were discouraged from having homebirths by doctors. There were a lot of VBACs, GD, one who had been categorized as high risk due to overweight. There was a twins story, but it was hard to tell if they were born at home or not. Probably not, because that’s a detail that a homebirther wouldn’t leave out.

    Their website says they “work in partnership with the NHS” but I thought the NHS had some risk-out criteria?
    “One to One ethos of care acknowledges that birth is a natural physiological process and as such support home birth for low risk women who request it. Our goal is to support women through evidenced based decision making.”–that’s their mission statement.

    Obviously there’s a lot of NCB going on with that place, but I thought the NHS definition of high-risk was similar to ACOG’s? If so, and these women are attending homebirths of high-risk women, they are not working in partnership with NHS, they are working at cross-purposes.

    • Cobalt

      Maybe THAT should be reported to the NHS.

    • Amy M

      Found one now where she labored for 3 days at home AFTER her water broke, but was “monitored” by the midwife for signs of infection. However, when baby was actually being born the monitoring was even more minimal. Several accounts (from different women) of how “hands off” they are–if it hasn’t already happened, eventually a dead baby will be born and they’ll be all “but he had a heartbeat an hour ago!”

      From another story: “…my waters broke, I felt a pop and looked down thinking `ooh aren`t they clear`. At this point the contractions changed, … started to bear down, feeling woozy and thinking `he is coming`, I ended up half sat/half lay, feeling his head as it came…then nothing, I opened my eyes and expected him to be here..his head had been delivered but his body wasn`t coming, my contractions had stopped, one weak one later he slowly started to come, I had to literally push him out myself without contractions. He was like a parcel, the cord wrapped around his body several times. He was shocked, we tried skin-to-skin and rubbing him, but he needed some help.” She was apparently unfazed by this.

      • Cobalt

        So, “the cord wrapped around the baby in a way that is difficult to deliver vaginally without extra risk of hurting something because the baby cannot descend properly”, does that have a categorical name?

        And is there a way to test for and definitively diagnose that in labor, instead of reacting to symptoms once the baby has committed to pelvic transit?

        • Amy M

          I don’t know, but if she had continuous electronic monitoring, it would have picked up if the baby’s cord was being compressed at some point. Plus she mentioned meconium—maybe that’s why he needed help, if he inhaled some? We can’t know from this story, but I doubt the mother or even the midwives know either, since it appears that there wasn’t much in the way of monitoring.

          • Cobalt

            The hospital monitoring means they can know sooner and react appropriately, as opposed to just seeing what happens and hoping no one does. Even if it’s still purely reactive management, there’s an awful lot of reactions available in the hospital that aren’t available at home.

            I was just wondering if there was a way to know sooner, like ultrasound or something. If I can know beforehand that my kid’s umbilical cord is wrapped all wacky and is likely to tether him short of the exit or cause other major trouble, I might make different choices.

          • Squirrelly

            I believe they can? At least I know at my last 2 ultrasounds (32 and 38 weeks I think?) I was told baby had a loose 1x nuchal cord. I was reassured this is very common and rarely a problem, but to be extra vigilant about doing kick counts. At the hospital I mentioned it to my delivering OB who also said no problem and, sure enough, she pulled the cord off as baby was born. I’m sure if they can spot a single loop they can tell you if baby is wrapped up like a baked potato. One caveat is I saw a perinatologist for my routine scans so maybe they had nicer equipment than a regular OB, but still.

          • Pinkie

            All babies are monitored during labour. IF there are additional risk factors they are monitored continuously (CEFM) IF they are considered to be low risk then they are monitored intermittently, whether at home or in hospital.. The guidelines are to listen for a full minute every 15mins during 1st stage & during every contraction for the full contraction during 2nd stage. The mother can decline this if she chooses. CEFM has been found to increase the chance of CS without any benefits to mother or baby in LOW RISK WOMEN,

      • Anj Fabian

        The baby “needed some help” chills me now.

      • The Computer Ate My Nym

        one weak one later

        I initially read this as “one week later”. The image in my mind was…startling.

        • FrequentFlyer

          Glad I wasn’t the only one!:)

          • Kq

            No, you weren’t the only ones.

    • Roadstergal

      So – how does this work when it comes to mothers in the UK making risk assessments? Do midwives have to sit down with them and give an overview of the risks, with numbers? Or can they just say with a nod and a wink, “Well, we technically have to advise you against homebirth, but if you insist on it, we’re happy to come out and support you”? I’m just wondering how a pregnant woman in the UK does or doesn’t get accurate information.

      • Amy M

        I have no idea, but would be interested to know as well.

      • Pinkie

        women have an absolute right to give birth at home, despite the risks ( real or potential). Midwives would discuss the risks/benefits/alternatives with the woman & support the woman whatever her decision. A midwife cannot refuse to care for a woman, whereas a woman can refuse to have care from a midwife/OB ( free-birth). So the HBA3C woman would have been told the potential risks etc, but it was HER decision. The midwives who attended her had no choice. It would be against the midwives rules to not attend. One to One Midwives have a contract with the NHS to provide care to women in various areas of the country.

        • Guesteleh

          But they didn’t have to publish her account of the birth and trumpet her choice on their website. The story is clearly posted to brag, which will encourage other mothers to make the same potentially (eventually) deadly choice. That’s what makes it despicable.

        • Roadstergal

          I understand that women have the right to HB, and that in the UK, midwives are required to attend. My question is different – how do women in the UK get accurate information regarding their risk? _Do_ they? What are the responsibilities of midwives when it comes to explaining risk?

  • Mad Hatter

    OT But I’ve seen a few references to midwives in Oregon on here. Are the midwives less competent than in other states, less regulated, more HB deaths? Just wondering since a family member who lives in OR is planning a birthing center delivery…

    • EmbraceYourInnerCrone

      In 2011 the Oregon House Health Care Committee amended the direct-entry midwifery—“DEM”—law to require collection of information on planned place of birth and planned birth attendant on fetal-death and live-birth certificates starting in 2012.
      There was an analysis of 2012 intrapartum and neonatal death rates by planned place of birth, at the request of the State of Oregon. It was performed by a CNM Judith Rooks, who is a supporter of direct entry midwifery. You can read the details here:

      http://www.skepticalob.com/2013/03/oregon-releases-official-homebirth-death-rates-and-they-are-hideous.html

      From CNM Rooks own report: “Note that the total mortality rate for births planned to be attended by direct-entry midwives is 6-8 times higher than the rate for births planned to be attended in hospitals.”

      • EmbraceYourInnerCrone

        Oregon has numbers available because they started requiring “planned” place of birth and “planned” attendant be included on the certificates. The reason that is important (as you may know) is that when someone is transfered from a crashing home birth to the hospital because of problems and the baby is born dead or dies soon after birth, that death end up in the hospital intrapartum or neonatal death rate.

        • KBCme

          They should require a warning label on birth centers (a la cigarette packs): Birthing your child here is 6x more likely to result in death.

        • JJ

          So if all states started tracking like Oregon we would probably see the same bad stats? Is a DEM the same as a CPM or LM? Thanks!

          • Ash

            CPM: has to pass certification with North American Registry of Midwives

            DEM: basically someone who calls themselves a midwife but wants to put a title behind it. No regulation of this term in many US states. I could call myself a DEM, move to Utah, and practice homebirth midwifery. I have zero experience or training.

            LM: this is all over the place, some states have an LM title, some don’t.

          • JJ

            Thanks! I had no idea about the DEMs. Scary!

          • Mad Hatter

            Would a birth be safer with a CPM than a DEM? I know a DEM with over 30 years experience, including the births of two of my siblings. I googled her name and ended up here. That was all it took for me to plan a hospital birth.

          • Cobalt

            Depends on the individuals, because what minimal standards sometimes exist aren’t consistent. There’s no way to know, the qualifications themselves don’t really mean much.

          • Medwife

            To me CPM and DE midwives are the same thing. Direct entry into midwifery without RN training first.

          • Liz Leyden

            CNMs are registered nurses with a Master’s degree who have passed a national certification exam. They practice in all 50 states, and regulated by the state board of nursing. Some states allow CNMs to work independently, some require collaboration with a physician. A small number do home births.

            Non-nurse midwifery varies widely. Some states allow them to do home births independently, some require physician collaboration. Some states don’t recognize non-nurse midwives. Some states don’t regulate non-nurse midwives at all.

          • Mac Sherbert

            So maybe this is something that should be brought up in states where CPMs are trying to get the right to practice. I feel another letter to my representative or several may be in order.

          • JJ

            Well in my state they are trying to pass bills making “assistant midwives” legit and essentially get homebirth covered by medi-cal. The states should be carefully tracking these outcomes to see if any of them are a good idea.

          • Cobalt

            I’ve heard some crazy things about Medi-Cal, like not covering epidurals and circumcision. I don’t know if that’s true, and I certainly hope it’s not.

          • Guesteleh

            Both untrue.

          • Guest

            I can’t speak for California, but I know that the North Carolina version of Medicaid does NOT cover routine infant circumcisions. Parents are charged $350 (last I checked) for a basic circ prior to one month of age. When the AAP changed their recs regarding circumcision (no medical reason to recommend routinely), several state insurances stopped paying for Circs.

        • The Computer Ate My Nym

          Are the data publically available? I do love rifling through a good data set.

      • KBCme

        Wow. This needs to be shouted from the rooftops here. I live in OR. I had no idea. I did consider a birth center for about 2 seconds with my first. I’m so very glad I didn’t. Those numbers are staggering and appalling.

        • Cobalt

          “Well, if you exclude Portland…”

          Someone actually tried to say that the numbers weren’t that bad, you just had to exclude that major metropolitan area (and therefore most of the deliveries).

          • Ash
          • Mad Hatter

            Because babies only die in Portland? There’s 4 birth centers that I found on google in Medford. That’s where my relative just delivered. Live, healthy baby, thank goodness!

          • Bombshellrisa

            It’s even scarier thinking of a home birth in La Grande, but there are midwives who attend them.

          • momofone

            I live in the state with the highest obesity rates in the country, and I think that could help our stats tremendously–we’ll just stop counting where the PEOPLE are, and see instant improvement! I feel healthier already.

          • stenvenywrites

            There are lots of things you can say about Illinois, too, if you leave out Chicago.

          • D/

            Wish I could apply the concept to my budget. 😉

            “Well, if you exclude the bills …”

      • Mad Hatter

        Thanks! That is what I was wanting to know. I think that should be required in every state! And from what I understand a birth center birth is just a home birth away from home.

        • EmbraceYourInnerCrone

          Depends on the birth center from what I understand. (please understand I am not a CNM nor an OB. I work in a Lab….in the IT department.
          What I know I learned from relatives in the medical fields (Nurses, EMTS, assistant coroners) from reading and from websites like this one, Doula Dani, babymed, etc
          A friend gave birth to all three of her kids in a birth center, but it is a hospital attached birth center and while it has all the home-like rooms and so forth it also has ORs down the hall.
          Many birthing centers have no hospital affiliation, little or no resus equipment or training, and no real plan if things go south. I am long done having kids but when I was I did not subscribe to the “If you don’t think about it nothing bad will happen” method of dealing with possible problems

          • demodocus’ spouse

            One of the local hospitals calls their labor and delivery unit “birthing center.” That one I wouldn’t have minded, the O.R. was immediately next t the regular rooms

  • Karen in SC

    I hope all readers in the UK tweet this to the Baroness and any appropriate authorities they can think of.

    • Hannah

      I just moved to the UK from Stateside, and although I don’t have Twitter, I’m thinking of sending a letter. And it’s going to be all about how midwifery culture scares the s*** out of me so badly I’m actually considering moving back to the States before we have kids because of the way they treat laboring women, and was considering this even BEFORE these reports started coming out. Women shouldn’t have to go private to be treated like human beings instead of animals.

  • KarenJJ

    In some ways I want them to keep digging that hole they’re digging (liasion? WTF?). In other ways, they are behaving in an unprofessional way and their management needs to draw the line on what is acceptable. If I, or a colleague, messed up and someone died and then I entered into discussions like Sheena has done with a family member that was campaigning for better safety standards and started copying in my employer.. Well. I wouldn’t be getting pay checks for a very very long time. I can’t think how that is acceptable in anyone’s mindset.

  • The Computer Ate My Nym

    So much for the threat to report you to the NHS. I certainly hope that particular threat backfires in a big way.

    • attitude devant

      report her to the NHS? for what exactly?

      • KarenJJ

        Hehe – for influencing them of course!

      • The Computer Ate My Nym

        I guess she didn’t really say she was going to report Dr. Tuteur to the NHS, only other people for associating with Dr. Tuteur (i.e. James Titcombe.) I note that Mr. Titcombe is on the committee so that threat seems especially empty. I also saw that three midwives are on the committee as well. I hope they’re reasonable sorts and not ideology driven.

      • Cobalt

        Is “associating” with someone relentlessly calling for better safety standards in maternity care a reportable offense?

    • Kesiana

      They wanted to report an American doctor… who isn’t even currently practicing… to the NHS?! That is equal parts hilarious and mind-boggling.

  • Daleth

    Well done. I certainly hope the Baroness listens.

    • mike

      She won’t. She’s a big part of the problem – see her previous role in enabling midwifery. The committee is full of homebirth apologists. There are as many internet tossers as obstetricians FFS!

      • KarenJJ

        That’s really disappointing to hear. Sounds like James Titcombe will have his work cut out for him then.