I will not stay silent so that you can stay comfortable

Silent comfortable

Just about everyone involved in the episode of midwife bullying that I detailed last week has weighed in.

In an open letter to the chair of the forthcoming maternity review, I wrote:

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.

And:

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.

The obstetrician shared his thoughts on Sunday:

I’m afraid I kept my head down – accusations of unprofessionalism, especially when copied to the RCOG make me nervous; I’m still in clinical practice and have had run-ins with them before – and when something goes viral it is difficult to avoid digging a bigger hole…

The loss father weighed in yesterday:

What has really surprised me though, is observing that even the mere act of copying Tuteur into a tweet led to a respected professor of obstetrics being accused of being ‘very unprofessional’ and the veiled threat of copying in the RCOG. For me, this crosses a line. As users of social media we have an absolute right to choose who we engage with and to block/ignore or mute those we wish. However, I don’t think it’s right that any person or group of people should decide that someone is so unacceptable to them, that they monitor who else engages with them and make very serious and public accusations about the professional conduct of anyone who does.

I do think that this is a form of bullying…

In contrast, Sheena Byrom held a pity party for herself and invited others to pity and support her (The dark side of social media):

But for those who continue to intimidate, harass and bully individuals and professional groups, and to undermine evidenced based models of maternity care, I have one message.

I have wobbled, but your actions have made me stronger.

Wait, what? Sheena Byrom barged into a twitter conversation that had NOTHING to do with her, bullied and threatened an obstetrics professor AND a loss father, and when called out for it, whines that SHE was bullied.

She received many tweets and emails from other midwives in support of her position. In support of her position? The one where she attempted to police whom others could communicate with on social media? I kid you not.

That typifies so much of what is wrong with UK midwifery culture: the inability of midwifery leaders and prominent midwives to acknowledge mistakes, the refusal to take responsibility for their own actions, the rush to blame everyone else, and most especially, a culture of relentless bullying that is not merely accepted as normal, but treated as a right with which no one should interfere.

My intention in writing about this incident so extensively was to shine a bright light on a pattern of action by a prominent group of UK midwives: bullying, contemptuous dismissal of infant loss, shirking of responsibility, refusal to acknowledge that obsession with normal birth leads to preventable deaths, and a relentless culture of closing ranks to ignore, dismiss and hide midwifery negligence.

A group of prominent midwives and midwifery leaders helped me achieve far more than I could have hoped, and I have a message for them:

I will not stay silent so that you can stay comfortable. The stakes — the lives and health of mothers and babies — are too high for me to walk away.

  • ltrasczak


    I will not stay silent so that you can stay comfortable” Well there goes any hope of you ever working at CNN…

  • Jocelyn

    OT: What is “asynclitic”? I’ve seen this on a couple birth boards and googled it, but google’s only bringing up woo sites. Is this a real thing?

    • Cobalt

      Baby’s head is tilted a bit instead of straight down. Can slow descent.

      It’s something you can’t really do anything about, but it gets bandied about as a reason for pain (as if labor itself isn’t enough), or a “difficulty badge” if you’re birth wasn’t “warrior” enough otherwise.

      It’s a neat thing to know, but it doesn’t usually mean much unless it’s really severe or your overall conformation makes birth harder.

      • Jocelyn

        Okay, so if I want my warrior badge, I have another question: My labor was really painful right from the get-go (as painful at 1 cm as transition was with my 2nd baby). When I reached 10 cm, my OB said my baby’s head was in a weird position and asked permission to turn it with forceps, which I gave. He turned her head with the forceps and I was able to push her out pretty quickly. Does that sound like asynclitic? (Definitely asking because I want a trophy.)

        • Cobalt

          It sounds close enough to meet the Babycenter standard, certainly.

          To know for sure you’d have to look at your records (and if tools were involved there’s a recorded reason for them), but it sounds about right. There are terms for all sorts of less than absolute ideal positions, so if you dig into your records you’ll get the definitive answer.

          Asynclitic is the current buzzword, though, so to win at Babycenter you should just roll with it. Although if it was a different presentation you might start a new trend.

          • Jocelyn

            Hahaha. I need to figure out how to make a little trophy to put in my signature, if I ever make a Babycenter account.

  • Bugsy

    A new Jill Dillard c-section update this PM: “Why New Mom’s C-Section Won’t Keep Her from Having ‘as Many Kids as God Will Bless Me with'”

    http://www.people.com/article/jill-duggar-dillard-cesarean-section-more-children

    • Cobalt

      I’m going to need a stronger filter before I read that, or I might say something a little too rude.

    • JC

      I was two weeks early with my first and induced on my due date with my other two. All 3 were easy vaginal births. I wonder if her going two weeks late led to a bigger baby and possibly caused the csection. I keep having FTM friends who go past their due date in order to avoid a csection because they think an induction will mean a csection. But then they end up with a csection despite going into labor “naturally.”

      • Well, if the placenta keeps on functioning fully, a baby will gain about 30 gm [an ounce] each day, so yes, if you’ve got a decent sized baby at term, at 42 weeks he will be bigger — IF that placenta keeps on working. But in fact, what happens often is that it doesn’t — not enough to actually harm the baby, but makes him vulnerable enough to the stress of labor that a C/S often becomes necessary.

      • Roadstergal

        “go past their due date in order to avoid a csection because they think an induction will mean a csection”

        I’m hardly a person with a great deal of OB knowledge, but this just never seemed logical. If the kid is viable and okay to live outside of the womb, waiting will only mean that either the kid will get bigger because the placenta is great, and a larger kid will be harder to deliver and will cause more damage to mom and baby even if it does manage to get through – and if the placenta isn’t great, the kid will be compromised and tolerate labor worse.

        Those studies that looked at induction at term vs expectant management and found just about every outcome to be better seemed a bit ‘well, of course.’

        • Cobalt

          My longest pregnancy (a whopping not quite 39 weeks) ended with my most difficult delivery. The almost 37 weeker shot out so fast we made jokes about him “catching air” and having a net ready for the next one.

          I know ONE mom who went overdue and didn’t end up needing a cesarean for a baby that just wouldn’t descend, and they were all big babies.

          So, yeah, sooner is easier if you’re trying to push a baby through your pelvis.

    • The Computer Ate My Nym

      Hey, Jill, I’m an atheist, but the god I don’t believe in isn’t mean. He wants you to have as many children as make you and them happy. He doesn’t demand that you have child after child to make him happy.

  • namaste863

    For some reason, I’m forcefully reminded of the character Hilly Holbrook in The Help when thinking of Sheena Byrom. Further evidence, I suppose, that my movie freaked mind finally lost its reality button.

    • Samantha06

      I watched that movie the other night and I thought the same thing!

  • TsuDhoNimh

    refusal to acknowledge that obsession with normal birth leads to preventable deaths,

    Obsession with THEIR definition of normal birth – they are forcing pregnancies into their vision of “normal”, a vision that will take the UK back to the good old days of maternal deaths of 50 or so per 1,000 births.

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/figure/fig1/

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1633559/

  • NoLongerCrunching

    OT: wtf?

    People Less Focused on Recurrent Bad Feelings when Taking Probiotics.

    http://www.sciencedaily.com/releases/2015/04/150414083718.htm

    • LibrarianSarah

      Reminds me of an article I read that stated that Tylenol might “lesson your joy.” My first thought ways “and pain doesn’t?”

      • demodocus’ spouse

        Seems to me that they are desperate for reasons why so few women achieve an orgasmic birth, other than those birth-is-a-lot-of-fun women are the ones who are not quite normal. They latch on to any idiotic idea. I do not get warm fuzzies from breastfeeding, but I don’t pretend it’s because they’re drinking kale smoothies and I’m not.

  • Lemongrass

    OT but looks like Jill Duggar did have a c section. She labored a total of 70 hours (20 at home) with meconium and tested group b strep+. Baby went transverse breech and started having irregular heart rates and the doctors were able to convince her to have an emergency c section at that point.

    http://www.people.com/article/19-kids-counting-jill-derick-dillard-introduce-baby-israel

    • Mac Sherbert

      I can’t help but wonder, if it would have gone better if she had been induced at 39 weeks. Surely, the baby would have been smaller and easier to get out. Also, how common is it to have a baby (an almost 10 pounder) flip to breech during labor? I’m glad they at least went to the hospital and everyone ended up being ok. Only worry now….is will she want to try for the HVBAC.

      • My guess — and it is a guess — is that the baby went from breech to transverse, not vertex to breech or transverse [If the head is engaged, it’s not turning to any other presentation]. There’s no such thing as a “transverse breech”. Transverse presentations are not deliverable vaginally. Jill should have been sectioned as soon as the baby was a transverse lie.

        • Ash

          if Jill’s birth was attended by a CPM in Arkansas, intrapartum position other than vertex requires transport per state regulations.

          http://www.healthy.arkansas.gov/aboutadh/rulesregs/laymidwifery.pdf

          • That assumes the midwife was intending to conform to regulations…

          • Kelly

            The article makes it sound like she decided it was time to go to the hospital after there was meconium. This may be a time where her training came into play and helped her make the right decision.

          • CrownedMedwife

            …my cynical side considers noticing the meconium and transferring as a distraction from the real issue that she was in labor for 70 hours without progress. In fact my cynicism also wonders whether she deferred the GTT and hence 9#10 (in order for a large baby to supposedly flip intrapartally postdates, polyhydramnios also might have played a role) whether postdates antenatal surveillance was done for AFI/BPP and if so, position would have been noted. While we’re at it, were any exams done in labor to identify presentation or was everyone waiting around for the mystical purple line? You know, because just maybe those evil interventions might actually have a purpose! Ouch, my cynical self is leaving the keyboard in search of a chocolate attitude adjustment.

          • CrownedMedwife

            …maybe I didn’t give the chocolate enough time to be effective, but my cynical self would also add the reported position as ‘transverse’ breech as an escape from criticism from NCB proponents that may purport delivering breech is a variation of normal, be it complete, frank of footling. Heaven forbid, the followings be let down if she deferred an attempt at a vaginal breech birth, thus the aptly named transverse breech garners sympathy instead.

          • fiftyfifty1

            My grandmother-in-law (now 98) gave birth to a transverse baby. This was in something like 1939/40. She was a L&D nurse, so I believe her description of what happened. She labored in hospital with the full knowledge of the OB that baby was transverse, but with the hope that baby would eventually turn enough toward vertex or breech so that it could be manipulated all the way with forceps. CS was dangerous enough at the time for mom that they were willing to risk baby to try to avoid it. After about 48 hours, all of a sudden something shifted and baby was fully vertex and from there it went well enough although recovery was awful. She was exhausted. Baby turned out fine.

            You are right, the only malposition that NCB will concede merits a CS is transverse. Not even footling breech. So don’t let my GM-in-law’s success story get out to the NCB crowd!

          • Cobalt

            I am so glad I live here and now and not then or elsewhere.

          • I believe that back then, to avoid C/S, doctors would often attempt an internal version if there wasn’t a prolapsed arm.

          • The Computer Ate My Nym

            That seems not unlikely. It would also explain why she was allowed to continue to labor for so long at the hospital. Though MY cynical side wonders if the cameras and publicity had anything to do with that: she wanted to be able to claim a “natural” birth for propaganda purposes and therefore either refused c-section for a long time or her (possibly rather wooish) medical team refused to consider c-section for a long time because no one wanted to be the evil doctor who “pressured” her into an “unnecessary” c-section.

          • Wren

            Being told I should have refused a c-section for a footling breech was the start of my journey away from birth woo.

          • Kelly

            I do agree. I don’t think we will ever know the entire story.

          • Cobalt

            50 of those hours were supposedly at the hospital.

            50 hours of labor at the hospital. With broken water, positive GBS, no idea which end of the baby is up until there’s a heart rate issue after more than two full days?

            Someone please check my math.

          • In a breech presentation there is always meconium, but that does not mean that the baby is in distress at that point. I agree, either a breech presentation OR meconium warrants transfer, and if the midwife was competent in Leopold’s Maneuvers, she should be able to diagnose the presentation [something of a lost art with US everywhere but it is still taught], Jill should have been in hospital almost immediately. The only way she could have had such a prolonged labor in hospital was if [1] she refused to consent to a C/S or [2] she wasn’t really in active labor all that time [prodromal labor can last 24 hours or more]

          • Mac Sherbert

            Always meconium? I had a breech baby. Water broke no contractions…Went straight to the hospital was put on Pitocin to start contractions…still no progress found baby to be breech, so then went to C-section. The whole time there was never any meconium. I looked at the towels being removed and ask my nurse several times. In fact, she remarked from the being that the fluid was clear. ?? Or maybe there’s always meconium past a certain phase in labor…once you’re further along.

          • Medwife

            Perhaps your baby wasn’t moving down at all. Breech babies tend to get the mec squeezed out of them on the way down. If the presenting part (baby’s butt) never engaged into your pelvis, that wouldn’t have happened. Make sense?

          • Wren

            Really? My son was footling breech and no mention was made of meconium. Maybe it depends on how far along in labour? My water broke and I got to 3-4 cm before they determined he was footling breech (he was supposedly head down 1 1/2 days beforehand, according to the OB). I probably got further than that, but they stopped checking dilation while I waited for an OR to become available.

          • Cobalt

            The article makes it sound like they had no idea what the presentation was at home. She just labored for a long, painful time and went in for meconium staining and discovered the malpresentation at the hospital.

            I don’t see a 10 pounder doing a complete flip in labor. There’s just not space.

        • Lemongrass

          Would the hospital have offered her pitocin though if she had come in with a breech or transverse baby?

          Seems like some details are wrong and/or missing from the story…

          • I agree that it is possible the story is incomplete. If the baby was a transverse lie, pitocin is of no value, in fact, it is contraindicated. If she is a multip breech who really, really doesn’t want a C/S, pitocin might improve the quality of the contractions, which are often not very good, as the softer buttocks pressing against the cervix do not stimulate contractions the way the head does. But there are risks.

            Nowadays, except if one is in a place where a C/S is impossible [like maybe Burkina Faso], it is MUCH safer for the baby to be delivered by C/S if breech in any case. No fear of a trapped head if the body descends before the cervix is fully dilated, no fear of brachial nerve damage if maneuvers to free extended arms are not properly done, no danger of cerebral hemorrhage due to rapid decompression of the skull in delivery, and/or hypoxia from cord compression and in general a lack of experience in delivering breeches, and the use of Piper’s forceps for the aftercoming head, can cause complications — all of which are obviated by a C/S.

          • KBCme

            Your description of breech deliveries sounds absolutely terrifying. So what is done if baby comes feet first and the head gets stuck?! Also, is there a name for the position if a baby is pointed head down, facing correct way, but head is tilted to the side and not straight down?

          • Cobalt

            Asynclitic is when the head is tilted.

            If the head gets stuck, sometimes they can cut enough of the mother’s tissue to release before the baby dies or has a major brain injury. Sometimes they can’t. It’s really awful.

          • Mac Sherbert

            Well, they did put me on Pitocin with a breech baby…but only because we didn’t know the little dude was wrong side up. It’s possible they just didn’t know.

      • PrimaryCareDoc

        Not common. My guess is that the baby was malpositioned from the offset (hence to failure to progress).

    • toni

      I assumed this was the case. His head was remarkably perfect shape wise. Also dad was in scrubs. Glad he’s all right and she doesn’t sound too bothered that that’s what she needed in the end. 70 hours though. eff that noise.

    • sony2282

      There’s no way the baby flipped during labor- more likely the baby was OP and it got written wrong in the translation. Happens all the time with clueless patients. We tell them the “baby isn’t facing the right way for delivery” and they hear breech.

      • Cobalt

        Or People Magazine got it wrong. It’s not exactly a bastion of science, or accuracy. And transverse breech sounds double scary.

        • Grumpadump

          I have a teeny tiny hope that the transverse part of the description is an exaggeration that they made to say that they super duper definately for sure needed the C-Section so she doesn’t lose her midwife natural birth gold star. I say hope because the alternative in my mind is that her uterus has an abnormality and all of her babies will be transverse and her religion will force her to keep having tightly spaced children until the stress of it kills her.

          • Ash

            The linked article says that the part about transverse breech is not a direct quote from the parents. I doubt that the People writers have a lot of experience with obstetrics. Misinterpretation is very possible.

        • Bugsy

          Wait, People isn’t a bastion of science!? There goes my weekly educational reading…

      • just me

        Not familiar with the terminology here…on reading the article I thought they meant the baby was sunny side up like mine. Harder topping bc they keep getting sucked back in.

    • CanDoc

      I suspect “transverse” refers to “Occiput transverse”, meaning the fetal head is looking sideways rather than directly down (typical, called “occiput anterior”) or directly up (atypical, called “occiput posterior” and associated with back pain in labour, or “back labour). “Deep transverse arrest” is the term for when a woman has been pushing in the second stage with the baby looking sideways and not descending. Sometimes can be rotated and delivered vaginally, but sometimes require cesarean section.

  • Guest

    Or scroll down so it is no longer on screen? (Rubbing eye)

    Double nerd alert

  • Trixie

    This whole thing is really just incredible to me. I can’t believe they keep digging themselves in deeper. This poor father.

  • The Computer Ate My Nym

    OT nerd moment: Does anyone else have the urge to keep a close eye on that image to make sure it doesn’t move?

    • Amazed

      *nerd waving hand* I do.

      • KarenJJ

        Me too.

    • demodocus’ spouse

      Um, yes. Especially with silent emphasized.

      • The Computer Ate My Nym

        What, the silence is getting in on this too? Oh, dear.

    • Guest

      Oops, can’t post well via phone: −

      Or scroll down so it is no longer on screen? (Rubbing eye)

      Double nerd alert

    • Mishimoo

      OT nerd mummy-jack: My older daughters love scaring other whovians by standing still with their heads bowed and hands over their eyes, then sneaking up on them and freezing with horrifying expressions. (It’s extra creepy because they’re normally very noisy)

  • moto_librarian

    I hope that this inquiry leads to a massive housecleaning in midwifery in the UK. People like Sheena Byrom who pose as “leaders” of the midwifery movement need to be cut out of the profession like the cancer that they are. As their ideology spreads, more women and babies are dying. This is completely unacceptable, and it needs to stop. Now.

  • NoLongerCrunching

    What are they so afraid of when people link to you? If you are truly a crackpot like they say, shouldn’t that be obvious to anyone who looks into you? Their efforts to silence your message speaks volumes.

    • Amy M

      Yeah, I don’t get this either. How can an American doctor (and a retired one at that) have any effect on RCOG/RCM policies in the UK? I think she can’t, at least not directly. The only threat is that the higher-ups will see the publicity that Dr. Amy is adding to the situation and maybe consider taking some action as opposed to sweeping it under the rug. But even that is a long shot.

      • The Computer Ate My Nym

        Frankly, I think Bryam et al ought to look up the term “Streisand effect”. The more they say, “Dr Amy is taboo!!” the more the RCOG, NHS, and RCM are going to want to know who this allegedly crazy person is and what she’s all about.

      • KarenJJ

        I see it as an implicit acknowledgement that Dr Amy makes a lot more sense than what some of those midwives do. If someone’s really a crackpot and making outrageous claims you might link to them for amusement factor and copying them into a tweet makes anyone’s argument look ridiculous.

        Dr Amy makes sensible and convincing arguments, they’re just very unpopular in some areas and they threaten the current power that midwives like Sheena have.

        • The Bofa on the Sofa

          Actually, a lot of it is based a lot on a straw man. They (like many) read her blog and think she is rampant anti-homebirth and therefore dismiss her as an anti-homebirth zealot. And while it’s true she opposes homebirth, the biggest crusade of this blog is against the culture that promotes dangerous crap like that, particularly, CPMs in the US (and more and more nowadays, foreign midwives).

          But look closely, it’s not just homebirth she is against. For example, the midwives in question here are also hospital MWs, and James’s baby was in a birthing center associated with a hospital (at least). They weren’t doing a homebirth, but still Dr Amy is going after them.

          Seems to me that it’s NOT actually about homebirth, is it?

          In fact, if Sheena would pay attention, you’d think that she would agree with a lot of what Dr Amy says. For example, how can ANY British MW think that the CPM credential is anything but a farce? Any midwife with any professional integrity would be appalled by the CPM credential….oh wait….I just answered my own question….

          • fiftyfifty1

            Yep. American CNMs aren’t appalled. Looks like UK midwives aren’t either.

          • The Bofa on the Sofa

            I did say, “Professional integrity…”

          • fiftyfifty1

            exactly

    • Bugsy

      That’s how so much of the all-natural world seems to function, though. I’ve been reading posts on “Things Anti-Vaxers Say,” and so many of the anti-vax groups seem paranoid in their attempts to weed out and silence anyone who dares to question their beliefs.