Saddened, frightened by the power of the sisterhood of deadly enablers among UK midwives

I Can't Speak

One of the great privileges of being a blogger is the ability to speak on behalf of the voiceless. If there is any group whose voice has been ignored and silenced it is the babies and mothers who have died at the hands of UK midwives.

As I wrote yesterday in my open letter to Baroness Cumberlege, Chair of the forthcoming maternity review:

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…

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.

Sadly, Sheena Byrom, her midwifery colleagues, and midwifery apologist Milli Hill are bullies.

Dr. Thornton, the professor of obstetrics who tweeted to me about the HBA3C has weighed in:

Byrom had crossed swords with Tuteur before – she regards her as an internet troll who enjoys picking fights with supporters of natural childbirth – and felt it inappropriate to copy a mother’s personal, albeit public, blog about her happy and successful birth to such a person. James Titcombe defended me, and soon found himself embroiled in the row. Others accused me of being unprofessional, and likened Titcombe, Tuteur and Thornton to Macbeth’s three witches

He explains:

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…

And, not surprisingly:

So let me be plain. Amy Tuteur is wrong. Sheena Byrom and her colleagues are also trying to make birth safer. I am sorry my tweet led to their motives being impugned yet again.

But …

When one of the retweeters wrote about the HVBA3C blog “What an amazing story thanks for sharing let’s hope it empowers more women”, I did have sympathy with Amy Tuteur’s response:

“Let’s hope it doesn’t kill anyone”.

I understand Professor Thornton’s predicament. Bullying works.

But it can only work if you have the power to harm someone who speaks out against you; they don’t have power over me.

I also understand how a medical system is supposed to protect patients. I briefly worked in a hospital that had 2 maternal deaths within one week. JCAHO (Joint Committe on Accreditation of Healthcare Organizations) immediately investigated and down graded the hospital’s safety rating so low that it nearly put the hospital out of business. The State of Massachusetts conducted full investigations into the deaths, and the media followed the cases carefully.

As a result, the hospital made numerous changes to improve safety and eventually regained a high safety rating. There was no cover up. There were no professionals protecting each other. The system worked as it was supposed to do. It could not bring those mothers back to their lives and families, but everyone involved made sure those deaths were not in vain.

In contrast in Morecambe Bay, and more recently in Royal Oldham/Greater Manchester Hospitals, deaths had to rise into the double digits over months or even years before anyone even took notice. UK midwives, who played a central role in many of these deaths because of their obsession with “normal birth,” are still ignoring those deaths, still incapable of tolerating criticism, still bullying their critics and still getting away with it.

Fortunately, UK midwives like Sheila Byrom and her colleagues, as well as midwifery apologists like Milli Hill can’t bully me. I will continue speaking out on behalf of babies and mothers who die preventable deaths in the US, the UK or anywhere else, and continue pointing out and publicizing midwifery bullying on social media.

The sisterhood of deadly enablers within UK midwifery must be held to account. I predict that more babies and mothers will die on the altar of midwives’ obsession with normal birth until that day of reckoning is here.

  • Ash

    anyone have the link to the legal document associated with this case? I would like to know more about this case:

    http://www.bbc.com/news/uk-england-lancashire-32288002

    • The Computer Ate My Nym

      How bad does care have to be for two children in a single family to end up with CP?

  • Amy Tuteur, MD
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  • Amy Tuteur, MD

    Sheena Byrom feels sorry for herself. The fact that she thinks this is about her highlights what’s wrong with contemporary midwifery.

    http://www.sheenabyrom.com/blog/2015/4/13/3xbfyvgnrsoc3992jhqmgdp71f8lx8

    • The Computer Ate My Nym

      Kind of off topic, but have you seen this one? http://www.sheenabyrom.com/blog/2014/12/16/the-mother-the-midwife-and-litigation-coming-full-circle

      Letting the fetus brady down to 60 before calling for help doesn’t sound to me like any kind of appropriate care. Not to mention not making sure the patient knew the risks she was taking by having a home birth.

      Then the pressure on the woman who sued her. Gaslighting at its worst. Yuck. And Byrom is proud of it! She puts it on her website for everyone to see.

      • Daleth

        She seems to think the saddest thing is how the litigation affected her relationship with the mother! Not how the child has cerebral palsy and epilepsy for life!

        • The Computer Ate My Nym

          Also she wants to make it clear that it was totally not her fault and she completely shouldn’t have been involved in the lawsuit. That’s very important, you know.

          • Daleth

            Right! She said she was just so upset and outraged at the (air quotes) “expert” midwife who gave evidence against her. Because god forbid she should be held accountable to any practice standards at all by members of her own profession.

    • Guesteleh

      I am clear about my professional boundaries, and
      personal integrity.

      Translation: Except when I’m accusing a father who lost his baby to midwife incompetence of “playing the victim card” and telling him to “stop banging on” and “move on.”

      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.

      Translation: Even though Amy is in the US and I am in the U.K. and she can’t actually do any direct damage to me or my livelihood, as compared to the power I wield when I copy RCOG into a twitter conversation to shut up a junior OB.

      (Also, if if Byrom is stronger then why not mention Amy’s name? That scare of her, are you?)

  • SporkParade

    OT: I am looking forward to Dr. Amy’s takedown of the new WHO report on C-sections. Apparently, we are having an “epidemic” of MRCS. I guess women exercising informing consent in their birthing choices are diseased.

    • Daleth

      Oh I cannot wait either! There are pros and cons to both vaginal birth and cesarean–risks and benefits to both–and it’s nobody’s business but the woman herself what risks she is willing to take.

    • Guesteleh

      It’s the WORLD Health Organization, which means they are looking at countries like Brazil where the CS rate is over 80 percent. Other countries like China are over 45% and climbing. It’s like the WHO’s breastfeeding recommendations–they aren’t really aimed at countries like the U.S.

      • Daleth

        Then they need to say so when they give out their recommendations. And even so, why should Brazilian or Chinese women have less of a right to make decisions about their own bodies than American or British women?

        • The Computer Ate My Nym

          They could even tailor their recommendations to the specific circumstances, depending on the specific technology available in a given country. I’m not sure why they don’t.

        • Guesteleh

          I’m all for MRCS but when you have a rate that high, the morbidity and mortality from the procedure itself far outweighs any health benefits on the population level. Even Amy admits there’s a point where the cost-benefit ratio tips away from CS.

          Also, when you have rates as high as Brazil’s, you can’t really call it a personal choice so much as a social mediated choice. It’s like women “choosing” to take their husband’s name. When 90+ percent of women are doing it, then it’s not about individual choices but a complex web of social factors that influence those choices (for example, the more educated and financially affluent a woman is, the less likely she is to take her husband’s name).

          • Daleth

            I’m not sure it’s true that after a certain point the morbidity and mortality from MRCS outweighs the benefits. A study in the UK that looked at all births at greater than 24 weeks over a 3-year period (more than 2.1 million births) found that elective pre-labor c-section was less likely to result in a dead mother than attempting vaginal birth was. Not that vaginal birth tends to kill (though it certainly can), but that when you attempt vaginal birth you have no way of knowing whether it’ll work out or whether you’ll be one of the roughly 25% of women (UK figures) who need an emergency CS, and emergency CS is much more dangerous than any other birth option.

            Here’s a link to an article about the UK study:
            http://www.telegraph.co.uk/news/uknews/1584671/Women-choosing-caesarean-have-low-death-rate.html

          • Cobalt

            If I’m remembering correctly, it’s not that a higher-than-optimum-healthwise rate starts causing higher morbidity/mortality, it just stops reducing it while becoming more expensive (at least short term).

            There is also the pressure to “conform to the norm” which exists with any choice, and cesarean becoming the overwhelmingly preferred option could become dangerous for whoever falls through the cracks and suddenly can’t get one. We’re nowhere close to that now, but give it a hundred years and it’s conceivable.

          • toni

            I have read a few articles, personal stories etc that suggest part of the reason the rate is so high in Brazil is because of enormous pressure from obstetricians to schedule a caesarean. And that if a Brazilian woman insists on trying for a vaginal birth and they agree to attend they will often make it as unpleasant and humiliating an experience for her as possible. So it sounds that while there is a big cultural preference for MRCS in that country (which is fair enough) it doesn’t explain all of it.

          • Daleth

            Fair enough–so Brazilian women need to protest that, and if WHO wants to get involved they should address a report to that specific country’s situation. Decrying all c-sections worldwide makes no sense.

          • How does a situation like that evolve, though? Is there a shortage of labor wards in Brazil, or are all of their OBs and midwives on the professional golf circuit?

          • toni

            idk, these weren’t exactly rigorous studies I looked at, just articles posted to facebook from jezebel, slate etc that had anti-c-section slants to begin with. But the explanations given were that caesareans became popular with wealthy women at some point and now vaginal birth is seen by most as something unfortunate that poor and indigenous women have to endure with c-sections being more sophisticated, dignified and so on. Also that doctors prefer them because they can schedule every birth and work convenient hours because c-sections are quick and easy so they are hostile to any requests for different models of care.

          • Yeah, I saw Jezebel’s version. Irritating.

          • DiomedesV

            “I’m all for MRCS but when you have a rate that high, the morbidity and
            mortality from the procedure itself far outweighs any health benefits on
            the population level.”

            It doesn’t have to outweigh the benefits on a population level. It has to outweigh the benefits for the individual patient, as long as she has a choice.

          • Guesteleh

            It doesn’t have to outweigh the benefits on a population level. It
            has to outweigh the benefits for the individual patient, as long as she
            has a choice.

            Would you say that about homebirth? Most women and their babies who homebirth will turn out okay, right? By your reasoning women shouldn’t consider the population numbers in that case either.

          • DiomedesV

            The situations aren’t remotely the same. The risks to the baby could be argued to drastically outweigh the benefit to the mother in homebirth. Per homebirth–the negative consequences of a homebirth for a baby are potentially profound, and the benefits to the mother are not substantial, and mostly amount to avoiding a very safe surgery.

            With MRCS in China, we’re talking about a *much* lower risk to mothers *when the surgical care is of very high quality* and a potentially huge benefit to the baby. This potentially huge benefit is even more substantial when you consider that you may only have one baby in your entire life. That fact also lowers the risk to the mother, since many of the risks of C-sections are only manifest in future pregnancies.

            The absolute risks of the different scenarios are not even comparable.

            And yeah, actually I don’t really give a damn whether women have homebirths. Not everyone who reads this blog is wringing their hands over the decisions of a few of the most privileged women on earth.

          • FormerPhysicist

            How do we know that morbidity and mortality from c/s outweighs health benefits at 90%? What health benefits are you accepting as real health benefits and what are you excluding? What are you “charging” to vaginal birth?

          • Guesteleh

            Amy herself wrote about this on her old blog, Homebirth Debate. http://homebirthdebate.blogspot.com/2008/04/c-sections-and-diminishing-returns.html

            Although the decision to perform a C-section is made on a case by case basis, analysis of C-sections in the aggregate show us that the C-section rate CAN be too high. When you get to the point that you are saving 1 baby every 10 years, but killing 1 mother every year, the C-section rate is clearly too high. Why has the C-section rate risen so high in first world countries? The reason is that a tremendous premium has been placed on the life of each and every baby. That societal value is directly reflected in the rising number of lawsuits and monetary judgments for babies who die or are disabled during birth. That societal value is reflected in the fact that our judicial system operates as if we believe that if a C-section had even a remote chance of preventing the death or disability, that C-section should have been done, and because it wasn’t done, the parents should be compensated.

            C-sections come with costs. We have not even talked about the financial costs, because, in my judgment, these are secondary. However, massive numbers of unnecessary C-sections cause unnecessary complications and unnecessary deaths. As the C-section rate rises, these unnecessary complications and unnecessary deaths rise from relatively trivial occurences, to occurences that far outweight the number of babies’ lives saved. We, as a society, need to think about where we draw the line, because we, as a society, through our punishments and incentives, determine how high the C-section rate should be. Doctors are merely responding to society’s wishes as expressed through our values and our legal system.

          • FormerPhysicist

            But that quote only says there is a theoretical maximum that are medically advisable, and it doesn’t tell me if 90% has reached that maximum.
            And it discounts maternal preference – on either side.

            Personally, I much preferred a c/s. I have no problem with the concept of surgery, very little problem with the actuality of surgery, and very little tolerance for watchful waiting of any sort. When I was offered the option of ‘c/s now’ or ‘try to push for another hour and then go to c/s if you don’t progress’ I went straight to c/s. And have zero regrets.

            Also – we allow cosmetic surgery. Which does have a certain amount of morbidity and mortality. Which far outweigh any health benefits of the surgery. I do think that’s relevant. If 100% of women opted for c/s on a truly informed basis, I wouldn’t have a problem with the situation.

          • Guesteleh

            It’s not helpful to frame this solely in terms of women’s personal preferences. As I said elsewhere, those choices are made for a variety of complex reasons and they are heavily influenced by how healthcare resources are allocated and delivered, among other factors. For example, we know that men are overtreated for prostate cancer, yet presumably all of those men are choosing to be treated–but how are they coming to that choice, how is that choice influenced by the structures of the healthcare system and what are the negative impacts (a lot of morbidity and expense with no increase in survival rate). So whether or not individual women prefer a CS isn’t really the point. I know that it can be infuriating fighting against the natural childbirth tide, but is it really so crazy to say there may be a CS rate that is too high because it harms more families than it benefits?

          • Sarah

            This is dancing dangerously close to problematising women’s choices because they don’t make the ones you want them to.

      • LibrarianSarah

        I am surprised that China’s c-section rate isn’t higher. We’re talking about people who are, by law, limited to having one child. Wouldn’t you do everything in your power to avoid that child getting any type of birth injury in that situation? It’s not like you have to worry about future reproduction anyway.

        That is the problem with these blanket edicts. They don’t address any of the legal or cultural factors that cause a c-section rate to be high or the cost of lowering it for a given population.

        • Nick Sanders

          The one child laws have been loosened over time.

          According to Wikipedia:

          “As of 2007, only 35.9% of the population were subject to a strict one-child limit. 52.9% were permitted to have a second child if their first was a daughter; 9.6% of Chinese couples were permitted two children regardless of their gender; and 1.6%—mainly Tibetans—had no limit at all.[3]”

          http://en.wikipedia.org/wiki/One-child_policy#Current_status

          • The Computer Ate My Nym

            Hmm…so if you’re an average Chinese person (or, let’s say, a middle class or upper middle class Chinese person with time and money to game the system) who wants 2 children, do you now try for a girl the first time* so that you’ll get your second child permit?

            *This can be done in a number of ways but the most obvious is abortion if the u/s or amnio shows a boy.

        • Sarah

          Bear in mind a lot of the Chinese population is very poor and rural, a long way away from anywhere that could safely perform a section. For the reasons you list, I suspect the urban section rate is probably considerably higher.

      • SporkParade

        I’m not surprised that those are the countries where rates are rising. These people have seen what truly natural childbirth is like, and they want to get as far away from it as possible.

      • DiomedesV

        What’s wrong with a C-section rate of 45% in China? Women typically have 1-2 children. If you’re only allowed 1-2 children, it is actually logical to choose to lower the risks to those children in any way possible, especially when the C-S risks to mother are small and mostly confined to future pregnancies that may never happen.

    • Bombshellrisa

      It’s really hard for women to view MRCS as just another birth choice when we have CNMs who have written papers and headed projects around the idea that MRCS is an “ethical quagmire”. True story, a very well respected CNM who attended UW who prattles on about “choice in birth” made that her project.

      • Nick Sanders

        “You’re free to choose, as long as you choose what I want you to.”

      • SporkParade

        Can someone please explain to me why MRCS is an “ethical quagmire” and a “waste of resources,” but VBAC isn’t?

        • Cobalt

          Right! The risks are a lot lower with the MRCS, and the extra immediate expense of the MRCS would surely be exceeded by very few bad VBACs.

          Not that VBAC is inherently bad, or should be categorically refused if there is access to a safe environment, but it’s is certainly riskier than MRCS.

        • manabanana

          https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Cesarean-Delivery-on-Maternal-Request

          I believe that women should be able to opt for maternal request cesareans – absolutely – it becomes an ethical quagmire when the woman is a teenager with poor contraceptive habits – who is not *planning* several pregnancies – but is likely to have multiple pregnancies – and multiple c-sections – and who maybe does not understand fully the implications of her request for a c-section for whatever reason she opts for a c-section. Do we deny this young woman the option (right?) of a maternal request c-section knowing that she is likely to face multiple risks throughout her lifetime? Do we only allow maternal request c-sections to those women that we know are responsible family planners? Or to those women who have the knowledge and understanding of the risks – and fully participate in the informed consent process?

          Yes – there is a similar ethical quagmire when telling women they should have VBACs when they do not want them.

          Actually – any situation where women’s decisions about their bodies are relegated to other people is where you run into ethical quagmires – they seem to be every here.

          Physicians and medical professionals have a responsibility to not do harm – multiple c-sections and multiple surgeries create increased risk

          It takes a lot more resources do perform a c-section than it does to have a vaginal birth – should these resources be offered to every woman and uninsured teenager who wants one? Again – the ethical quagmire. Pretty sure there would be those up in arms over MA patients getting ‘Cadillac births’ just because they want them.

          • Daleth

            You haven’t even mentioned how that could possibly outweigh the ethical quagmire of permitting VBACs, when we know that about 1% of them are going to result in rupture.

          • araikwao

            Actually only 0.2% for after 1 cs (or 0.5%, depending on the paper)

          • SporkParade

            I see your point about teenagers, but that is true for all medical decisions made by minors, not just MRCS. For example, should a teenager be allowed to get vaccinated without parental approval? I would also quibble with your assertion that C-sections require so many more resources than vaginal deliveries, assuming we are talking about developed countries and hospital births.
            No country with a tolerable perinatal mortality rate has a CS rate below 20%, so right off the bat, at least 20% of MRCSs would have ended up as a CS anyway AND they would have also consumed the resources necessary for a vaginal delivery. We also need to consider the long-term costs of vaginal delivery, which may include physical therapy for babies who are neurologically damaged by birth, physical therapy and/or surgery to repair pelvic floor damage to the woman, and psychological counseling (whether it is intended to coax the woman into a vaginal delivery or to help her recover from the trauma of an unwanted vaginal delivery).

          • Roadstergal

            “poor contraceptive habits”

            Is LARC easily available to teens in the UK?

          • Cobalt

            If not, it should be. Nothing wrong with making responsible choices more convenient.

          • Sarah

            In urban areas, reasonably. It can be harder to get to a clinic if you’re rural, particularly if you need to keep your sexual activity a secret from parents and you’re too young to drive.

    • araikwao

      Am wondering if there is a corresponding “epidemic” of allergies and other autoimmune disease in countries such as China and Brazil, given that CS are the root of all evil?

  • staceyjw

    Whenever women get actual power, and a real platform (not just a blog, no offense), you have to wonder- who are they really serving (often unwittingly)? When these women, are actually harming women, there is little to question about where the ideas and power came from.

    Basically, NCB is the patriarchies back lash against particular gains of feminisms 2nd wave. From their biological essentialism, to their blatant paternalism, those that pushed NCB into OB/MWery represent all that women fought AGAINST (and won).

    Think about who started the NCB movement and who are some of the other foundational members. Mostly male, with a few women that were approved of, influenced, or even controlled, by men (ala Ina and her cult leader husband) which should not be surprising. All of these men, and occasional women, had a very narrow view of what women are for, which mirrored the traditional roles (surprising! LOL). The female gender role that had defined and imprisoned women since the upstart of civilization had been challenged, and these men were determined to shove us back into that box.

    They were very smart to take a backdoor approach; by appropriating midwifery for themselves. By identifying as the group of women that were historically the only ones “with women” (and hated/feared for it), they were able to piggyback on their well earned credibility. I fully believe that they installed their own thought leaders that took what once was a deep connection to women, with the sole purpose of helping them, and turned into something adversarial and ugly

    That they, and their lay MW minions, were able to have such a stunning amount of success legislatively, were able to get paid by states, Medicaid (!), and eventually influence entire nations medical processes? It seems so implausible that in a nation like the USA, the CPM could be widespread, legal, paid. Have women really ever been able to do this? Anything we have gained has only been after a long, hard, fight.

    Just food for thought.

    • Lizzie Dee

      I think you are absolutely right – though I would say again, I don’t think these women have real power – they are just allowed to run riot by those who do. Getting women to define themselves through their ability to give birth “naturally” and persuading them that putting up with pain makes them strong is a neat trick, really. I am not sure it works all that well, as young women here don’t buy into it all that readily, and not many define themselves by their ability to push out lots of babies. Midwife-led units are popular because they are more laid back and if you don’t need high-tech care, not much harm is done. The rhetoric and posturing is still a problem though. The idiot midwives gain status at the expense of other women’s pain and distress.

      The NERVE of telling the father of a lost child to “Move on” is unbelievable.

      • Who?

        Who does it serve though? Who allows them to run riot? I agree your interpretation fits the facts I’m aware of, but to what end?

        Perhaps it is really as simple as the comparative cheapness of midwife led unit, which leads to (mostly) live babies and okay-ish mums, as opposed to offering a full service environment with better outcomes.

        That is depressing.

        • Inmara

          I agree that possible explanation is cheapness of midwife-led care. Keep in mind that in UK and almost all other EU countries huge portion of healthcare is government-funded so government has to calculate how to spend funds in most effective manner. Unfortunately that makes politicians and healthcare officials prone to NCB lies, as this ideology claims to ensure great results with minimal expenses (at least from government side – it’s up to women themselves to spend a fortune on doulas, prenatal yoga classes and individual birthing rooms).

          • DaisyGrrl

            It might be cheaper in the short run, but brain-damaged babies are very, very expensive. The lifetime care costs of one severely compromised child are astronomical and born by the same government that funds these “cheaper” options. A proper cost analysis would have to take that into account.

          • Inmara

            Of course you’re right, but government, at least in my country, has never been known for long-term strategical planning…

          • Who?

            All true but the propriety of a cost analysis is very much in the eye of the beholder, or more specifically, whoever commissions it.

          • Lizzie Dee

            I believe cost analyses have been done, and paying compensation works out cheaper in the long term – because in the Brit system damages can only be claimed if care deviates from the norm – i.e., is clearly and blatantly negligent, and this is not easy to prove. Not sure if the Titcombe family were compensated. Far as I know, James’s project was to highlight a poor system – and that proved to be hard enough.

          • DaisyGrrl

            It’s not so much the damages I’m thinking about, as the increased funds governments must spend on healthcare for a severely disabled child. Of course there are other costs, such as damages, special equipment, lost income opportunities, social assistance, etc., that also impact those involved. But even if we look strictly at the direct healthcare costs, it’s cheaper to exercise caution.

            In some ways, the US shows us how enormous all the costs are because the awards for such cases are in the millions of dollars and represent all costs that would be covered under public health care and a strong social safety net (plus the additional financial burden on the family). Even if only half of the award represents the cost of ongoing care, it’s an astronomical cost.

            And yes, this is looking strictly at the financial cost. The human cost is even more important and I can’t even imagine how to quantify that.

          • The Computer Ate My Nym

            True, but how many politicians think about the long run? They’re interested in whether they can cut costs and therefore cut taxes on their rich donors next week, not whether there will be more brain damaged childen in a decade.

          • Mariana Baca

            How frequent are severely compromised children that need much more in medical costs? Does it amortize? 1 child having 100x more medical costs when it happens 1 every 1,000 times is still a deal.

        • Lizzie Dee

          Sexist attitudes to women benefit, and yes it is depressing.

      • Amy Tuteur, MD

        But they wield real power over babies and mothers who are dying as a result.

        • Lizzie Dee

          You are right, of course, which is even more depressing. And if those who would stand against this nonsense are silenced and excluded from taking proper care of women, that isn’t great.

          • Amy Tuteur, MD

            How can they be held to account? Does anyone in the NHS care about the deaths?

          • Lizzie Dee

            I don;t think anyone has an answer to that in the present climate. Scandal after scandal of poor care, and not much done about it. I think a lot of good people care a good deal – including the sane midwives – but for some reason these things go on happening. The usual practice is to set up an enquiry, which takes a long time and comes to no useful conclusion.

    • The Computer Ate My Nym

      Part of the problem, IMHO, is that bringing about equality is not always as simple as it seems like it should be. Any thesis on how gender works and how it can affect work and relationship dynamics can be used in an oppressive manner.

      Women are equal to men and can do what men do? Great, then I guess we don’t have to worry about little things like the fact that women get pregnant and are more often responsible for the majority of child rearing and that affects their work. Women get pregnant and that affects their work lives? Well, then, that explains the 77 cents on the dollar finding, no need to do anything to make income more balanced. The person who is pregnant should decide where, how, and if they give birth? Sure, why not, home birth with poorly trained midwives is cheaper anyway!

      I support the idea of patients, including pregnant women, having more autonomy in their medical care. People have the right to make decisions, including bad decisions. But I don’t support allowing people to lie to potential patients about the risk. To paraphrase a person who hasn’t commented in years, If you want to give birth in a forest at midnight in a thunderstorm with no one around but people chanting affirmations that’s your decision. Just don’t claim that it’s the safest way to give birth or that everyone ought to do it that way.

  • Cat

    OT, but: Sheila Kitzinger died. http://www.bbc.com/news/uk-32277415
    Perhaps Dr. Amy wants to write about her. She is one of the people we can thank for the natural birth BS.

    • Who?

      Sheila was a big noise when I was having my kids. I didn’t hear a lot about her from my NHS midwives but the leader of the NCT group I was in thought she was great.

      I found her very uneven-romanticising the whole process while always ready to be ‘earthy’ if need be. Perhaps I was more interested in the facts and figures, thinking the emotional stuff would work itself out, which it did, but I didn’t find her compelling. I far preferred (and felt more comforted by) a very dry tome by a male obstetrician (title and author both lost to memory) who solemnly spelt out all kinds of facts and backed them up with figures. Hey, if someone was taking care of all the nuts and bolts, I thought, I can just get on with doing what I’m doing.

  • Amy Tuteur, MD

    Some people never learn:

    • fiftyfifty1

      I can hardly understand this exchange beyond that Milli Hill is still trying to shame and threaten the OB who linked you to the UK midwife webpage that was using a story of HBAC3C to promote their business. And that now you are no longer a Macbeth witch, but rather a Westboro Baptist member. A retired Jewish OB who expresses almost nothing other than mainstream ACOG recommendations is now a radical Christian homophobe. My goodness!

      • Dr Kitty

        I don’t use or like Twiitter for this reason.
        A tweet is often too short to be coherent, and all the “@soandso” make it hard to understand who is talking to who.

        So, no nuanced discussion, no reasoned arguments just “you’re mean”, “no you’re mean”, “no you are”.

        Waste of time and energy trying to engage anyone on it.

        • The Computer Ate My Nym

          I was just thinking the same thing…I can’t follow twitter discussions at all. I keep hoping that twitter is one of these technologies like 8 track tapes that will simply disappear before I am forced to pay attention to them.

        • Guesteleh

          Most Twitter conversations aren’t like that. The reason these are hard to understand is because they’re tagging the universe. It’s kind of deranged.

          • Roadstergal

            Twitter has its place, and its place just isn’t nuanced discussions. I like it, but you can’t have a reasonable debate there.

      • The Bofa on the Sofa

        A retired Jewish OB who expresses almost nothing other than mainstream
        ACOG recommendations is now a radical Christian homophobe. My goodness!

        This is the thing that always gets me. It’s not very often that Dr Amy says anything that is NOT mainstream ACOG. She’s not a fringe.

    • Why isn’t this front page news? This is ghastly!

    • lilin

      We can let babies die and it’s in the past and we’re not going to apologize. But *I* won’t move on until YOU admit it’s not appropriate to talk to a blogger!

    • MWguest

      Vile. Truly vile.

  • Amy Tuteur, MD
  • Dr Kitty

    I just wanted to put this here.
    Re: CPMs carrying medications they rarely (if ever) use.

    Pitocin is supposed to be stored at 20-25C, Methergine at 2-8C (I.e. In a refrigerator).

    Any CPM who keeps all of her drugs in a locked cabinet in her office is already improperly storing her meds, unless she can guarantee climate control 24/7. If she lives in Florida and the office AC is turned off at night or at the weekends, or she lives in Wisconsin and the office heat is turned low outside of business hours, the drugs will be affected.
    Worse still if the drugs are kept in a grab bag that lives in the boot of her car 24/7!

    If your CPM doesn’t put her methergine from the separate cool bag she used to transport it from her home fridge into your fridge as soon as she arrives at your home for the birth, she isn’t storing her meds properly.

    If she rarely uses Methergine and keeps it in a bag during each birth, it’ll have been out of the fridge several times, for hours at a time, before it eventually gets used…not recommended!

    I say this as someone who has a bag full of meds I rarely use, who has to keep them in my house in a room with a thermostat, do regular audits to ensure everything is in date, and who doesn’t carry drugs that require refrigeration because it wouldn’t work logistically.

    It isn’t just as simple as having the drugs with you.

    • araikwao

      I had wondered about the temperature and storage issue too…

    • And, given how seldom some of the meds are used, whether they are even still within their usability dates. In my Women’s Clinic, we had to check our resuscitation cart monthly, and it was amazing how much stuff was outdated at each check [different items, obviously]. Since medications can be expensive, it is tempting not to throw out meds only “a little” beyond their expiration dates.

  • How frustrating. And if he dares speaks out, he’s going to be pointed at and accused of being catty and unprofessional, that he’s proof of the misogynistic, patronizing culture of obstetrics.

    • Lizzie Dee

      I don’t think he is afraid of being thought catty. Speaking out can get very perilous in the NHS. This is a political as well as an ideological issue here.

      • mabelcruet

        Look at the recent Francis report on whistle blowing. Any one daring to speak out against poor standards of care is villified and edged out. The current NHS attitude towards bullying is how the ‘victim’ feels, not what the perpetrator intended, so if a person makes a valid comment about substandard care, the person criticised will immediately cry bullying, and the perpetrator then gets investigated for their attitude problem, rather than the victim being investigated for their clinical failings.

        • Amy M

          That goes back to the money issue. It’s cheaper to shred the character of a whistle-blower than it is to make big changes.

          • mabelcruet

            Absolutely. The whole issue is pathognomonic of a dysfunctional team, and a dysfunctional NHS. Its evident that the situation in Barrow is being portrayed by midwives as one bad apple, one group of ‘musketeers’ and that this was a unique situation and lets move, on, nothing to see here. In my experience, groups of musketeers exist in far more units-these are a group of vocal, dominant staff, often few in number but with an impact that distorts normal practise in that unit-the silent majority are too scared to speak up because their working lives will be affected.Midwives are independent practitioners, but in situations like this, they use the perception of hierarchy-in the NHS, the general perception of management is that bullying only occurs top-down, never bottom-up. If a junior doctor dares to contradict or question one of these muskateers, the cry of bullying rings out, and because its a doctor vs a midwife, the midwife wins every time. So juniors keep their heads down, seniors don’t like to step in because they have to work with these people all the time, and so it goes on.

            I have worked with many superb midwives, but significant numbers of them are facing musketeers regularly. The underlying issue is teamwork. Teamwork is great when the team works together, but when a team is dysfunctional, how can it be dealt with? At the moment, there is no will in the NHS to do this. Despite the Francis whistleblowing inquiry, I have no confidence that anything will change.

            Imagine-someone makes an allegation that there is sub-optimal care. It is usually a single person who makes the allegation, and the tribe closes ranks against them-they get excluded, isolated,
            the opinion of an individual is trumped by the communal response of the tribe of musketeers denying the allegations. If management process in invoked, it becomes a ‘trial’ based on balance of probabilities, and its easier to go along with the musketeers group-think that ‘the problem isn’t us, its them’. Its easier for management to write this off as difference of opinion, poor communication, lack of teamwork, rather than looking at the original issue which was substandard care.

            Dysfunction by person or system flourishes because everyone involved is employed by the same employer creating conflicts of interest, so the employer wants this dealt with as quickly as possible, and its far easier writing off issues as a lone troublemaker rather than tackle the group-think of musketeers.

            So, why are groups of musketeers allowed to form? With fixed teams comes stagnation- fixed opinions, fixed ways of acting, fixed ways of dealing with issues, and the development of corrupted hierarchical systems. Whilst its useful to work in a team with colleagues you trust and can work collaboratively with, a dysfunctional team needs to be broken up and separated so collusion cannot occur.

  • DaisyGrrl

    I found Dr. Thornton’s predicament profoundly disturbing on many levels. First, that the bullying tactic worked (and it would probably have worked on me had I been in his shoes). Second, that such tactics on the part of midwives make it impossible to put patient safety first. A culture of intimidation and distrust are dangerous. A culture of silencing dissent is dangerous.

    The worst thing is that the patients pay the price.

    • Kelly

      It is sad that they can say whatever they want without repercussion but he can’t. I feel for him.

      • toni

        Yeah.. how did they get so powerful? People are falling over themselves to praise midwives and deny their obvious inadequacies. Doctors, this government, the previous government.. It’s bizarre.

        • Maya Markova

          When this happens in an advanced democratic country, there is usually an underlying issue with culture and public opinion. Actually, in a previous comment thread here, a British commenter said something to this effect. I wonder, are there British blogs similar to “Skeptical OB”? If not (or too few), it would be nice to start some! Even if written by lay authors. I remember that a lay person in medicine – investigative journalist Brian Deer, contributed much to debunking the “vaccines-cause-autism” propaganda in Britain.

          • Guesteleh

            I remember someone saying how people are very defensive whenever the NHS is criticized because the conservatives want to privatise and they view any negative publicity as ammo to destroy the system. Which means that legitimate complaints will be dismissed and people legitimate grievances like James Titcombe will be attacked.

          • Sarah

            That was me. And yes you’re right.

        • Lizzie Dee

          I don’;t think they are that powerful, really.

          One of the things that you have to bear in mind is that dead babies – and even dead mothers – are cheap, here. No sympathetic juries, no awards for pain and suffering, just a hard headed costing of economic losses. Good care for women is expensive, budgets are tight, and the natural childbirth rhetoric is popular with women voters. The large majority of babies will get born safely no matter who is running the show, so why rock the boat.

          The NHS can be wonderful. But I am quite glad my daughter’s family is complete.

        • Ed Miliband is on record promising a “midwife for every pregnant woman”. Yeah, really.

          • Amy M

            Better he should promise adequate and compassionate care for every pregnant woman.

      • Mattie

        It is sad, partly because a retired midwife can’t be sanctioned by the NMC, so Sheena Byrom can pretty much say what she likes, and partly because there are many HCPs who share Dr Thornton’s unenviable position.

        • mabelcruet

          Dr Tuteur is retired, and she is regularly criticised as no longer practising therefore should not be allowed to have opinions or comment, but Byrom, also retired, is considered to be some sort of prophet and font of all wisdom. No internal logic to their arguments.

          • Who?

            I don’t think logic has lived there for a while now…