British midwifery has degenerated into a cult

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With the publication of the recent report of obstetric liability payouts, the transformation has been completed. British midwifery has become a cult.

How many babies have to die before British midwives recognize that their veneration of “normal birth” is a mistake? Apparently there is no number of dead babies high enough to force a change. That’s because British midwifery is a cult devoted to “normal birth,” and as in any cult, it is impossible for the leaders to admit that they are wrong.

The Kirkup Report published in the wake of the Morecambe Bay scandal where 11 babies and one mother died preventable deaths makes for chilling reading:

[M]idwifery care in the unit became strongly influenced by a small number of dominant individuals whose over-zealous pursuit of the natural childbirth approach led at times to inappropriate and unsafe care. One interviewee told us that “there were a group of midwives who thought that normal childbirth was the… be all and end all… at any cost…”

James Titcombe, a loss parent who has become a patient safety advocate, details the contemptuous response of the Royal College of Midwives in the recent issue of their magazine:

The scene is set straight away by the RCM CEO Cathy Warwick on page 5. Cathy refers to the issue of the ‘normality agenda’ and asks ‘are we pushing this too far?’, Cathy’s response is ‘no’.

This response really does amaze me, not least because Cathy doesn’t refer to any study or evidence to support her answer. In this piece, the RCM President Lesley Page even questions the Kirkup report’s clear conclusion that the over zealous pursuit of normal childbirth was a significant factor in what happened at Furness General.

“I searched carefully to find out what was the basis of this emphasis but couldn’t find much.”

Really?

When the Kirkup report was published, some midwifery supporters claimed that this was a one time failure on the part of rogue midwives. Kirkup himself publicly disabused them of this excuse and the Recent publication of last year’s liability payments illustrate the extraordinary dimensions to the problem.

From The Times of London, NHS errors leave 1,300 babies dead or maimed:

The NHS paid or set aside just under £1 billion [$1.5 billion] last year to settle 1,316 claims of negligence in maternity units, up from £488 million a decade ago, data from the NHS Litigation Authority show. The most costly claims involve babies brain-damaged during labour, who will require constant care for the rest of their lives.

One basic error accounts for a quarter of payouts, with campaigners saying it was a “scandal” that the health service was failing to learn from its mistakes. They blamed divisions between midwives and doctors, saying that the desire for “natural” births — without interventions — sometimes went too far…

How have midwives and their supporters responded to this scathing indictment?

Midwifery apologist Elizabeth Prochaska of Birthrights UK simply ignores the findings:

The latest incarnation of this trend towards midwife-blaming came in yesterday’s Times editorial (paywall). Commenting on a Leicester University study into stillbirth rates in the UK, it claimed that ‘the roots of the problem are inadequate monitoring before birth, inadequate Times editorial investigation after it and a faddish bias in favour of midwife-led “natural” maternity care.’

Ms. Prochaska simply ignores the more than 1300 dead babies because to do anything else would call the primary belief of the cult into question.

In a fascinating article in Mother Jones (The Science of Why We Don’t Believe in Science), the author offers the classic tale of psychologist Leon Festinger’s research on a doomsday cult after its prediction for the end of the world proved false:

… [T]he aliens had given the precise date of an Earth-rending cataclysm: December 21, 1954. Some of Martin’s followers quit their jobs and sold their property, expecting to be rescued by a flying saucer when the continent split asunder and a new sea swallowed much of the United States…

Festinger and his team were with the cult when the prophecy failed…December 21 arrived without incident. It was the moment Festinger had been waiting for: How would people so emotionally invested in a belief system react, now that it had been soundly refuted?

… [R]ationalization set in. A new message arrived, announcing that they’d all been spared at the last minute… Their willingness to believe in the prophecy had saved Earth from the prophecy!

… They lost their jobs, the press mocked them, and there were efforts to keep them away from impressionable young minds. But while Martin’s space cult might lie at on the far end of the spectrum of human self-delusion, there’s plenty to go around…

British midwives and their apologists exhibit the same behavior in order to preserve the cult of “normal birth.” It makes no difference to them whether 10 babies die or 1,000 babies die. They are incapable of acknowledging their deadly mistakes because British midwives are less healthcare providers than members of the cult of “normal birth” with all self-delusion that entails.

  • FrederickBPerez

    Your first choice skepticalob Find Here

  • Ellen Mary

    The most disturbing thing about birth providers I know that are involved in HB tragedies is that their paradigm doesn’t seem to shift at all afterwards, as they continue to post about NCB ideology w/o the nuance you would expect after a demise.

  • Amy Tuteur, MD

    James Titcome has been awarded OBE in Queen’s birthday honors! Congratulations to Sir James.

    http://www.bbc.com/news/uk-england-cumbria-33117158

    The NHS was no match for the power of a father’s love:
    http://www.skepticalob.com/2015/03/a-health-system-was-no-match-for-the-power-of-a-fathers-love.html

    • mabelcruet

      An OBE doesn’t make him a Sir (thats a knighthood)-maybe one day though. He’s doing far more for patient safety than any of the official systems or royal colleges are doing. Its so horrible that someone has to go through what he and his wife had to, to begin drawing media and public attention to such an important area. Even now he’s still being attacked by various midwives and their hangers-on for pointing out the truth to them.

      • Daleth

        Let’s see, on the one hand some demented midwives are insulting him. On the other, THE ACTUAL QUEEN just awarded him an OBE ***for services to patient safety***.

        Earth to demented UK midwives: shut your traps.

        • mabelcruet

          Yes, but Sheena Byrom got an OBE for services to midwifery a while ago, so it all evens out….Personally I think he deserves far more recognition for what he’s going through, there seems to be a media blackout on the harassment he’s facing from these women. Did you see the evil comment from someone claiming he was undermining a professional organisation (the RCM, if you want to call them professional, which I wouldn’t based on some of the comments and statements coming from them), and stated that ‘you disgust me’ when he posted a picture of his dying son. Any vaguely critical comment of his is immediately copied into CQC, a regulatory body that he is currently working with, despite him making it clear that he’s tweeting in a personal capacity.

          Why is this not being highlighted by the media? This is mobbing, this is bullying that is apparently being sanctioned and approved of at high level in the RCM. Why is this not being dealt with? He seems to be the focus of a lot of aggression and viciousness and despite this he is generally dealing with them politely and respectfully. Frankly, they don’t deserve it. But how come they are getting away with it-are midwives so very scary or is it that the public see them as angels and wouldn’t believe it if they were told that they are ganging up on and bullying a bereaved father for trying to find out who was responsible for his son’s completely preventable death.

          • Gatita

            Speaking of which:

            @silv24 @JamesTitcombe @MidwivesRCM are you criticising RCM again James? @CareQualityComm it's such shame. What do you want?— Sheena Byrom (@SagefemmeSB) June 14, 2015

            Pardon the language, but the word that comes to mind is cunt.

          • Gatita

            @silv24 @SagefemmeSB @MidwivesRCM I'm used it it now-notice how CQC copied into tweet as if I've done something unprofessional or wrong.— James Titcombe (@JamesTitcombe) June 14, 2015

          • Fallow

            I also saw that horrible person bothering Mr. Titcombe again. She really is a piece of shit.

          • mabelcruet

            And now Sheena byroms daughter Anna, another midwife, is laying into him putting the boot in. Have they any insight at all into how they are coming across? On the one hand Byrom is twittering about leadership in. NHS midwifery and feeling the love in the room, and on the other she’s telling bereaved parents to fuck off and stop bothering her with his questions about why his baby was sacrificed on the altar of normal birth.

          • Gatita

            Did you see this?

            Hard not to feel angry when come across tweets like this…. https://t.co/VWpzit0g5l— James Titcombe (@JamesTitcombe) June 15, 2015

          • Liz Leyden

            Is that Titcombe’s wife and son (who died a few days later)?

          • Gatita

            No, thankfully. But the message is terrible.

    • KeeperOfTheBooks

      Damn. Good on Her Majesty, and many congratulations to Mr. Titcombe! He deserves it.

  • Annie

    Could someone clarify for me, are the “NHS errors that leave 1,300 babies dead or maimed” all from midwife-led cases, or are some attributable to primary OB mistakes too? I understand that in a system of overlap in care, this might be hard to differentiate but I’m just trying to understand where these statistics are coming from!

    • Wren

      If you read the article, both midwives and doctors are claimed to be at fault. It isn’t specified whether these cases were all midwife-led.

    • mabelcruet

      I’m involved in our local stillbirth investigation panel. I think the vast majority of these cases are midwife led care, but most midwife deliveries take place in hospital, or in a midwife led unit adjacent to a hospital. There are a few stand alone centres, but the majority of deliveries are in hospital where there is access to medical care on the same site. However, it depends on how the unit is operated. One of the cases I’ve been involved with concerned a midwife who failed to recognise secondary arrest of labour with mum staying at 9 cm for 6 hours, but the unit had the policy that medical staff weren’t allowed to attend unless they were invited onto the unit, so obviously if the midwife failed to recognise a problem then no doctor was called. I think a substantial proportion of cases involves failure to recognise problems on the CTG trace, so of course, the answer is stop doing CTGs ……

  • RodneyRBratten

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  • When I studied in the UK, British midwives were the best in the world (and, not coincidentally, all were also registered nurses). It makes me very sad to see the deterioration of the profession.

    • Who?

      My children were both delivered by midwives in a hospital in the UK, with obstetricians and paeds around as both had mec. Everyone seemed very respectful and professional, and certainly the doctors and midwives who shared care during the pregnancies were great.

      It’s so sad to hear how things seem to have changed in the last 20 years.

      • Wren

        I had a similar experience 7 1/2 and 9 years ago. Care was shared and all seemed professional.

  • Kesiana

    Um… is anybody else not seeing posts beyond early February 2015 in the archive?

    Even weirder, for a few minutes there I couldn’t see anything past February on the main page, either–I tried reloading, but it didn’t help, and I have no idea what made it kick back into gear. (The last post I see in the archive is this one.)

    • Rebecca13

      Have had this issue for several months now. The only way for me to get to the current posts is to click on the comments on the right side of the page. Otherwise “Home” is February 2015.

      • Inmara

        Try typing http://www.skepticalob instead of simply skepticalob in address bar- I have the same problem and it’s the only solution that help so far.

        • KeeperOfTheBooks

          Using the “www” prefix works for me every time; if I don’t, then the page isn’t properly updated.

    • Gatita

      It’s a DNS error, if you type in the www as Inmara said you will get the most recent homepage. Amy needs to get that fixed.

  • Liz Leyden

    In somewhat related news, the Atlantic just published an article about the rise of midwife-led births in the US. http://www.theatlantic.com/health/archive/2015/06/midwives-are-making-a-comeback/395456/

    Edit: I see someone beat me to it.

  • Who?

    May cause high blood pressure in susceptible individuals:

    http://www.theatlantic.com/health/archive/2015/06/midwives-are-making-a-comeback/395456/

    • Sue

      “you begin to create a cascade of domino responses”

      Best mixed metaphor I’ve read for a while – referring to labor interventions.

      • Daleth

        I’m picturing a veritable tsunami of Domino’s pizza boxes.

    • EllenL

      It took a wine cooler for me to get through that article. So many clichés of NCB in one place.
      At least the mother in the picture is wearing a hospital bracelet (small mercies).

  • 1,300 dead babies. 1,300 mothers with empty arms, heartbroken. 1,300 mothers silenced by an ideology that discounts their losses as being the cost of “normal birth”. And then there are their partners, the fathers, their families. Every baby counts, every mother counts – there should be no mother who suffers this kind of loss who would not have, if only she had access to adequate care.

    • Lizzie Dee

      As I have said before, dead babies are very cheap in England. No awards for pain and suffering, no juries. The only award is for the parent’s loss of earnings, so hardly anyone sues as far as I know. The large sums of money are going on babies who survive with devastating brain damage, and even these are very hard to pursue (or win.) Fetal monitoring does tend to provide evidence, so not doing it (natural birth, everything just peachy, we couldn;t know the baby was in trouble…)”

      The going rate for catastrophic injury is currently about £7m – again, no pain and suffering, just cost of care and loss of earnings, costed down to the penny. So not sure what these figures tell you about the present state of obstetric care. It was poor when my daughter had her children, and getting worse.

      The Government’s response to this expensive crisis is to cut legal aid, and wring their hands about the shortage of midwives.

      • mabelcruet

        Financial compensation for the loss of a patient depends entirely on what the individual was worth, so if a husband loses his wife and medical treatment is to blame (i.e. a ‘wrongful death’) he will be awarded economic compensation calculated to cover the cost of child care, housework, nanny duties, loss of her income, loss of her pension etc. Stillborn or dead babies aren’t worth anything really as they don’t contribute to the household finances. There have been cases where the hospital/NHS has compensated the parents for the loss of the baby by reimbursing them for the cost of prams, nursery equipment and the funeral costs.

        • Lizzie Dee

          Yes, the loss of a wife would be costlier – but the cost is still worked out rather brutally on modest estimates of what the financial loss would be. Legal settlements are often shrouded in secrecy, so hard facts are hard to come by – and the amounts that go to lawyers are staggering. Negligence is seldom difficult to prove, but causation and quantum are very different in England than in America.One cerebral palsy case I read in detail boiled down to: Yes, yes, we did everthing wrong, but you can’t PROVE your child didn’t suffer brain damage before we messed up! The idea that it can happen mysteriously around 22 weeks comes in handy in Court. Same with late stillbirths – if we weren’t looking, we couldn’t prevent it, and isn’t everybody low risk until they are not?

          • mabelcruet

            Yes, its far cheaper if the baby dies. In the NHS at least there is a certain level of care that a birth damaged baby would receive. Whenever there are reports of children receiving huge settlements, I know there is some grumbling about all those millions going to one child or family-I don’t think people realise this is life time payment. Its paid out gradually over time over the length of the child’s life, and brain-damaged children generally do not survive as long, so the actual amount paid out may be nowhere near what the original settlement was set at.

    • mabelcruet

      And then when parents who lose a baby dare to speak up, they are subject to the most vicious mobbing, name-calling and bullying. Look at James Titcombe and what he’s had to face purely for trying to highlight failures of care. At least Sue Byrom appears to have taken a step back from it, hopefully she’s got a modicum of self-awareness and realises just how vicious and unprofessional she came across in her interactions with Mr Titcombe, but Milli Hill has no such compunction and continues to villify the poor man simply because he’s trying to address the cultish behaviour of certain midwives and the remarkably nasty response of the RCM to the whole Morecombe Bay problem.

      • mabelcruet

        And now Mr Titcombe has been called ‘disgusting’ for posting a picture of his dying son, as proof of failure of midwifery care in the hospital where he was born ,by some ignorant witless supporter of normal birth at all costs.

  • Guest

    OT: Formula-bashers are out in full force over at the FearlessFormulaFeeder Facebook page (Charlotte Faircloth article)….just in case somebody feels like being a voice of reason….

    • Tiffany Aching

      Wow. I read the Charlotte Faircloth article and wanted to send it to a friend of mine who is struggling with breastfeeding her new baby and is feeling very guilty. Then I read the comments, and they are so heinous and so crazy that I decided not send it to her, as she’s fragile now and could be affected by such bs. These people are dangerous and crazy.

    • JoannaDW

      I have all but had it with FFF. There’s some great material there, it filled and continues to fill a void in maternity discourse, so I visit on occasion. That said, the last time I checked, I felt like at least once a week, the moderator had to write some a$$-kissing conciliatory peace about how we all need to support each other, we need to support breastfeeding women, make it easier for women to breastfeed, etc. Excuse me, I thought this was a site offering support to mothers using *formula.* In one of the only tiny corners of the net that doesn’t worship breastfeeding, we still feel the need to cater to it. Yeah, I agree, there exists a need to support BF and make it easier, and I will support those causes or at least not interfere. I don’t advocate insulting or making life hard for BF moms. But we have so many other supporters and facilitators of BF, a cause that is massively overrated anyway, and very few advocates or facilitators of formula. I wish that FFF would be as fearless as it claims to be and focus on the pressing issue at hand, which is the vaporization of mostly irrelevant act of mothering and filling a void for those mothers that don’t comply and cannot find support elsewhere.

      • Guest

        I am going to have to disagree on that one. The fact that FFF has a very conciliatory stance is one of her strengths I think and I just think that’s her personality. I think we need many diverse and authentic voices in this crazy discourse about infant feeding. We need blunt and unapologetic voices (like Dr. Amy and I really appreciate her for it) but we also need the more “in the middle ones”. Tons of moms will breastfeed as well as formula feed in their babies first year- no need to circle the wagons- but that’s just my opinion.

      • Poogles

        “Excuse me, I thought this was a site offering support to mothers using *formula.* In one of the only tiny corners of the net that doesn’t worship breastfeeding, we still feel the need to cater to it”

        I just felt like I had to point out that this is the same exact thing I used to hear on MDC, when they would try and support their echo-chamber:

        “Excuse me, I thought this was a site offering support to mothers having *homebirths.* In one of the only tiny corners of the net that doesn’t worship hospital birth, we still feel the need to cater to it”

  • EllenL

    We need a training film for midwives, titled “Call the Doctors!”

    • Sue

      Indeed. Interestingly, in the actual BBC television series, the MWs collaborated happily with the doctor. When ‘natural’ happened at home, it was out of necessity, not ideology.

  • Karen in SC

    Tragic numbers! I hope this brings awareness to UK mothers.

  • As for me, I tire of this relentless perpetrator-blaming. When, oh when, will we learn that there’s no room in society for perpetrator-blaming?

    • attitude devant

      sigh.

    • Amazed

      Look the other way please. And let’s talk homey and naturally. No nasty heart rate monitors involved!

      • Heart rate monitors, along with any other method of determining fetal distress, is anti-midwife; they make it unnecessarily difficult to blame birth injury and death upon mothers not wanting it enough. Responsible, well-educated midwives with the newborn’s interest in mind are also anti-midwife, as is modern science and technology.

        • Cobalt

          “they make it unnecessarily difficult to blame birth injury and death upon mothers”

          This is the core of the rot, and there is NO EXCUSE for it.

  • EllenL

    Ms. Jokinen of the Royal College of Midwives blames heart rate monitors for the high number of reported errors in labor care, calling them “a very good instrument for claimants.”

    If we could just get rid of this irritating technology, we could continue to ignore birth injuries and deaths.

    • Cobalt

      Forget the errors, just reduce the reporting.

      Keep injuring the babies, just make sure we don’t have to pay for it.

      I again find myself at a loss for adjectives.

      • “Fucking unbelievably lunatic” comes to mind.

        • Cobalt

          It’s a start, anyway.

    • Roadstergal

      “We couldn’t be 100% sure your baby was in danger, so don’t blame us for waiting to act until a disaster was actually imminent.”

    • Sue

      Those pesky monitors! If we could only stop doing EKGs for people presenting to ED with chest pain, we wouldn’t have to worry about being held to account for missing heart attacks!

      (Sarcasm font)

      • Reminds me of one of the Laws of the House of God (HoG is a great book!): if you don’t take a temperature, you can’t find a fever.

    • Rosalind Dalefield

      I loved having a monitor on and listening to my baby’s heartbeat, knowing no matter how rough things got for me, my baby was still okay. After the midwife during my first labour concealed fetal distress from me and from my husband for nearly three hours, I got an article on how to read CTG traces and my husband studied it. He used to pick it up and read it during my labours. I remember one time the OBGYN said to him ‘Are you happy with that?’ and my husband said ‘Yes, fine, the beat-to-beat variability is good, isn’t it?’. The astonished expression on my OBGYN’s face was priceless.

  • Daleth

    The Elizabeth Prochaska quote has a typo. It says, “inadequate Times editorialinvestigation after it” when obviously it should just say “inadequate investigation after it.”

    • Amy Tuteur, MD

      Thanks!