Everything wrong with contemporary midwifery encapsulated in a single slide

Life affirming glory of birth

Here we have everything wrong with contemporary midwifery in a single slide:

Focussing on risk is one of the ways we close down the life-affirming glory of birth

The slide was presented today at the Normal Labour & Birth: 10th Research Conference.

You might think that the recent revelations about dozens of preventable deaths at the hands of midwives would have prompted them to reassess their mindless veneration of unmedicated vaginal (“normal”) birth. You would be wrong. Indeed, the heartless woman who tweeted the image called it “poignant” in the wake of the 12 preventable deaths detailed in the Morecambe Bay report. Poignant is not the word that occurs to me; disrespectful, unfeeling, and heartless leap to my mind.

Here’s my question, midwives: how life affirming is the birth if the baby is dead?

Apparently, it’s still life affirming … because it affirms the lives of MIDWIVES. What? You thought contemporary midwifery was about babies and women? Aren’t you naive.

Midwives have become everything they claimed to despise in doctors: they are arrogant, dictatorial and contemptuous of scientific evidence. Most importantly, they appear to believe that the profession exists for their benefit and women should shut up and do what they say.

The ugly, deadly truth is that “normal birth” is not healthier, safer or better in any way for mothers or babies than childbirth with the entire panoply of obstetric interventions. But “normal birth” is a nail, and midwives are hammers and they just keep on pounding.

As anthropologist Margaret MacDonald explained in the Lancet, The cultural evolution of natural birth:

Natural birth has long held iconic status within midwifery and alternative birth movements around the world that have sought to challenge the dominance of biomedicine and the medicalisation of childbirth… The recent transition of midwifery in several Canadian provinces from a social movement—for which “reclaiming” natural birth was a critical goal — to a regulated profession within the formal health-care system is a unique opportunity to track changes in how natural birth is understood and experienced. Midwifery in Canada has much in common ideologically with independent or direct-entry midwifery in the USA and with radical and independent midwifery in the UK and so insights about changes in Canada have implications for maternity caregivers in a range of health systems.

But normal birth actually involves lots of technology. There is nothing natural about checking blood pressure, listening the fetal heart with a Doppler or recommending chiropractic. Other technological interventions have also become a part of normal birth. In fact:

[If an intervention] can bring back the clinical normalcy of the labour pattern and keep it within the midwifery scope of practice, it is generally regarded as a good thing by midwives and clients alike …

That is the key point. Anything is acceptable as long as it can keep the birth within the scope of midwifery practice. Normal birth is about midwives keeping patients under their control.

Consider a handyman, Bob, who only knew how to use a hammer. Whenever he was called to a job, he brought his trusty hammer and banged in the nails. Imagine that a new handyman, Steve, comes to town and he knows how to use a hammer AND a screwdriver. He can do twice as much as the original handyman and as time goes by, more and more people call Steve, since many of their projects involve nails and screws.

Bob, the original handyman, now faces a difficult choice. What should he do about jobs that involve screws? There are several tacks that he could take:

He could always learn to use a screwdriver, but that might be difficult for Bob. What else might he do?

  • He could insist that screws can be pounded in.
  • He could insist that screws are an unnecessary use of technology; anything that can be made with screws could also be made with hammers.
  • He could insist that Steve invented screws just to take business away from him.
  • He could insist that Steve recommends screws for a project when nails would have been just fine.


He could insist that only things assembled with nails are normal.

All of these strategies share one thing in common. They imply that using a hammer is always best.

Just like Bob the handyman, a midwife faces a difficult choice when confronted with a patient who needs advanced technology like a C-section. She also has several choices, remarkably like the choices from which Bob can choose.

  • She could insist that the patient can give birth safely without a C-section.
  • She could insist that C-sections are an unnecessary use of technology.
  • She could insist that obstetricians recommend C-sections just to take business away from midwives.
  • She could insist that obstetricians routinely recommend C-sections when vaginal birth would have been just fine.


She could insist that only vaginal birth is normal.

Midwives use all these strategies. What women need to understand is that midwives define normal birth by what is good for THEM, not what is good for women or safe for babies, and certainly not by what is actually normal. When they hold conferences to promote “normal birth,” they are holding conference to promote themselves. And in their efforts to promote themselves, they have become arrogant, dictatorial and contemptuous of scientific evidence that does not support their biases.

They’ve actually gone one step beyond what they despised in doctors; they appear to be incapable of learning from their mistakes. It makes no difference to them how many babies or mothers die preventable deaths; it makes no difference how many reports are written about their egregious negligence; it makes no difference to them how many midwives are struck off for deadly practices. They have staked their professional lives on the altar of “normal birth” and they don’t care how many babies and women must be sacrificed to continue worshiping at that altar.

164 Responses to “Everything wrong with contemporary midwifery encapsulated in a single slide”

  1. Frum lady
    June 23, 2015 at 9:01 pm #

    I love what you wrote above. Nails the point down. This ought to be a column in the New York Times.!

  2. Amazed
    June 23, 2015 at 1:12 pm #

    Ah, Laura, Laura. Why did you delete your post, Ms Honesty? Ashamed of letting the world see your lies?

    For those who missed the exchange: there was this midwife, Laura. A British midwife foaming at the mouth at this post. She insisted that the Birthplace study showed the absolute best outcomes, that homebirth was best for low-risk multip, and that she attends HBAC and never had a rupture, as she bragged. And she got all huffy when I named her a liar. Really, what else is giving information to women regarding only low-risk women and then promptly forget about it when a non-low-risk woman approaches you for a HBAC?

    Why deleting, Laura, if you aren’t a liar?

    • Roadstergal
      June 23, 2015 at 1:19 pm #

      It had certainly been a very interesting conversation. What I got from Laura, the representative of current midwifery practice in the UK, is that:
      -She does not believe in giving the women in her care informed consent for her preferred course of action (the risks of HBAC, uncontrolled pain, vaginal delivery) and letting them make their decisions based on data, rather than Laura’s personal beliefs.
      -She believes that women are best off in a position where safe and effective pain relief is not an option they can have access to if they wish.
      -She misunderstands the current data on the safety of birthplaces (her erroneous comments re: The Birthplace Study showing that home is safer for all multips).
      -She does not understand issues around causation that a high-schooler should be able to identify (eg, her statement that epidural anesthesia causes complications, rather than considering the valid alternate explanation that women with more complicated pregnancies have more pain than those with simple and straightforward ones, therefore a greater need for pain relief).

      It just makes me wonder what Laura would say if a woman told Laura that she was planning on birthing with an OBGYN who does not give informed consent about the options presented, and who does not have the ability to properly evaluate the available literature.

      • moto_librarian
        June 23, 2015 at 1:36 pm #

        Laura also demonstrates that she is not up-to-date on research in her own field. We have seen several studies in the past year that refute the assertion that epidural anesthesia increases your rate of interventions, including c-section. I’m betting she also hasn’t noted the study that demonstrated that induction led to fewer c-sections than expectant management, regardless of parity or Bishop score.

        Laura came here to try to hold herself up as a normal example of midwifery in the UK. Her beliefs simply offer more evidence that the midwifery model of care is more interested in promoting the status of midwives and “normal” birth rather than adhering to evidence-based standards of care.

        • The Computer Ate My Nym
          June 23, 2015 at 2:08 pm #

          I suspect no one told her that she was stepping into a nest of vipers, aka people who have read and evaluated the research and aren’t afraid to discuss it critically. She thought she could just say, “the birthplace study shows homebirth is best” and be done with it.

          • Amazed
            June 23, 2015 at 2:12 pm #

            Most likely. Look how hysterical she got when she got people confronting her with evidence. Deleting means being unprepared and panicked in my book.

          • The Bofa on the Sofa
            June 24, 2015 at 10:53 am #

            Some people think they are immune to Pablo’s First Law of Internet Discussion. They come into a rude awakening.

        • The Bofa on the Sofa
          June 23, 2015 at 2:56 pm #

          Laura also demonstrates that she is not up-to-date on research in her own field. We have seen several studies in the past year that refute the assertion that epidural anesthesia increases your rate of interventions, including c-section.

          But that begs the question of whether she actually cares about the research in her own field. To the extent she used the birthplace study, it is to prop up her preconceived notions (which is why she mistated the conclusions; you think she actually read it?)

    • Sarah
      June 23, 2015 at 1:57 pm #

      I did believe the part about her having done a HBAC without rupture. I mean, the average risk is what, 1 in 200? So she probably hasn’t had a bad outcome even if she’s done a few (and she won’t have done a lot because HBAC isn’t common in the UK). The problem most women have with the idea isn’t the risk of rupture, more the virtual certainty of losing the baby and quite possibly their uterus if it happens at home. Hence hospital VBAC is quite popular, as a potential rupture can be managed there, HBAC not so much.

  3. Laura
    June 21, 2015 at 4:34 pm #

    This is a very irresponsible post. I understand the anger surrounding the Kirkup report. And how we all need to speak up and ensure safety in birth. BUT you can not blame this on midwives. This was a team failing in Morecombe Bay. Midwives and obstetricians not working together. Not communicating. The birthplace study has clearly shown that giving birth in a midwifery led-unit or a home is the best option for multips. But you fail to mention this. this slide was taken out of context via Twitter. Categorising women into high and low risk. It’s not beneficial. There is of course risk in all birth. But midwives are the experts in normal birth and recognise when it’s time to escalate. I have been a midwife for 4 years. You cannot say all midwives risk women/babies lives for normal birth. I love supporting women at home. But I won’t risk there lives to achieve this. You fail to mention all the morbidity that surrounds intervention in birth. Or the fact that women die in childbirth isn’t because of reckless midwives. But because of sepsis. Or influenza. Stilbirth and neonatal death is linked with poor access to antenatal care and social deprivation. I’ve worked in a small unit, a London unit and even in Africa. And what women have told me they want in ALL these areas is to be listened to. Cared for with respect. And given choice. That is why midwives are needed in maternity. And why the UK is the envy of most countries. Negative posts such as these don’t prevent another Morcombe Bay. They only create another environment of fear and mistrust.

    • Fallow
      June 21, 2015 at 5:08 pm #

      Substandard care and tribalistic attitudes on the part of Morecambe Bay midwives = not as bad as MEAN MEAN INTERNET POSTS about loser midwives who killed children with their bullshit. Noted.

      Why do you people bother with this shit, anyway? You all come here and recite the same goddamned party line, and someone here shows up with actual facts and wipes the floor with your ass. I don’t get what you people enjoy about that, but maybe you’re masochists or something.

    • Amazed
      June 21, 2015 at 5:24 pm #

      This is a very irresponsible post, I agree, Yours, I mean. Tell me, Laura, do you tell the women you love supporting at home that the Birthplace study showed not how homebirth IS practiced but how it is SUPPOSED to be practiced under the best of circumstances that women like your Morecombe Bay murdering sisters and your lying self do not aim for because if you were, you would have not lied in the first place?

      I *love* how even in this post, you whine about the supposed morbidity at the intervention of birth and avoid admitting the proven mortality after the non-intervention of multiple of births attended by your murdering MB sisters who did everything in their power to keep it non-interventional.

      You liars disgust me.

      • Laura
        June 23, 2015 at 11:28 am #

        Wow. I think you need to really do some relaxation and breathing techniques. I’m not a liar. Nor am I saying what happened was ok. It wasn’t. Taking risk to achieve something that is unachievable is wrong. As is blaming all midwives. As is saying normal birth is not possible. I bet none of you have ever seen a physiological normal birth. And that is what scares you. How do I care fur a woman walking around the room. Wanting to make noise. Birth squatting?! Ridiculous. get this woman an epidural. She’s too noisy. A ctg and some synto. Hell let’s just cut it out now.

        • The Bofa on the Sofa
          June 23, 2015 at 11:31 am #

          I’m not a liar.

          Amazed, I agree with Laura. She probably isn’t lying. It’s more likely that she is just clueless.

        • Sarah
          June 23, 2015 at 11:31 am #

          Relaxation and breathing techniques? Righty ho. I think you need some opiates.

        • Megan
          June 23, 2015 at 11:34 am #

          Actually as a family doctor I have seen these kind of births and they were done in the hospital, with immediate access to obstetric care if needed. You don’t have to be in your living room to achieve a safe “natural” birth. I admit though, that those births were in the minority because most women, if given a choice, want pain relief, which is their choice, no? As a woman who tried for a natural birth and “failed” I can tell you that no amount of one on one support (I had a doula, a very supportive family doc and my husband) compared to the pain relief of an epidural.

          • The Bofa on the Sofa
            June 23, 2015 at 11:44 am #

            I admit though, that those births were in the minority because most women, if given a choice, want pain relief, which is their choice, no? As a woman who tried for a natural birth and “failed” I can tell you that no amount of one on one support (I had a doula, a very supportive family doc and my husband) compared to the pain relief of an epidural.

            In talking to parents and expecting parents, my impression is that
            a) most say they are going to TRY to do it without and epidural, and
            b) most end up getting the epidural

            IOW, I would suggest that your experience is pretty much the mode of action when it comes to childbirth.

          • MaineJen
            June 23, 2015 at 1:04 pm #

            And most, I suspect, just say that because it’s what they’re supposed to say. You supposed to *want* to try for a natural birth, because…it’s better. For some reason. I personally had no wish to go all-natural, and I still felt the need to hold off on pain relief as long as I could, because…why? Why should I? I still don’t know. The NCB stuff has so seeped into the public consciousness, I feel like it’s assumed that you want to go natural. Even if you don’t.

          • Roadstergal
            June 23, 2015 at 11:52 am #

            “You don’t have to be in your living room to achieve a safe “natural” birth.”

            More than half of the women I work with are mothers (and I work in a group that’s more than 50% women). They’ve had all sorts of births, and two in particular had the easiest, most straightforward, intervention-free natural births an NCBer could dream of – in hospitals. That’s the thing about hospitals. If there’s no reason for an intervention, you don’t get one. Nice how that works.

          • MaineJen
            June 23, 2015 at 12:53 pm #

            Hell, staff in OB wards like nothing better than a straightfoward, uncomplicated birth where they don’t have to do anything but catch the baby. They fight over those patients.

            Interventions are not done for shits and giggles. And FYI, I spent most of my last labor on hands and knees, out of bed, because that was where I wanted to be, and I was supported in that 100%. No one forced me back to bed. I also spent half of it on pitocin to speed labor, because there was meconium, low fluid, and the baby’s heart rate was tachy. I was also GBS positive. I suppose the IV antibiotics and pitocin drip would be “interventions,” and according to Laura I should be traumatized and outraged. Instead, I couldn’t be happier. I got a healthy baby and I didn’t need a c section. Yay.

    • Amy Tuteur, MD
      June 21, 2015 at 5:25 pm #

      Not only can I blame this on British midwives, I am blaming it on British midwives. The only people who think the midwives aren’t at fault for these deaths are the midwives themselves. As long as they are more interested in their beliefs and self-image than whether babies live or die, these preventable deaths will continue.

      The leadership of British midwifery is unethical, immoral and utterly self-absorbed. Many of the rank and file aren’t far behind.

      Merely holding a conference on “normal birth” in the wake the Kirkup report was reprehensible. The slide was repugnant, and if midwives can’t recognize that (and apparently you can’t) you have become everything you claimed to despise in doctors: arrogant, dictatorial and willing to ignore real world evidence that you don’t like.

      British midwives should be on their knees begging forgiveness. Instead, like you, they are whining that they shouldn’t be held to account for the babies who died at their hands.

      You should be ashamed of yourself.

      • Laura
        June 23, 2015 at 11:23 am #

        I’m not ashamed of myself. I AM ashamed of what happened in Morcombe bay. But that is not my fault. Nor is it British midwives. It’s a failing on many people but as I said previously. It’s more a lack of communication. Leadership. We are all learning from what happened. And finger pointing at midwives is a very immature and irrational reaction. I’m just very grateful that where I work we speak up, work together. And respect each other.

        • The Bofa on the Sofa
          June 23, 2015 at 12:08 pm #

          I AM ashamed of what happened in Morcombe bay. But that is not my fault.

          What happened at Morcombe Bay is not directly your fault, no, but could just as well be, because you have made it clear that your espouse and support the factors that led to the problem there in the first place.

          You may not have caused that problem, but you exemplify it.

      • Linden
        June 23, 2015 at 12:14 pm #

        “Merely holding a conference on “normal birth” in the wake the Kirkup report was reprehensible. ”
        It’s the equivalent of NRA rallies in the wake of gun massacres.

    • Who?
      June 21, 2015 at 6:06 pm #

      Why is wanting to be clear about risk a bad thing? It took you a little while to get to ‘choice’, but decisions aren’t a real choice if actual risks, and their frequency, aren’t adequately communicated.

      Please outline the context missed with the slide. I’d be really interested to know how shrugging off the risks of childbirth amounts to seeking informed consent or providing a professional and knowledge-based standard of care.

      And given what happened at Morecombe Bay I would think fear and distrust should be the default position for pregnant women until this terrible mess gets cleaned up.

      I had my two children in the UK with midwives in the early nineties, and it is so saddening to see the levels to which British midwifery has apparently sunk.

      • Amazed
        June 21, 2015 at 6:20 pm #

        “I had my two children in the UK with midwives in the early nineties, and
        it is so saddening to see the levels to which British midwifery has
        apparently sunk.”

        You and Antigonos both. After all, she was one of the women who made the UK “the envy of most countries”. Laura’s wish is to sit back and bask in that reflected flame while using it to cover her own lies and risk-taking.

        • Laura
          June 23, 2015 at 11:17 am #

          I’m not lying. Nor am I risk taking. I give women the evidence. I support their choice. And if labour progresses without concern we have no need to intervene. If things arise in pregnancy or labour that are not within the norm then we esculate early snd ensure interdisciplinary working. Being a midwife doesn’t mean I hate doctors. I highly respect my obstetric colleagues. Just unlike this post I also respect women and the freedom to birth how they feel safe in doing so.

          • Sarah
            June 23, 2015 at 11:30 am #

            Given that you think yourself qualified to decide whether a woman needs an epidural, I don’t believe you.

          • Linden
            June 23, 2015 at 12:12 pm #

            Yes, right off the bat, you’ve lied and said women who have midwife support don’t need an epidural.
            Most women need pain relief in childbirth. Unrelieved pain can cause serious issues ranging from elevated BP to PTSD.
            What you should have said is, women who have only midwife support can’t get an epidural.
            I’m so glad the midwives who took care of me were nothing like you. But clearly, the NHS needs to weed out people spouting this paternalistic, dangerous BS.

          • Linden
            June 23, 2015 at 12:24 pm #

            “I’m so glad the midwives who took care of me were nothing like you.”
            That was a response to Laura, not Sarah. Apologies, Sarah!

          • Sarah
            June 23, 2015 at 2:03 pm #

            That’s ok. I’m also glad the midwives who cared for you were nothing like me, since I have no qualifications in midwifery, nursing or medicine and would be about as much use as a chocolate teapot.

          • Who?
            June 23, 2015 at 9:57 pm #

            You could totally be qualified for US homebirth midwifery in that case! Maybe don’t mention the teapot thing though…

          • Sarah
            June 23, 2015 at 1:34 pm #

            I presume she’s doing that thing NCBers do when they try to extrapolate outcomes for women who want an unmedicated birth to the entire population. It is true that a woman who chooses one to one midwife support in a facility where an epidural won’t be available to her is, if labour goes smoothly, likely to give birth without requesting said epidural. But those women are an entirely self-selecting and unrepresentative group. By definition, the women who know they want the serious drugs aren’t going to be found in MLUs, FMLUs or at home.

    • The Computer Ate My Nym
      June 23, 2015 at 10:10 am #

      The birthplace study has clearly shown that giving birth in a midwifery led-unit or a home is the best option for multips.

      How do you come to this conclusion from reading the birthplace study? The most optimistic reading of the study I can come up with from the study is that home birth might not be significantly more dangerous for low risk multiparous women whose first birth was utterly uncomplicated. If you have really good transfer protocols and extremely strict criteria for “low risk”. And you risk out those who have complications during pregnancy very aggressively. And you’re comfortable making these statements given that the confidence intervals went as high as 50% higher risk for the very best risk women.

      But there is no way to read home birth as the “best option” unless by “best” you mean “cheapest”. The only outcome clearly superior in the home birth/nurse-led unit category was immediate cost. Which, of course, does not include the costs of ICU treatment for mother and baby when it goes wrong or treatment of long term complications of hypoxia.

      • The Computer Ate My Nym
        June 23, 2015 at 10:15 am #

        I should also note that the primary outcome was a composite score of “events”, which included outcomes such as stillbirth with living fetus at start of labor or neonatal mortality but also included things like broken clavical or brachial plexus injury, which are things that can occur due to appropriate emergent delivery of shoulder dystocia and are completely self limited. I’d like to see what the data would look like if the events were limited to truly severe outcomes, i.e. neonatal death, intrapartum death, severe hypoxia.

      • Roadstergal
        June 23, 2015 at 10:37 am #

        Yes, the only way they could jigger the numbers to make home birth look safe is using a small sample size of the very lowest risk women – which doesn’t represent home birth as currently implemented.

        Eg, there is at least a subset of these supposedly better-educated and more-responsible UK midwives who are actively supporting and encouraging HBAC. My NCB-loving former friend is NCB-loving partly because of the influence of these midwives; they performed an HBAC waterbirth for a friend of hers (who got lucky and didn’t have a rupture; I don’t know any other details) and are helping her plan her HBAC waterbirth (for a woman with no previous successful vaginal deliveries).

        • Laura
          June 23, 2015 at 11:13 am #

          No way. Are they ALLOWING a woman to chose how she births her baby. Put her in prison and lock her up. I have also supported women to have vbac water birth. At home. And guess what. No rupture.

          • Roadstergal
            June 23, 2015 at 11:17 am #

            There’s a massive hurking gaping chasm between preventing a woman from doing something and not being honest with her about the risks. What do you tell women is the risk of an HBAC, when you’re supporting them?

          • The Computer Ate My Nym
            June 23, 2015 at 11:40 am #

            Nope. By coercing women into giving birth at home or in inadquately prepared midwife led units you are forcing them to do without pain relief and to take risks ranging from worse perineal tearing to higher neonatal mortality.

          • momofone
            June 23, 2015 at 11:55 am #

            Is it only a valid choice if she chooses a dolphin/moon/water homebirth? What about women who CHOOSE a c-section?

          • Roadstergal
            June 23, 2015 at 12:03 pm #

            This wasn’t a rhetorical question, Laura: “What do you tell women is the risk of an HBAC, when you’re supporting them?”

          • Linden
            June 23, 2015 at 12:05 pm #

            I drove home completely blotto last night*! And guess what? No car crash fatalities!
            *Needless to say, I didn’t. Because I am not a moron.

          • Roadstergal
            June 23, 2015 at 12:12 pm #

            And wasn’t it empowering?

          • Linden
            June 24, 2015 at 5:03 am #

            Yeah! Driving drunk and not having an accident totally empowers the driver and all the people they don’t kill!

          • The Computer Ate My Nym
            June 23, 2015 at 12:14 pm #

            Put her in prison and lock her up.

            That would be Darby Partner’s move, yes.

      • Laura
        June 23, 2015 at 11:11 am #

        It’s not about the money. It’s about the safety of mother and baby. The study does show that there is a large reduction in maternal morbidity by giving birth at home or in a midwife led unit. And equal safety measures for mortality. In your ideal world im sure women should have sex in a sterile room and have the baby cut out at 37 weeks. Read all the growing evidence surrounding cesarean sections. And what this is doing to our future generation.

        • Sarah
          June 23, 2015 at 11:24 am #

          Would that be all the speculation on microbirth?

          • Roadstergal
            June 23, 2015 at 11:27 am #

            That microbiome that might be different at birth between vaginal and C-section babies in a way that might or might not be larger than the overall inter-baby variability, with no knowledge of any functional consequence? The one that normalizes to the household one once the baby spends a little time at home getting everything in its mouth? I think that’s the one she’s talking about.

          • Sarah
            June 23, 2015 at 11:29 am #

            Yep. The presumption without any evidence that because section babies have different gut flora to VB babies, that means the section babies must be worse off for it.

        • The Computer Ate My Nym
          June 23, 2015 at 11:28 am #

          Again, not sure where you’re getting the statement that there was less maternal morbidity since I can’t see anywhere that maternal morbidity was reported. Fewer interventions were reported in the home birth or midwife led unit group, but maternal morbidity was not reported at least in the initial paper.

        • moto_librarian
          June 23, 2015 at 12:32 pm #

          So do you give your patients true informed consent regarding the morbidities associated with vaginal birth? Do you discuss the potential for sexual dysfunction, bladder and/or bowel prolapse, fecal and urinary incontinence, etc.?

    • moto_librarian
      June 23, 2015 at 10:35 am #

      “Categorising women into high and low risk. It’s not beneficial.”

      Oh, it’s quite beneficial for women and their babies. It’s not beneficial for midwives, which I guess would be why you oppose it. I am amazed that you can parachute in here and tell us that midwives “recognise when it’s time to escalate” when recent reports show that the UK is paying out astronomical amounts of money related to malpractice during childbirth. Do you really think that we are going to believe that bad actors are limited to Morecombe Bay?

      • Laura
        June 23, 2015 at 11:07 am #

        You are American? Because you do realise that America has the highest maternal mortality rates in Western context. Highest litigation. Because they can’t see past the fear of childbirth.

        • The Bofa on the Sofa
          June 23, 2015 at 11:26 am #

          Because you do realise that America has the highest maternal mortality rates in Western context.

          We do. And we also know why.

          Because they can’t see past the fear of childbirth.

          And that’s not it. Shit,that doesn’t even make sense. You are going to have to connect the dots for me and explain how one is related to the other.

        • Sarah
          June 23, 2015 at 11:28 am #

          You don’t think their also having some of the highest rates of poverty, inequality, obesity and women receiving no/inadequate antenatal care might be the reasons for that?

        • The Computer Ate My Nym
          June 23, 2015 at 11:31 am #

          Actually, didn’t the UK pay out more in obstetric malpractice claims than the US in 2014? I think there was a post here about it recently.

          The US has numerous confounders for maternal mortality: higher percent minorities, more uninsured women, higher average BMI and more obesity, more older women giving birth, etc. Simply quoting the maternal mortality in each country won’t help much. Also, what would home birth do to help reduce maternal mortality in the US?

        • moto_librarian
          June 23, 2015 at 12:30 pm #

          You are ignorant. As Nym says below, women in the United States aren’t dying because of intervention during childbirth. They are dying because many lack access to proper medical period over their lifetimes, because we are, as a population of birthing women, heavier, older, and more prone to preexisting conditions that used to make carrying a pregnancy to term impossible. An emphasis on “normal birth” won’t do shit to keep women in the U.S. from dying in childbirth.

    • AllieFoyle
      June 23, 2015 at 10:56 am #

      The birthplace study has clearly shown that giving birth in a midwifery led-unit or a home is the best option for multips.

      Nonsense. For starters, epidural anesthesia isn’t available in either location, so right off the bat, both locations are going to be inferior to hospital care for those women who want or need pain relief.

      Second, in the event that something goes wrong, which can happen to any woman at any time, regardless of parity or history, transfer and handoff will need to occur, needlessly complicating and delaying time-sensitive care.

      • Laura
        June 23, 2015 at 11:05 am #

        Epidural is not needed for the majority of women if they have one to one support that they get from a midwife. And more importantly epidurals are one of the main reasons normal birth is unsuccessful. It starts the inevitable route of intervention. Have you ever supported a woman in natural, unmedicalised birth. I’m guessing not. I have been supporting homebirth for over 7 years. And I myself am having one. Not because I’m irresponsible. But because I know that is the right environment for my baby and my body to birth.

        • Amy Tuteur, MD
          June 23, 2015 at 11:13 am #

          It’s not needed? Who died and appointed you arbiter of women’s pain?

        • Sarah
          June 23, 2015 at 11:22 am #

          Who the fuck gave you the right to decide whether other women need epidurals? Speaking as a woman who gave birth very recently, miss me with that shit. You don’t get to make that call on my behalf. The mere fact that you consider yourself entitled to do so means I’m terrified at the possibility of you caring for me or any of my loved ones.

          And while you’re at it, let’s see you prove that ‘inevitable rate of intervention’ claim. Clue- you’ll need to have some idea what happens to women who want epidurals but are denied them. They are the appropriate group to compare those receiving epidurals to, not women who didn’t feel the need for one.

        • momofone
          June 23, 2015 at 11:52 am #

          Who are you to say what’s needed for someone else? Thanks, but I’ll decide that for myself.

    • The Computer Ate My Nym
      June 23, 2015 at 11:39 am #

      Or the fact that women die in childbirth isn’t because of reckless midwives. But because of sepsis. Or influenza.

      And how do women (and babies) end up with sepsis? Sometimes due to non-sterile technique like the midwife who gave her poor patient flesh eating bacteria by delivering without any gloves or even hand washing. But more often it’s due to group B strep infection that hasn’t been detected or has been detected but not adequately treated. Many home birth midwives in the US do not test for group B strep.

      And influenza? It’s a risk and pregnancy is a risk factor for death from influenza, but that risk can be decreased with vaccination. Many midwives, at least in the US, do not support or recommend vaccination.

    • momofone
      June 23, 2015 at 12:12 pm #

      I want to be cared for with respect and given choice, too, but neither of those things precludes my also having pain relief and an actual OB.

  4. mabelcruet
    June 20, 2015 at 10:01 am #

    I genuinely don’t understand why explaining risks is seen as bad. Any patient undergoing a surgical procedure has to be informed of the risks-even for the very simplest procedures such as scraping off a freckle or something, its not going to kill you but any doctor who didn’t explain that you might be left with a scar could be sued, and rightly so. Not discussing risk in detail with patients was fairly commonplace many years ago and has been rightly derided as paternalistic-doctor knows best, let us worry about everything. Health care is a partnership between provider and patient-not a hierarchy, not a dictatorship. So how come discussion of risk is discouraged when this is potentially the riskiest thing that the woman is ever going to do? The woman has a right to know the full implications of everything she decides to do, but the midwives seem to be acting just like 1950s outdated clinicians and fudging or dismissing risk-paternalism (or maternalism) has no place in health care, whether chopping bits off or getting babies out.

  5. FrederickBPerez
    June 17, 2015 at 1:52 am #


  6. Into soul winter I fly
    June 16, 2015 at 12:18 am #

    Had no idea some provinces were like this. So what is the home birth and midwife situation in Canada?

    • DaisyGrrl
      June 16, 2015 at 8:45 am #

      It depends on where you live. Most provinces regulate midwives, and of those provinces, all of them require midwives to have a degree in midwifery. We have a bit of a hybrid between the American and British systems. In the UK, midwives act as L&D nurses who attend all uncomplicated labours and only call in the doctors when there are complications that exceed their skills (there is ample evidence that they don’t call in the doctors even then, but I digress). Many UK midwives also attend home births. In the US, they have nurse midwives who may attend births in hospital but there are distinct L&D nurses in addition who assist both OB and midwife attended births. American lay midwives do not have hospital privileges.

      I’ll describe Ontario, since I’m most familiar with that system. In Ontario, midwives must attend both hospital and out-of-hospital births. Our midwifery system is patterned in many ways after the British system with the exception of midwives acting as L&D nurses for all births. This can be a good thing, since having hospital oversight over a number of births will keep the crazier things in check. However, a quick perusal of many websites for midwifery practices will show you how deep the woo runs. I have friends and family who have had epidurals refused or delayed. I know one mother who was not provided informed consent on the risks of going beyond 41 weeks (against college rules). There’s a midwife in my city who attends breech deliveries and teaches American lay midwives her technique. But hey, we have a pretty birth centre only 10 minutes from the hospital!

      Current Canadian studies don’t appear to show an increase in mortality or morbidity associated with midwife-attended births, but I suspect it’s only a matter of time. Most of the published studies are underpowered to detect mortality, so we’ll have to wait on ones that are large enough to give better answers.

      There are some Canadian doctors who post here who can probably give you a better idea of the current situation, but I wouldn’t trust the local midwives with my healthcare.

    • Zoey
      June 16, 2015 at 12:06 pm #

      I’m in Manitoba, and I absolutely would not trust my care to a midwife here. Midwives here are a self-regulated profession that sets their own standards, and from what I’ve read of these standards (available on their website), I am not impressed. Manitoba midwives base their standards on the midwifery literature, which doesn’t seem to be terribly science-based and leads them to recommend things like homeopathy to try to induce an overdue baby (maybe a good thing it can’t work?) or unspecified herbs or teas for a variety of issues. Some of the midwives also do HBACs, which is unbelievably irresponsible to me. If a baby has not already died at a HBAC here from a uterine rupture, I feel like it’s only a matter of time. They also built a multi-million dollar birth centre a 10 minute drive (more like 15-20 minutes in traffic) from the nearest hospital that sits empty most of the time because it’s only for a small subset of low risk women – they actually won’t do VBACs there because they know how bad it would look to have a baby suffer an adverse outcome there.

      I also was acquainted personally with a midwife from a local parenting group that openly advocating skipping the Vitamin K shot, told parents that vaccines caused her son’s autism, and didn’t believe that Group B strep was dangerous to babies. Standards be damned. It scared the heck out of me, thinking she was caring for mothers and babies.

      • Into soul winter I fly
        June 19, 2015 at 3:46 am #

        Holy crap, I thought our midwives were held to a higher standard than CPMs in the US. Are they still uni educated or do they have their uni ed but then base most of their practice off woo?

      • Into soul winter I fly
        June 19, 2015 at 3:48 am #

        People bring up home birth as a proposed solution for Aboriginal women having to travel far to a hospital. I feel like this is an easy way out to sneak around the fact that people in Aboriginal communities have less access to the resources they need. They need science based medical care not dangerous crap that devalues their safety and lives.

        • Mishimoo
          June 19, 2015 at 6:09 am #

          For example: The media listing the vehicle stolen in a riot this year as a “QLD Heath vehicle” when it was actually the town ambulance (allegedly understocked Landcruiser Troopcarrier), and it was collected after being abandoned not “police and elders negotiated for it’s return”.

        • Sarah
          June 23, 2015 at 11:46 am #

          Yeah but that would be more expensive. Plus, all indigenous people want spiritual births and blessingways and you can’t have that in a hospital.

  7. L & D RN
    June 15, 2015 at 8:39 pm #

    OT: Another neonatal death due to lay midwifery that will never be seen in midwifery stats. G1, P0 who was seeing an Amish lay midwife in my local area. The midwife has no phone so her clients just walk-in. This patient started bleeding, drove an hour to the midwife’s “birth center” which is in her house. The midwife assessed her bleeding and sent her to the hospital (another hour away) where she had an emergency Csection for an abruption. The baby was born alive, but needed to be life flighted to a NICU where he was cooled for several days before he passed. This one is not so much due to midwife incompetence, (though she may have had risk factors for abruption that were undiagnosed) but to planning an out of hospital birth in the first place. Had she been under an OB’s care, she would have called when she started bleeding, been told to come in stat, and had a section 2-3 hours sooner. Quite possibly the baby would have survived.

    • Daleth
      June 16, 2015 at 9:18 am #

      That one is down to maternal incompetence too. I’m sorry, choosing a midwife who lives an hour away from you and has no phone?!?!?!? And then, when you have bleeding near or at term, getting in your car and driving an hour to see the midwife instead of going straight to the hospital?!? That’s just idiotic.

      • Cobalt
        June 16, 2015 at 11:09 am #

        It certainly speaks to the depth of distrust in hospitals that the mother had. It’s a distrust the midwife should have addressed by reassuring her that hospitals are safe and lifesaving in emergencies, and the midwife should have given her clear directions to proceed straight to the hospital if any risk factors (like bleeding) present. I have a suspicion that that’s not what happened though.

      • The Computer Ate My Nym
        June 16, 2015 at 12:39 pm #

        How about oversight incompetence? How the heck is a woman who has no phone allowed to even call herself a “midwife”? She has pretty much set up a situation where this sort of thing will inevitably happen by making herself unavailable. The mother could well have died as well as the infant.

  8. attitude devant
    June 15, 2015 at 8:31 pm #

    Let’s focus a little on the last words of the tweet: “How poignant to be near Morecombe” Who IS this clueless person? Is she saying it’s poignant because of the families injured by midwifery there? Or does she feel that the midwives are threatened and need support?

  9. Angie
    June 15, 2015 at 5:19 pm #

    Dr Amy is right they are incapable of learning from their mistakes. Our experience is they lie and cover up. Their agenda is to deter complainants by whatever means they can. We are having a hard fight for an open and honest investigation. They are affronted by our determination to seek the truth. The continuing damage inflicted on bereaved parents is shocking. It is a total travesty and is beyond belief.

    • June 15, 2015 at 5:56 pm #

      It is! We’re with you, though. You can do this.

      • Angie
        June 15, 2015 at 6:30 pm #

        We will, they will not deter us, thanks for the support.

        • KeeperOfTheBooks
          June 19, 2015 at 9:54 am #

          Good. If any of us can help–say, by bringing attention to the situation via social media?–please let us know.

          • Angie
            June 19, 2015 at 4:10 pm #

            Thank you. Social media has been a great help to us. We battle on with the knowledge many are with us which helps so much.

  10. mabelcruet
    June 15, 2015 at 4:41 pm #

    Do you remember Claire Teague? A woman who choose a homebirth and who died of catastrophic haemorrhage after the midwife failed to recognise the fact that a huge chunk of the placenta had been retained, and failed to recognise that Mrs Teague was bleeding out in front of her. That midwife had the gall to say that the bereaved husband should remember that his wife had had a really lovely spontaneous homebirth. That’s alright then, a bereaved husband and motherless child but at least she had a ‘normal’ delivery.

    • June 15, 2015 at 4:55 pm #

      I’m sure countless widowers in the time before modern obstetrics took that same comfort; of a lovely, spontaneous homebirth.

      • Amazed
        June 15, 2015 at 5:49 pm #

        I’ve mentioned it but a few years ago, the protagonist of a James Patterson novel had a wife who had a few problems in her twin pregnancy but wanted to give birth “naturally, at home”. He bowed to her wishes. At the time the novel took place, he was a single father of 2.

        Normalizing normal birth, this is. And the very normal consequences. Because no, our character didn’t get divorced and the wife didn’t run away with Jim the Fisherman.

      • Sue
        June 15, 2015 at 9:27 pm #

        And there WERE lots of young widowers – with motherless young children. That’s where the distress of the ‘evil stepmother’ came from.

    • superhappycamper
      June 15, 2015 at 6:52 pm #

      I am convinced that some of these folks are sociopaths.

    • Monkey Professor for a Head
      June 19, 2015 at 1:49 am #

      F*** that. I gave birth 8 days ago and there were some scary moments – first the baby started having decels during pushing as the cord was round his neck twice, then I had a PPH and lost 1.6L of blood. Thankfully I was in a hospital and we both came through safely. A few days ago my husband told me about how scared he was that he was going to lose both me and the baby. He sat up the whole night after I gave birth while I slept with one hand on the baby and one hand on my pulse. Anytime I mention the birth I can tell how traumatised by the whole thing he is. I think that if someone said what that midwife said to him, he’d be in jail for murder right now.

      • Busbus
        June 23, 2015 at 9:40 am #

        How scary! I am glad everything turned out well, and I hope you have a quick recovery. Congratulations on your new baby! 🙂

  11. theadequatemother
    June 15, 2015 at 4:22 pm #

    It’s nice to have someone affirm my impression that Canadian midwifery is more ideological and less professional. Sure they aren’t all bad and some physician friends of mine have chosen their midwifery group very selectively but there has never been an interaction I’ve had with them that led me to feel comfortable with their approach or their care. When I started practice and in training I was but my impression has eroded significantly with increased exposure.

  12. Angie
    June 15, 2015 at 4:03 pm #

    And not focusing on risk killed my Grandson, no life affirming glory then!!

    • Box of Salt
      June 15, 2015 at 4:20 pm #

      I am sorry for your loss.

    • Daleth
      June 15, 2015 at 4:24 pm #

      I’m so sorry.

    • Amazed
      June 15, 2015 at 4:48 pm #

      I’m so sorry for your loss.

    • momofone
      June 15, 2015 at 6:29 pm #

      I am so sorry.

    • Mishimoo
      June 15, 2015 at 6:30 pm #

      So very sorry for your loss.

    • attitude devant
      June 15, 2015 at 8:21 pm #

      I am so sorry.

    • Cobalt
      June 15, 2015 at 9:26 pm #

      I’m so sorry.

    • June 15, 2015 at 10:19 pm #

      Angie, I haven’t read your story yet but I am so very sorry. I wish there were words to help. I know there aren’t, but I send my empathy anyway.

    • yentavegan
      June 16, 2015 at 6:44 am #

      I am sorry.

    • KeeperOfTheBooks
      June 16, 2015 at 9:17 am #

      I am so very sorry. There really isn’t anything else I could possibly say. 🙁

    • June 20, 2015 at 4:33 pm #

      My condolences. There are no words.

  13. Meredith
    June 15, 2015 at 3:39 pm #

    Yes, there is something illiterate about claiming the word “normal” to justify your beliefs. And the word’s imprecision seeps into our culture so that even women who don’t consider themselves susceptible to woo start to feel they should give birth a certain way (guilty as charged). In fact, I just wrote a post about the so-called normal births before modern medicine: http://motherfigure.com/questioning-childbirth-folklore/

    • Cobalt
      June 15, 2015 at 4:02 pm #

      “Despite the popular naturalist refrain, hospitals didn’t steal women’s autonomy. It is reductive to say hospitals were patriarchal institutions trying to medicalize the natural and rip childbirth out of women’s hands. Childbirth was never in their hands. They weren’t making choices. They were trying to not die.”

      Well said!

  14. June 15, 2015 at 3:27 pm #

    Want to be a truly patient centered care provider – connect with patients. Not just the people who hold the same beliefs you do, but the ones who don’t. Connect with those who have had the worst happen to them – listen to their stories and reflect on the practice of care and what can be done to improve the outcomes that matter to the patients who are being served. Listen to the James Titcombes, listen to the Kate Austin-Rivases, listen to the Jenn Hoopers – these people aren’t against “normal birth” they’re against “normal birth” at the expense of their children. Further – accept that some people want their objects put together with screws for a wide variety of good reasons…and don’t assume that the substitution of a nail with a screw is automatically a bad thing.

  15. Amy Tuteur, MD
    June 15, 2015 at 3:25 pm #

    In the game of “normal birth,” you win or you die.

    • MegaMechaMeg
      June 15, 2015 at 3:29 pm #

      Be fair, sometimes you are maimed.

    • Rosalind Dalefield
      June 16, 2015 at 2:10 am #

      Natural childbirth all too often means natural childdeath, and sometimes maternal death as well.

    • The Computer Ate My Nym
      June 16, 2015 at 10:30 am #

      A strange game. The only winning move is not to play.

  16. Kim
    June 15, 2015 at 2:51 pm #

    I’ve been reading about the American midwife system with interest. Here in NZ your LMC is almost always a Midwife, it’s not considered hippyish at all. In fact where I live there is no other choice unless you have a complicated pregnancy and get referred to a hospital OB. They do have to do a four year degree first and they are mainly there to do the routine check ups and testing. If something is not right they refer you to Women’s Assesment Unit at the hospital as I was due to blood pressure issues. My midwife used to be a nurse and her philosophy was she was there to get my baby out safely, not to give me a birth experience which suited me fine. She stayed with me throughout the birth at hospital and made sure the medical staff took notice of me as me. She was a great advocate. That was my experience, however natural birth is still up on a massive pedestal and some midwives do advertise as specialising in home birth. I’ve seen a couple people on Facebook bragging about having “free births” which as I understand are totally unassisted, with one of them saying “yay, I finally got my free birth!” I hope that trend stays of the fringes. Thanks Dr Amy for you common sense articles 🙂

    • Karen in SC
      June 15, 2015 at 4:04 pm #

      Kim, click on Action to Improve Maternity on the blogroll to read stories about the deaths and brain injuries due to the worship of normal birth in NZ.

      • Rosalind Dalefield
        June 16, 2015 at 2:12 am #

        Yes, the AIM website has many truly heartbreaking and appalling stories of midwife incompetence in New Zealand. They do not all have 4 years’ training, some have only about a year.

    • Bombshellrisa
      June 15, 2015 at 5:40 pm #

      Your midwife sounds professional. You will have to forgive my cynical attitude about the standards of midwives in NZ, a few have come to this board and posted and from their comments, show that they value “natural birth” more than science and have very little sympathy for the women they care for.
      In the US, real midwives are masters or doctorate prepared and are almost always RNs first. They have hospital privileges and do yearly exams, prescribe medications and order tests. There are is also a group that calls themselves midwives and can do none of these things. They attend births only at home or at what is called a birth center which really is just a rent a room with a tub where women can give birth.

      • Kim
        June 16, 2015 at 2:52 am #

        Yes, I’m very aware that midwifery needs tighter regulation here in NZ. I’m lucky I found my midwife who is very best practice. In my region you cannot go private and use an OB as there are none practicing privately here, you only get an OB if you are referred into the hospital system or you a willing to travel a couple of hours, I know this as I would’ve gone with the OB option if I had the option -although it may have changed since my last baby. We do have birthing centres in my region which you can give birth at if you choose, you can only get gas and pethidine there I think. The nice thing about them is you can go there for free after the hospital to recover and get looked after for a couple of days, kind of like a nice hotel. Now days you can even go there after a couple of days after a c section. I went there after the hospital as the thought of nice food being bought to me was too hard to resist :). I wasn’t keen to give birth there myself though plus I kept visiting midwives until I found one who values science. I am biased toward those sorts of people having worked in Molecular Biology for most of my working life. Most people I know go for these sorts of midwives, they are the “good ones” that are hard to get in to. Am also aware of the heart breaking stories of where it all goes wrong, which is why these sorts of common sense opinions are needed to take away the stigma about assisted births, breast feeding etc.

  17. Zoey
    June 15, 2015 at 1:41 pm #

    What that slide says to me is that all the rhetoric about midwives providing women with the ability to make more informed choices about their own births than OBs in hospitals is total BS. Providing women with information about the risks of their choices is a necessary component of informed consent – even if it means losing business, or may involve a women making a choice that *gasp* they might not agree with. Trying to distract women with these vague, value-laden concepts of how “glorious” and “life-affirming” natural birth can be is completely disgusting and paternalistic. With woman, my a**.

  18. Liz Leyden
    June 15, 2015 at 1:28 pm #

    Who are the mother and baby in that slide?

  19. Daleth
    June 15, 2015 at 12:17 pm #

    As just one more data point against them, here’s further proof that NCB types are wrong to claim that “nature doesn’t make babies you can’t deliver”: I just saw the pathology report on my babies’ placenta and cords. Everything looked great, except that my twins both had very short umbilical cords (23 and 25 cm, or 9-10 inches, vs. the usual 40-70cm/16-28 inches). So, not much more than *half* the usual length.

    Guess what can easily happen when delivering babies with short cords? Placental abruption, for the obvious reason that when the baby gets too far from the placenta, the cord goes taut and starts pulling the placenta off. Even in a singleton pregnancy that puts the baby at risk, but when mono-di twins share a placenta, abruption triggered by the vaginal birth of Baby A often means death or severe brain damage for Baby B. And I’m guessing that the risk was even higher in my case because I had anterior placenta–in other words the placenta was at the front of my gigantic pregnant belly, about as far from the “exit” as it could have been.

    I feel like getting down on my knees and thanking all that is holy for my insistence, in the face of pushback from several doctors, on delivering via c-section. Fear of abruption was my primary motivator for insisting on a c-section. I also feel like punching the doctors who kept trying to talk me into trying for a vaginal birth.

    • mythsayer
      June 15, 2015 at 3:05 pm #

      And it is beyond terrifying that you had to INSIST. Delivery of identical twins can be dangerous…

      • Daleth
        June 15, 2015 at 4:00 pm #

        I know, it’s crazy, especially because my Baby B was breech or transverse at every ultrasound but one! Weirdly, it wasn’t because of ignorant doctors–quite the opposite: I was in a world-class university maternity hospital attended by a team of MFM’s, and like Amy M. I would have been required to labor in the OR with an epidural in place. I suspect their attitude was partly a reflexive (and IMHO wrong) belief that unnecessary c-sections are bad, and partly a confidence that they were so skilled, and we were in such a good hospital, that even if things went really bad during labor they would still be able to save everyone.

        But from my perspective, as the patient, I did not in any way, shape or form want to spend 20 hours (or however long) praying that things would go well, while knowing there was a high chance they wouldn’t… and then spend X amount of time in a state of sheer terror while the doctors worked to save us… and then X number of months or years recovering from the emotional and possibly physical trauma.

        I was like, you know what, let’s just skip all that and go straight to the c-section, ok?

        • FormerPhysicist
          June 15, 2015 at 8:31 pm #

          Yes, yes, yes. With a high chance of emergencies/bad outcomes, it is reasonable to go straight to the finish line.

      • Sue
        June 15, 2015 at 9:35 pm #

        Indeed. The ideological drive to minimise cesarean rates influences everyone – and competes with safety.

    • Amy M
      June 15, 2015 at 3:46 pm #

      Wow, that is weird that you had to ask for that. I did have a vaginal birth of mono-di twins—only because it was determined they were both head down and doing fine when I showed up to the hospital in labor. I was offered a choice at that point, and I decided not to have a Csection at that moment, knowing full well it was still pretty likely. In order to make vaginal birth of twins as safe as hospital policy was to have them in an OR, with an epidural in place and people ready to cut the instant things started looking iffy. They did a quick u/s between babies to make sure that B was still in the right position. Ultimately, I chose vaginal birth because I feared a difficult recovery while caring for twins—but it was a difficult recovery anyway because of a bad pph. So in hindsight, opting for the section during early labor could have been the better choice.

      • June 16, 2015 at 4:07 am #

        At several of the hospitals I worked in, a twin delivery was ALWAYS “double set up” — that is, the woman delivered IN THE OR; vaginally if possible, but literally no more than a quick 1 minute scrub from a C/S. The OR packs would be laid out, but not opened, the anesthesiologist would be on hand, etc.

        I’ve seen twins, both vertex, go from first baby delivered as vertex, second baby transverse or breech, in a matter of minutes. I’ve also seen twins where the second twin became entangled in the umbilical cord, or where the cord of the second twin prolapsed. Not to mention, of course, that many twins are either premature, or one may be IUGR at the expense of the other.

        Multiple pregnancy is no laughing matter.

  20. yentavegan
    June 15, 2015 at 11:38 am #

    Maybe it’s time for us to recapture the word ‘Normal”. It is time for us to unite and take the word normal back from the woo crowd.

    • Roadstergal
      June 15, 2015 at 11:53 am #

      It’s totally normal for women and babies to die in childbirth. Without medical intervention, it happens at a shocking frequency. ‘Normal’ is like ‘natural’ – a word that has no inherently positive connotations for me.

      • yentavegan
        June 15, 2015 at 1:35 pm #

        it is normal to need medical intervention. It is normal to deliver via a c/section. It is not normal to give birth in a heated kiddie pool to a glitter coated unicorn.

      • Rosalind Dalefield
        June 16, 2015 at 2:14 am #

        The only ‘normal’ I ever wanted for my kids was a normal 1-minute Apgar score…

    • Sue
      June 15, 2015 at 9:38 pm #

      I would argue for replacing ‘normal’ with SAFE.

  21. Angharad
    June 15, 2015 at 11:00 am #

    The thing that bothers me most about calling a particular mode of birth “normal” is that it means everything else is “abnormal” and it says this to women who are in a very vulnerable position. I’m sure it was a combination of hormones, sleep deprivation, and being in poor physical condition following a difficult labor and delivery, but I felt terrible about a lot of things that were the right choice for my family right after giving birth. I had a friend tell me that I should have resisted induction even though my OB recommended it when I went in for my 39-week check and my blood pressure was 160/90. The same friend said that it was the pitocin or epidural that caused my daughter’s difficulties during labor and led to me needing an episiotomy and instrumental delivery and the difficulties I had breastfeeding (cascade of interventions). Now, obviously pregnant women who are apparently developing pre-eclampsia and who are full-term should be delivered ASAP, so there was no reason for me to listen to this friend or feel any regret about listening to my doctor. But I did anyway. And I think it’s morally appalling to be attacking women in this vulnerable position by calling their choices abnormal. It doesn’t serve or protect pregnant women, but only midwives.

    • Squillo
      June 15, 2015 at 11:07 am #

      Aside from the moralistic overtones, the word “normal” is frustratingly vague. It’s perfectly “normal” for a large percentage of women and babies to experience complications. Does “normal” mean with no complications? Does it mean with no interventions? Or what interventions are allowed before a birth is deemed not “normal”?

      As a medical term, it’s useless. As a popular term, it’s a brand.

      • The Bofa on the Sofa
        June 15, 2015 at 11:11 am #

        I also consider it worthless. To the extent it is definable, it is meaningless. Who cares what’s normal or not? Otherwise, it is so randomly used that it has no meaning, either.

        • June 15, 2015 at 11:54 am #

          Forty years ago, a very experienced doctor said to me, “There are no ‘normal’ births. There are only uncomplicated, or complicated ones, and you only know that after it’s over”

          • MHAM
            June 15, 2015 at 2:14 pm #

            This is very similar to something that my OB said to me. “A birth is only ‘normal’ in retrospect.” Things can change so quickly, there’s no knowing what kind of delivery to expect. She said that even as doctors with access to all kinds of technology, there are still so many things that can happen that no one could possibly foresee (like the umbilical cord thing the poster above mentioned or like my baby’s fetal-maternal hemorrhage) — how could anyone have the arrogance to claim that they can accurately predict and manage “normal birth”?

          • Gozi
            June 15, 2015 at 8:01 pm #

            Yes! This! Only much better than I could have said it.

          • June 16, 2015 at 4:13 am #

            My email sig line is “The problem with ignorance is that it gains confidence as it goes along”

    • yentavegan
      June 15, 2015 at 11:34 am #

      I also had to learn the hard way …women who I thought were supportive friends that dumped me from their inner circle because I did not have a “natural birth” were nothing more than twisted bullies. Please for the sake of your family open yourself up to the possibilty of new friends. Friends don’t judge friend’s uteri.

      • The Bofa on the Sofa
        June 15, 2015 at 11:38 am #

        I like that. Actually, it reminds me of another quote I have seen recently, in a different context:

        “Our job is to love others without
        stopping to inquire whether or not they are worthy.” –THOMAS MERTON,

        If others need to know how you gave birth in order to be your friend, then they aren’t worth it.

      • Angharad
        June 15, 2015 at 3:29 pm #

        Thanks. It is really disappointing to find that some otherwise lovely people I have been friends with for years (since before any of us had children) are suddenly so invested in and judgmental of how I gave birth, how much time my daughter spent being held, how I feed her, etc. I think it’s partly because they need to justify to themselves why they won’t need interventions or have trouble with breastfeeding or have a child with food allergies.

    • Montserrat Blanco
      June 15, 2015 at 5:56 pm #

      As a Fellow preeclampsia sufferer: no, you should not have risked anything to not get induced. I ended up with HELLP syndrome because I needed to stay pregnant a little bit more and it was not nice, not funny and pretty dangerous. You should try to avoid that. Your friend has no idea at all what it is like to be seriously ill and she should be profoundly ashamed of her attitude.

      • Angharad
        June 16, 2015 at 1:09 am #

        That sounds like an extremely harrowing experience. I realize I was lucky to not have to weigh the risks of prematurity against the risks of preeclampsia. I hope everything turned out ok for you and your baby!

        • Montserrat Blanco
          June 16, 2015 at 2:55 am #

          Everything turned out fine, thank you very much. We were at a very unnatural hospital and had great facilities, he was born early but three expert neonatologists were at the OR and got him breathing in seconds. He got admitted to the NICU for two months but right now he is thriving with a great neurological development so far. I really hope you get past those feelings of failure.

          • Angharad
            June 16, 2015 at 9:14 am #

            Thank you. I’m feeling much better these days. This blog has helped a lot, and seeing my happy, thriving daughter, and the fact that I really know my OB is a good doctor who knows what he’s doing.

    • Daleth
      June 19, 2015 at 10:58 am #

      You poor thing. What a sorry excuse for a “friend” that woman is. I can only imagine how she would have berated me if I told her that when I got preeclampsia, I went straight in for a c-section.

  22. Squillo
    June 15, 2015 at 10:53 am #

    I guess I’m confused about the role of midwives. I hire a health care provider precisely to focus on risk — reducing it and dealing with the repercussions of same. I can take care of the life-affirming part myself. I don’t pay a midwife to explain my feelings to me.

    • Daleth
      June 15, 2015 at 12:19 pm #

      Wait, you’re saying hand-squeezing, aromatherapy and empowering words aren’t worth $3000-$6000?

      • Gozi
        June 15, 2015 at 8:12 pm #

        This is why I don’t understand the role of a hired doula/birth attendant. It is great to have someone to support and advocate for you, but hiring someone seems unnecessary unless you have no family or friends-or ones you feel comfortable being there. Unless the hired person has medical training, are they worth the money?

        My elderly mother was with me during the birth of my first. She’d been happy to have been taken to Cracker Barrel.

        • Bombshellrisa
          June 15, 2015 at 8:19 pm #

          Sometimes family or partner aren’t great at giving support or give it in a way that rubs you the wrong way. My parents annoyed the crap out of me and having them there made me terribly uncomfortable, but it’s hard to get people to leave once they are there “supporting” you. Someone hand picked and hired to rub your back and feet and just stay with you can be a tremendous help (if they don’t try to give medical advice and actually focus on your needs, not text and tweet the entire labor)

      • Medwife
        June 15, 2015 at 10:40 pm #

        Hell, the people that work the supplement aisle at Whole Foods can do that for you, for free, plus there are tasty food samples.

    • demodocus
      June 15, 2015 at 3:36 pm #

      Explaining my feelings, isn’t that why we hire shrinks instead?

    • Comrade X
      June 15, 2015 at 3:56 pm #

      *EXACTLY*, Squillo.

      Also, “focusing on risk” doesn’t “close down” the “life-affirming glory” of birth. It FACILITATES it by keeping everyone alive and healthy to enjoy the life-affirming wonder of it all. The idea that knowledge, expertise and technology somehow “spoil the magic” of things, especially of something as awesome as bringing a new life into the world, is completely insane. I don’t understand it.

      It would be a very VERY fragile “wonder” indeed that could be extinguished merely by failing to follow an exceptionally detailed and narrow pre-determined script.

  23. June 15, 2015 at 10:47 am #

    I get your point but your generalising about midwives leaves me feeling iffy. There are plenty of good, decent, selfless, & sensible midwives who don’t deserved to be lumped in with this.

    • Michele
      June 15, 2015 at 10:56 am #


    • Squillo
      June 15, 2015 at 11:00 am #

      Yes, but it goes to what Amy wrote in her earlier posts about British midwifery and cult-think. It’s hard for me to determine if the disturbing trend towards venerating “normal” birth is the predominant attitude or just a very vocal subset of midwives.

      • Sarah
        June 15, 2015 at 3:16 pm #

        It certainly exists, and it’s not uncommon or isolated either. I have experienced midwives who buy into all that entirely, and midwives who really don’t. Which group, if either, are in the majority, I couldn’t say. But the veneration of ‘normal birth’ is definitely common enough to be concerning. Of that, I’m sure.

    • Medwife
      June 15, 2015 at 11:27 am #

      It doesn’t bother me because I know it’s not about me. I don’t share the ideology. But I know that there are a lot of midwives, more CPMs than CNMs but of both types, that do.

    • DaisyGrrl
      June 15, 2015 at 1:07 pm #

      The problem is that the leaders of midwifery in many countries (UK, Canada, US, etc) are not sensible and science-based. They are leading the charge on promoting “normal” birth, reducing c-sections and other interventions, and prioritizing the mother’s birth experience over the baby’s safety.
      If the good, decent, selfless, and sensible midwives don’t want to be lumped in with this, then they need to speak out about this culture that has appeared. The “normal birth” fetishists currently control the discourse and are educating the next generation of midwives.

      • Rosalind Dalefield
        June 16, 2015 at 2:17 am #

        That’s certainly true of Karen Guilliland who has headed up the College of Midwives in New Zealand for decades. She actively discourages any consideration of the welfare of the fetus during pregnancy and labour.

    • Amazed
      June 15, 2015 at 3:57 pm #

      As heartless as it sounds, I am far less interested in being fair to the good, decent, selfless & sensible midwives than I am about my health and my baby’s health. Midwife leadership in the countries where midwives are integrated into the healthcare system seems to be headed down a dangerous cultish road. Sorry but since they ARE the face of midwifery, I see no more reason to trust someone taking their cues from Cathy Warwick and Sheena Byrom than I do to trust those taking their cues from their “beloved Jan Tritten” (a letter to JT from a midwife who has never met her and was asking for a professional advice).

      And yes, I recognize it’s unfair. I would never dream of dumping Antigonos, Medwife, and Crowned Medwife with the Cathy Warwicks. But when the Cathy Warwicks are becoming the majority, that’s not a good thing for the profession as a whole.

      As Bofa says, when the line of defense is “We are not all like this!”, the profession has a problem.

      • Who?
        June 15, 2015 at 7:15 pm #

        It’s like the NRA. No doubt lots of gun owners are NRA members and are thoughtful people who respect the rights of others, and who like guns.

        Unfortunately there is an element in the NRA who think their rights trump everyone else’s, that if you get shot it is your problem, presumably for annoying someone with a gun, and that we all need more guns (except of course the ‘bad guys’ who they claim they can identify, perhaps by smell?).

        So the nutjobs give everyone else a bad name. And deaths and serious injuries, with the perps claiming it was all someone else’s fault for not being more careful, ensue.

    • Renee Martin
      June 15, 2015 at 4:24 pm #

      I know an amazing women who just got her CNM and will be a fantastic provider.
      But this has nothing to do with the CULTURE of midwifery, which is hell bent on NCB in almost all places. Ask any of those sensible MWs you know, and they will tell you what its like in their profession regarding woo. NCB is even written right into their code for our best MWs, the CNMs!
      I think good MWs are many, but I think they are good in spite of their guidelines and MWery ideals, not because of them.

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