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.