Midwives think it is more important to rescue women from technology than to rescue babies from death

Got ethics?  Vintage wood type.

I don’t think I’ve ever read anything as heartless, coldblooded and self-interested as this anywhere else in the scientific literature.

Midwives have a pesky problem. Many people think that having a live baby is more important than having an unhindered birth. That’s especially true for the medical professional that has the thoroughly annoying habit of insisting that dead babies are unacceptable.

Never fear. Marie Hastings-Tolsma, PhD, CNM, FACNM, Professor, Nurse Midwifery, and Anna G.W. Nolte, PhD, RMc, Professor, Midwifery have come to their rescue with a philosophical “justification” for letting babies die in childbirth. Their piece in the journal Midwifery, Reconceptualising failure to rescue in midwifery: A concept analysis is a paean to the moral bankruptcy of contemporary midwifery in placing the avoidance of technology ABOVE saving babies’ lives.

The authors lay out the problem:

[pullquote align=”right” color=”#d78e3e” ]Obstetricians rescue women from dead babies and midwives rescue women from interference in the birth process.[/pullquote]

Failure to rescue was developed by Silber et al. (1992) who suggested the term as an indicator of quality of care with focus on surgical patients in the inpatient setting though others have since suggested including medical patients. Failure to rescue was originally conceptualised as management of complications or preventing death after a complication and was operationalised to mean the number of patients that health care providers failed to save after developing surgical complications that were life-threatening. The original concept focused on recognition of unexpected though preventable events that influenced mortality. Subsequent effort has centred on the identification of interventions to reduce events through early recognition and the skills required to do so.

Therefore, the concept of “failure to rescue” in midwifery OUGHT to mean failure to prevent death after a complication, employing early recognition of complications and the technology to treat them. But midwives don’t like technology. That leaves them open to the charge of letting babies die by refusing to use the technology that would save their lives. You or I might imagine that dead babies would cause midwives to reassess their aversion to technology. Instead it has caused them to reassess their aversion to dead babies.

How? By insisting that failure to rescue women from technology is a greater calamity than failure to rescue babies from death, or even worse:

Failure to rescue as applied to labouring women likely undermines confidence in the ability to birth spontaneously and denies women access to normal birth. Such values have been purported to be of central concern to midwives worldwide

What’s a pile of tiny dead bodies compared to women’s confidence in their ability to birth spontaneously? Not worthy of concern, apparently.

Environments with high intensity of services may have short-term value for decreasing mortality for select patients with medical complication but at what cost when applied to those who are not with risk requiring continuous monitoring?

Sure, modern obstetrics may have short term value in preventing dead babies, but at what cost to unhindered birth?

Midwives believe that there is much more at stake than the lives of a bunch of babies. They can “rescue” women from technology! They offer:

…the unique contribution of midwifery surveillance in prevention of failure to rescue from unnecessary interventions during childbirth …

See! They’ve squared the circle! Midwives rescue, too. They just rescue women from different things. Obstetricians rescue women from dead babies and midwives rescue women from interference in the birth process.

Several organisations have been instrumental in calling attention to the quality and safety of hospitalised patients (e.g., Institute of Medicine, Agency for Healthcare Policy and Research and National Quality Forum) and concerns about iatrogenic harm as a result of care processes. For the perinatal patient, such harm has centred primarily on mortality, surgical intervention rates, admission to the intensive care unit, length of stay, readmissions, and trauma (Mann et al., 2006). Midwifery data for these quality indicators is often absent or data are provided for the same outcome measures, failing to differentiate them from physician-led care. Although midwifery data for these outcomes are crucial in detailing the quality, safety and cost of care, what is conspicuously absent are data which provide support for how the midwife has maintained normative birth processes.

But the Institute of Medicine, the Agency for Healthcare Policy and the National Quality Forum naively imagine that mortality is an indicator of quality and safety. Midwives know better:

Patients may need to be rescued from the health care system and midwives are challenged to so do. The importance of addressing maternal psychosocial and physical needs during birth is crucial, potentially preventing unnecessary physical and emotional suffering where birth is perceived as traumatic.

Because everyone knows that a dead baby is less traumatic that failing to prevent emotional suffering!

But wait! There’s more!

For conceptual fit with the midwifery philosophy of care, failure to rescue needs to be refocused as not only an outcome measure, but also as a process measure.

It’s almost as if they read my writing on midwives privileging process over outcome (a deep ethical and legal failure for any healthcare provider) and embraced it.

The process involved in midwifery care is the important phenomenon when assessing promotion of normal physiologic birth rather than the actual outcome… A successful rescue process means rescue from unnecessary interventions.

I couldn’t have said it better myself. There’s no truer evidence of the chilling moral bankruptcy of contemporary midwifery than that statement.

The authors recommend their reconceptualization:

Failure to rescue is a crucial phenomenon in midwifery care and is central in the protection and promotion of normal birth. At a time when few experience totally physiologic birth and with evidence that interference with normal processes increases the risk for complication, midwives are challenged to consider the need to rescue women from the health care system.

I’m prepared to go one step further:

Failure to rescue babies and mothers from death is an immoral, unethical phenomenon in contemporary midwifery and is central in the protection and promotion of THEMSELVES. Going forward, obstetricians are challenged to rescue women from MIDWIVES who place their professional concerns above the lives and health of babies and mothers.