Social media has turned UK midwives into killers

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Another day, another group of funerals brought to parents and families courtesy of UK midwives.

According to the Telegraph:

Mothers said their children had died because midwives “couldn’t be bothered” to fulfil basic monitoring tasks, or to act on warnings that babies were in danger.

Twitter allows UK midwives to recuse themselves from the reality of the injuries and deaths they cause and rewards them with a never ending round of dopamine-releasing self-congratulation.

Including:

Ella and Lola Greene – 2014. The twins were stillborn after the trust failed to properly read and interpret their heart rates

Oliver Smale – 2015. He died after his shoulders became stuck during a natural birth after his mother was refused a y Caesarean section

Kye Hall – 2015. His death was “caused or contributed” to by the trust, said the coroner, who failed to classify his mother as a high risk pregnancy or to listen to his heart beat

Graham Scott Holmes-Smith – 2015. The trust failed to properly monitor the foetal heart rate during labour

Ivy Morris – 2016. Ivy was born 10 days after Graham but died four months later in May 2016. The coroner ruled her death could have been prevented if appropriate monitoring of the heart rate had taken place during labour

Pippa Griffiths – 2016. An inquest concluded one-day old Pippa’s death could have been prevented if an infection had been spotted earlier

Families have raised questions about two further deaths over the period. They say there was no investigation into the death of Jack Stephen Burn in 2015, who died within days of Oliver Smale, or of Sophiya Hotchkiss in 2014.

It sounds like Furness General where 2 mothers and 6 babies died preventable deaths(Race probe over six deaths on a maternity ward amid claims midwives conspired to cover-up evidence).

It sounds like Queen’s Hospital where 5 babies died preventable deaths (‘If you don’t hurry up, I’ll cut you’: What one mother was told by midwife at NHS Trust where five died during labour).

It sounds like Milton Keynes where 11 babies died preventable deaths (Updated: ‘Not good enough’ hospital chief apologises over baby death toll scandal at MK maternity unit).

It sounds like Royal Oldham/ North Manchester General Hospitals where an appalling 7 babies and 3 mothers died in just 8 months!

You might think that this hideous death toll would inspire soul searching among UK midwives. You would be wrong.

Apparently nothing interferes with the endless round of self-congratulation that makes up UK midwifery Twitter feeds.

I have written repeatedly about the ways in which social media leaves laypeople simultaneously ignorant and arrogant in their ignorance, but that effect is not limited to laypeople.

I’ve quoted Carolyn Stewart who wrote in The American Interest:

We recuse ourselves from reality via the device in our hand, which rewards us for ignoring reality with a series of dopamine-releasing mini-tasks. From Candy Crush and Twitter to work emails, these activities hook us on a seeking-reward feedback loop that is infinitely more gratifying than staring at the commuter sitting across from you. These cyber preoccupations allow us to customize our surroundings, and accustom us to regulating and controlling the information that comes our way. This has several effects: an expanded sense of what falls under our personal social domain, an increased expectation of control over that domain, and a greater sensitivity to input that deviates from our preferences.

Social media, particularly Twitter, allows UK midwives to recuse themselves from reality and reward themselves with a never ending round of dopamine-releasing self-congratulation. That rewarding feedback loop is infinitely more gratifying than facing the injuries and deaths that occur because of UK midwives overweening self-regard. Twitter allows them to customize their surroundings by blocking anyone who might intrude (laypeople and professionals) with distressing stories of babies and mothers who were injured or died because of midwives’ unethical promotion of “normal birth.”

Don’t believe me? Check out the Twitter feeds of UK midwives like Sheena Byrom and RCM head Cathy Warwick on any day. You will rarely find any mention of the preventable deaths that flood the mainstream media (except to excuse them). Instead you will be treated to a fantasy world where midwives proverbially kiss and congratulate each other over and over and over again.

UK midwives prefer to think of themselves as beneficent guardians of normal birth and they are extremely sensitive to any input that deviates from their preferences. Twitter allows them to insulate themselves from such input. On Twitter they can they can dwell in their fantasy world and never give a thought to the seemingly endless parade of tiny coffins — babies who died preventable deaths to preserve midwives’ good opinion of themselves and their reckless commitment to “normal birth.”

  • Hannah

    Slightly OT: I posted a couple months ago about an awful registrar I had who spent most of the appointment trying to berate me into not asking questions and accepting whatever they wanted to do even though I was unwilling to take the risks associated with certain procedures (namely forceps). Good news is the two consultants I’ve seen since then have been absolutely lovely. I had my appointment with the consultant midwife to go over birthing options yesterday, and they have all said that there will be no issue getting signed off for an ELCS because of my lupus. Spent about 45 minutes yesterday talking it over, and that’s what I’m going to do. Because my hospital is one of the ones listed above (I’m actually the one who sent in the info on them to Dr Amy when I found it in our local newspaper), and I’ve heard mostly negative things about them. The positive stories seem to be the exceptions. So elective c-section it is, high risk is working in my favour in this case. I’ve been given some literature on it to read over, so it’s not officially in place, but I’ve pretty much been given the all-clear to proceed. Thank goodness. It’s a weight off my mind.

  • Angie

    When my Grandson was born lifeless the midwives carried on as if everything was fine. They simply did not acknowledge the tragedy that occurred. Later they said to my daughter “If only you’d told us you were in labour things could have been different” She told them over and over, they said “You just think you’re in labour”. They said this to an experienced mother delivering her third child. “I am in labour” she said “No you’re not there’s a long way to go”. All said without examination or checks. She was in labour with an induction drug in situ, this caused hyperstimulation. Her pain was so intense but still no acknowledgement, “It’s the way the baby is laying causing the pain” they said. No checks just left the room. He was born on a public antenatal ward, no pain relief, there was no time they said to get her to the delivery room, they chose to forget the four hours she’d been telling them she was in established labour. He died due to HIE aged nine days. Nine days of pure hell. Then the battle to investigate the birth began, then we really saw what lengths they would go to to hide the truth. Two years it took, hard years fighting for honesty. We got that in the end but it brought no resolution. A baby died because they would not listen. This beautiful child died due to indifference, arrogance, ineptitude and risk taking. The Normal Birth Brigade talk of focusing on risk being one of the ways we close down on the life affirming glory of birth, really, well for sure not focusing on risk closed down any chance of life for this innocent baby. We live forever with deep regret and utter sorrow yet they carry on regardless.

    • Heidi_storage

      I am so sorry this needless tragedy occurred.

      • Angie

        Thank you, it is so sad that it was needless. I often say it is likely that if the smallest proportion of the massive effort given by the NICU team to save my Grandson had been directed at his birth by the midwives, we wouldn’t be where we are now, Baby Angelo would be a thriving 2 year old now. If only.

    • Empress of the Iguana People

      I’m so sorry

      • Angie

        Thank you.

    • momofone

      I am so sorry.

      • Angie

        Thank you for your kind thoughts.

    • yentavegan

      I am so sorry

      • Angie

        Thank you.

    • Amy Tuteur, MD

      I’m so sorry for the preventable death of your grandson.

      • Angie

        Thank you for your kind thoughts and thank you also for your commitment in exposing those who deny the facts.

    • KeeperOfTheBooks

      I am so very, very sorry.

      • Angie

        Thank you for your kind thoughts.

    • Christina Maxwell

      Angie, I am both horrified and sorry that your family has suffered this terrible, wasteful, needless loss. Something similar happened to my godson. Mother (4th live birth, 5th birth) was not listened too. Oliver did survive birth and the immediate aftermath but died aged 8. For me one of the most chilling things is that nothing has changed, nobody learns anything.
      My love and condolences to you.

      • Angie

        I am so sorry for the loss of your Godson Oliver. It is a travesty that so many babies are harmed and die still. One wonders what it will take for this to stop. Our experience is that the first thought is to cover up and deny. Learning can never happen with this attitude. Thank you for your kind words.

    • Lilly de Lure

      I am so very sorry for your loss.

      • Angie

        Thank you for your kindness.

    • Christy

      I am so sorry for the loss of your beautiful grandson.

      • Angie

        Thank you for your kind thoughts.

  • mabelcruet

    I’m a paediatric pathologist, which means that I do autopsies on babies who are miscarried or stillborn, and those who die in the neonatal period and beyond. As part of this, I teach midwives about pathology.

    I was invited a while ago to take part in a one day bereavement seminar designed for midwifery students. These were direct entry midwives (meaning they didn’t have a primary nursing degree but came straight into midwifery training), and were 3rd years, very close to finishing the degree and qualifying. Not a single one of them had ever dealt with a mum who had had a stillbirth, they hadn’t even seen a stillborn baby. They had also never dealt with a miscarriage-they had done a gynaecology module but that had been spent on a gynae oncology ward, not an early pregnancy ward. My talk was the first time that this group of very nearly qualified midwives had ever seen a dead baby (photos, obviously). I don’t know if its just this particular region or college, but it seems that they were training new midwives to deal with poor outcomes by not really discussing them. So I can kind of see why the Royal College of Midwives deals with these awful reports by sticking its fingers in its ears and going ‘La La La, can’t hear you…’

    I worked with some bloody brilliant midwives-hard working, dedicated, wonderful women (and one man), and I know how frustrated they are when it comes to patient care because they are over stretched and the wards are poorly staffed, but they are being seriously let down by their college.

    • Dr Kitty

      Question…
      Do you get involved in Medical student teaching?
      As a medical student in Dublin I spent 2 days at the early pregnancy clinic (where my job was mostly to hand out tissues, mind toddlers and make sure the partners were OK), but I definitely learnt a lot.

      In the two weeks my class spent on labour ward there was an unexpected Down syndrome diagnosis, an intrapartum loss from vasa praevia, a uterine rupture during a VBAC attempt that didn’t end well and a retained placenta with massive haemorrhage. There was even one very wonderful woman who let one of my classmates stay with her during labour after she lost her baby at 36weeks.

      We had twice weekly debriefs for the whole class with the obstetricians to discuss the cases we saw, so everyone heard about the bad things as well as the good.

      The student midwives wanted to get all the normal deliveries to add to their numbers, the medical students just sat in with whoever would allow us in the room for 8hours- and it was the Coombe, so no-one laboured for more than 12 hours.

      • mabelcruet

        I used to, but now they do pathology via ‘special study modules’. They all have a core programme of basic pathology, and then they choose an area for a more in-depth study doing a morning once a week for 3 weeks, so some choose to do neuropathology, gastrointestinal pathology, hepatopathology etc. Within the core programme, they get one lecture on the role of paediatric pathology, one lecture on SUDI and one on paediatric tumours, so it means that very few of them get much more than a quick taste of what we do.

        • Dr Kitty

          Eep…
          It all seems so different to my medical school teaching!

      • Gene

        I teach residents and I purposely direct them (and most seek out) more unusual cases. You’ll see a thousand cases of viral gastro, but I want them to recognize the rare case of volvulus or salmonella. Lots of cervical strains but not a brachial plexus injury. Thousands of pharyngitis, but not retropharyngeal abscess or epiglottitis.

        • Empress of the Iguana People

          Just because it’s not likely that a zebra escaped the zoo doesn’t mean you shouldn’t recognize the one trotting down the streets of Toronto?

          • The Bofa on the Sofa

            Then again, remember Gene is in the ED. They operate very differently there. Their #1 job is to rule out something tragic. Therefore, they need to make sure it’s not a zebra. Or a camel. Or a centaur. Because those are emergencies.

            If they can conclude it is merely a horse, they can either treat it if it is easy or send you on to your PCP for non-emergent care.

            That is what she i training her residents to do.

    • Dr Kitty

      I have very fond memories of a particular matron I worked under on a gynae ward.
      She was old school terrifying- white hair in a bun, a voice that could strip paint and she did not suffer fools.

      She personally supervised all the “early inductions of labour”- which was the euphemism for terminations for foetal abnormality, when we could still do those here. She made sure it was never an issue of nurses conscientiously objecting to providing care, by caring for the women herself.
      She would make sure those women were written up for every kid of painkiller and sedative they might possibly need beforehand, bathe and dress their babies, take hand prints and foot prints, make sure the photographer was called and she guarded their doors from anyone she thought might upset them.
      Most of them probably didn’t know that she made the tiny Moses baskets and blankets and baby clothes herself (and they were beautifully made).

      I bet the student midwives would have learnt a lot from her.

      • Sarah

        Hideous that women in NI no longer have these choices. Still, at least the budget airlines are doing well out of it.

      • mabelcruet

        We had a knitting club that made a lot of things for us-they are called ‘angel pockets’, little blankets for the tiny ones too small to dress. There’s also a knitting charity called Loving Hands run by a phenomenonal woman Lou Japp who made us loads of tiny Moses baskets. Sometimes I find it very hard to reconcile the care and consideration shown to women who miscarry spontaneously with how horribly we treat those women who choose to terminate in the event of lethal anomalies. They basically get shown the door. It was only in March last year that the DHSSPS guidance on bereavement specifically mentioned this group of women and indicated that they maybe should have access to bereavement care pathways. Until then, they hadn’t been mentioned at all.

  • StephanieJR

    Since we’re discussing UK maternity issues: http://www.johnogroat-journal.co.uk/News/Cattle-are-treated-better-than-pregnant-women-are-27032017.htm

    My little Scottish town, Wick, routinely sends labouring women down to Raigmore, Inverness, a city a hundred miles away, because although Wick General has a unit, it does not have enough staff. Especially after being both downgraded and with some huge NHS budget cuts.

    It seems like there’s been an increase in most patients being sent down south, with 429 ambulance rides last year (a couple of which were probably my gran, come to think of it), though only one was pregnancy related. With a town of about 10,000, that’s a lot of people. http://www.johnogroat-journal.co.uk/News/429-patients-taken-from-Caithness-to-Raigmore-in-a-year-17022017.htm

    I can find at least one baby death in 2015 after a quick search; it’s likely there is more, along with possible birth related injuries.

    Unfortunately, things look to get worse, as they are now switching to midwife led care instead of OB’s; add in a healthy dose of increasing NCB ideology, and it gets real scary. http://www.johnogroat-journal.co.uk/News/Midwife-on-call-service-set-to-be-introduced-at-CGH-27012017.htm

    Having to travel a hundred miles, in labour, most likely because of complications that can’t be handled in your home town’s hospital, in an ambulance, is anywhere from uncomfortable to dangerous to deadly. It is utterly ridiculous.

    (Can you imagine a homebirth, where the nearest hospital that can save both yours and your baby’s life- ’cause the local one twenty minutes away is under qualified- is a hundred miles away by ambulance, when something goes horribly wrong?)

    ETA: Just some more articles:

    http://www.bbc.co.uk/news/uk-scotland-highlands-islands-38025053

    • Christina Maxwell

      We have a similar situation down here in Tayside. The distances are slightly less but the results are the same. There have been at least 2 baby deaths due to transport inefficiencies coupled with midwives guarding their territory in recent times.

  • mabelcruet

    it has always amazed me that Byrom, one of the most unpleasant, arrogant, self-aggrandizing, vainglorious, bullying braggarts on twitter is actually considered an expert in the use of social media and lectures about it around the country, specifically how ‘professionals’ should use social media. I sincerely hope that one of her lectures is ‘how not to insult parents bereaved by the actions of midwives’. Oops, no. She covers ‘how not to get upset when those horrible parents dare to attack you when you fail to do your job properly’. I believe she’s actually doing a PhD in communication skills. Her feed is full of humblebragging posts and comments from others about how wonderful she is. That’s because she’s blocked anyone who dares to raise any sort of concern about the state of British midwifery.

    • Roadstergal

      Really? Damn. Someone should send screencaps of her bitchiest tweets to the folk paying her for that ‘expertise.’

      • mabelcruet

        She’s been called out on it a few times (mostly by James Titcombe) so she now tends to restrict herself to tweeting about how midwives are all beacons of love and hope and twinkly sparkling angels descending from heaven to escort mamas to meet the souls of their babies, alternating with advertising herself at various conferences (athough her current pinned tweet is a message to stay strong (presumably in response to media attention about various failures in healthcare).

    • moto_librarian

      She blocked me a long time ago. Because calling her out for her abusive treatment of James Titcombe was “harassment.”

      • Roadstergal

        She intervened in Twitter for her own comfort? Doesn’t she know it’s better to let things proceed naturally? :p

    • Allie

      “unpleasant, arrogant, self-aggrandizing, vainglorious, bullying braggarts”
      Wow. positively Shakespearean : )

      • mabelcruet

        Sorry, she just gets my back up! In local parlance, she’s right up her own shuck.

  • MaineJen

    Wow. If I lived in the UK I’d be terrified to deliver a baby! You have to practically walk in there with a court order to get any pain relief, as it is.

    • Sarah

      See you don’t, necessarily. There’s massive variation. In midwifery quality too. Runs the whole gamut from wonderful to awful. I’d tell anyone to go in prepared to fight, but equally I know plenty of women who said epidural and an anaesthetist was conjured up in minutes. In some ways the unpredictability makes it harder because if you eg knew they were going to stall until you were 6cm, you could factor that into your plans and ask early, but it’s also a realistic possibility that asking for one before you feel you definitely need it might get you one before that stage too.

      The problem we have is that while not all midwives are like that, enough midwives are like that.

    • Christina Maxwell

      It was fear at the idea of my daughter having a baby here in the UK that led me to the Skeptical OB in the first place. I emailed her at the suggestion of Orac (Respectful Insolence) and she was very kind.

      • That’s pleasingly professional.
        They may clash on a personal level but he still defers to her judgement on these issues.

  • Lilly de Lure

    All of this sounds lovely in theory but is useless if all the midwives are singing from the same NCB hymnsheet, groupthink is a powerful thing and can easily persuade people they aren’t seeing things that are right in front of their faces – which can and do negate your first and third points in practice (if indeed the third actually happens at all, it certainly didn’t in the trust I was in).

    Your second point made me laugh out loud – I can only assume the hospital you work at is not a busy one? In a busy L&D ward you get seen on arrival by a midwife who determines what kind of state you are in – the OB can’t see everyone immediately so they rely on midwives to determine what priority each patient is and go from patient to patient in order of priority – on a busy night this can mean a wait of several hours to get seen by an OB if you haven’t been classed by the midwife as a high priority case. In theory absolutely sensible – but in practice all to easy for the midwife to ensure the woman screaming for a ceasarian that the midwife doesn’t think she needs to not be seen by an OB for hours after admission.

    • nata

      The second point is more about a situation when someone is already is on the delivery suite. If situation changes or complicates the women are usually seen quite quickly.

      I sincerely don’t have much triage experience. However, the problem that you mention here again is more about the overstretched services than intentional neglect. The majority of triage midwives that I’ve met are very experienced, intelligent and educated and would not hesitate to refer.

      I will mention again – the promoting normality and similar campaigns are not about ignoring need for interventions or wishing them away. They never intended to be this way.

      • Lilly de Lure

        Not really – bcause, again the midwives are the ones monitoring the patient even in the L&D suite and who make the determination that the situation has changed/complicated so we’re back to where we started.

        I know that in principle no midwife would ignore what they see as needed interventions – the problem is that wishing away evidence of complications to avoid interventions is exactly what is happening in these cases – and other midwives seem more interested in defending current practices and sweeping these issues under the rug than in preventing them from happening again.

        I’m sure overstretched resources do play a role in this as well but the fact that this situation is a nasty confluence of two factors rather than due to just one is not an excuse to not do something about the factor you can change (the culture of midwifery).

      • Daleth

        the promoting normality and similar campaigns are not about ignoring
        need for interventions or wishing them away. They never intended to be
        this way.

        I really appreciate and respect that this is your attitude. Unfortunately quite a lot of midwives in the UK, and in the US, don’t share that attitude. They are the problem.

  • Deewhybaby

    The National Health Service in the U.K. is under a great deal of financial stress. Many decisions around protocols have a cost saving element to them and are made my management who don’t have a clinical background. There are also huge short-staffing issues. (My mum was an NHS Nurse)
    I could imagine that trend towards incouraging Midwife lead ‘natural’ childbirth is a financial measure as well as ideological.

    • Lilly de Lure

      Me too – I have no doubt its an unholy alliance between the two, NCB providing wonderful cover to cut funding for maternity provision under the guise of BFHI, cutting the intervention rate etc. All for women’s own good, of course.

    • Sarah

      Some of both, although NICE is clear that offering ELCS isn’t any more expensive.

      • Roadstergal

        And didn’t they decide that without taking into account long-term health issues for women?

  • Sue

    “You might think that this hideous death toll would inspire soul searching among UK midwives.”

    THIS.

    In most professional cultures, a series of adverse events like this would lead to a great deal of investigation and re-thinking – not excuses.

  • J.B.

    Remind you of anyone else on Twitter?

  • nata

    x UK midwives cannot make or influence a decision to perform a planned C-section. Your view of the midwives’ influence on obstetric decisions is highly exaggerated.
    x Who monitors fetal wellbeing in the US? Obstetric nurses? Who interprets the trace? Do you have an obstetrician 24/7 doing this job or do you entrust nurses with this task? Do obstetricians rely on nurses to alert them if a problem arises – abnormal trace, maternal fever, etc?? Are these nurses always right, do they ever make mistakes?
    In UK midwifery is quite a wide term. The majority works for NHS trusts; in obstetric lead units midwives function similarly to US obstetric nurses, with the difference that midwives do perform uncomplicated deliveries. They also look after mothers and babies after birth.
    The majority of stories mentioned above would involve that type of midwives – professionals, functioning as obstetric nurses. The majority catastrophes happen due to humane factors such as tiredness and high work load; they would have involved the whole maternity team – obstetricians, neonatal nurses as well as midwives.
    Promoting normality sounds good on paper and on twitter, but does not reflect the reality of real life maternity care.
    American obstetricians and nurses are as human as British doctors and midwives. Tragedies happen at hospitals on both sides of the Ocean. The difference is that our wrong doings are reviewed, analysed and publicly acknowledged, otherwise you would not have known about them.

    • LaMont

      You’re saying that hospital deaths are not reviewed and analyzed? Those are reviewed and analyzed in-house and by insurance companies with real financial power to end a career, should such rookie mistakes happen. Familiarize yourself with *rates* of fatal incidents in the two places. Saying “doctors make mistakes” is not an excuse to move to a system that has a higher rate of failure. It’s equivalent to saying “sober people have accidents too, definitely don’t blame drunk drivers for the accidents they cause.”

      • nata

        are reports on the hospital failures freely available for everyone to read? Like Morecambe Bay report?

        • EmbraceYourInnerCrone

          I found these (first is a news article, second like in the actual report:

          https://www.gov.uk/government/news/morecambe-bay-investigation-report-published

          https://www.gov.uk/government/publications/morecambe-bay-investigation-report

          Points:
          -Clinical competence of a proportion of staff fell significantly below the standard for a safe, effective service. Essential knowledge was lacking, guidelines not followed and warning signs in pregnancy were sometimes not recognized or acted on appropriately.

          Poor working relationships between midwives, obstetricians and paediatricians. There was a ‘them and us’ culture and poor communication hampered clinical care.
          Midwifery care became strongly influenced by a small number of dominant midwives whose ‘over-zealous’ pursuit of natural childbirth ‘at any cost’ led at times to unsafe care.

          Failures of risk assessment and care planning resulted in inappropriate and unsafe care.
          There was a grossly deficient response from unit clinicians to serious incidents with repeated failure to investigate properly and learn lessons.

          The report says proper investigations into serious incidents as far back as 2004 would have raised the alarm. It was not until 5 serious incidents occurred in 2008 that the reality began to emerge.

          • Roadstergal

            “Poor working relationships between midwives, obstetricians and paediatricians. There was a ‘them and us’ culture and poor communication hampered clinical care.”

            This is absolutely critical and unconscionable. And from the anecdotes I hear here, I’d really appreciate a deeper official dive into whether ‘breastfeeding uber alles’ drives midwives to demonize pediatricians (they’ll recommend formula if the baby seems to be starving!) and ‘unmedicated vaginal birth uber alles’ drives them to demonize obstetricians.

      • nata

        also, as you’ve rightly noticed, I don’t know much about the US system – concept of insurance, for example is very confusing to me. What makes people think they are great experts about UK system and midwifery?

        • Empress of the Iguana People

          In the US, ultrasound techs and obs do ultrasounds, not nurses.
          Dr. T. has been talking about Morecome Bay for some time and we do have several UK regulars who can correct her when she makes a mistake about UK healthcare.

          • nata

            In Uk majority ultrasounds are done by ultrasound techs and obs as well. I was speaking more about continuous fetal heart rate monitoring in labour – it’s a routine task and I cannot imagine an ob doing this job. When we previously discussed UK midwifery, some other regulars disagreed as well…. I believe that posts like this offend genuine hard working, responsible and educated midwives who work very closely with obstetricians for mothers and babies .

          • Lilly de Lure

            If they are more offended by Dr T’s posts than they are by the preventable deaths presided over by their colleagues (which, frankly, appears to be the case considering the protective circling of the wagons that accompanies the latter and the howls of outrage that greets the former) then frankly they need to be more than offended – professional retraining in basic medical ethics would appear to be in order at the very least.

          • moto_librarian

            So if your labor is progressing normally and you have opted to deliver without pain medication, you will not have continuous monitoring. And if you are in need of continuous monitoring, the trace is viewable on the monitor in the room and at the nurses’ station. When things look questionable, they consult with an OB. I know this from personal experience in the U.S.

          • Mel

            I did have an ultrasound in L&D done by a resident OB. They needed to know the position Spawn was in pretty quickly because I was quite unstable and they were prepping for an emergent CS….

        • Mel

          Medical insurance in the USA is pretty simple.
          Short course:
          1) Most people receive health insurance from their employers.
          2) Low income persons and the elderly can participate in a government insurance system called Medicare and Medicaid respectively.
          3) For people who fall outside of 1 and 2, there individual and family plans available for purchase on the market.
          4) Most people must be covered by insurance. The “carrot” is subsidies based on income for people in groups 1 +3. The “stick” is increasingly severe tax penalties for people who refuse to have health insurance.
          Long course:
          During WWII, the US essentially locked the rates of pay for workers during wartime. To attract workers, companies then started offering benefits like paid health insurance.

          From that, the majority of people in the USA receive health insurance through their employer. The cost to the employee and the quality of the plan vary greatly from company to company. ACA – termed Obamacare – put in place some requirements that employers of a certain minimum size provide a plan that is equal to or above a minimum level of care for employees who work more than 28 hours a week.

          There is also an individual market for health insurance that was expanded under the ACA. This is a way that people who do not have access to an employer-based health plan to buy medical insurance plans.

          For both of the groups above, there are government subsidies available for people below certain income levels.

          For people who have very low incomes, there is a state sponsored health care program available.

          Why did the US do it this way?

          This was a messy compromise between Democrats (who want universal health care coverage and are not opposed to a single-payer governmental system) and Republicans (who prefer personal freedom to refuse insurance and strongly prefer free-market solutions to governmental solutions.).

          Why do we think we’re experts on the UK system? Well, we can read. The UK does have a healthy history of investigative reporting and open reports on preventable deaths. The US does have a education system that teaches people how to read for information. Combine the two and non-UK subjects can become reasonably informed on the local issues.

          • nata

            thanx 🙂 I live in the UK, but was born in the USSR, grew up in one small Eastern European country. Health care was always free at the point of entry. My only experience in the US (lived there for 2 years in early 2000s was a quite harsh eye opening experience.

        • Sarah

          Well, quite a lot of us posting have experienced it and more than one works in it. And the fact that you as a non American don’t know much about their system is hardly a reason to presume none of them could possibly know a lot about ours.

        • Linden

          UK system of insurance: we all pay for the NHS, which has to set aside and pay out huge sums of cash for negligence/medical incompetence during childbirth. Investigations are done (with varying levels of enthusiasm/participation) and root causes sometimes found. Medical professionals who want to improve matters take findings to heart, incompetent/negligent medical personnel ignore or minimize it. Some even, shamelessly, try to shift the blame to the people who have suffered the loss.
          Incompetent medical professionals often have to be egregiously so before they are struck off.

    • “Promoting normality” … what does that mean, exactly? Real life maternity care includes acknowledging that things can go wrong, so monitoring and testing are Good Ideas (TM). It seems like these midwives assumed everything would go fine, so they didn’t monitor, and so they missed things that shouldn’t have been missed. Why do you think they didn’t monitor properly?

      • nata

        I don’t know why they did not monitor… There are quite a few cases in dr A’s article… But as one of senior UK midwives said: we should never normalize abnormal. Once there is a problem, it should be addressed and I even observed some midwives pushing for an intervention.

        If you look at the RCM promoting normality campaign, it is not about ignoring need of treatment. A lot of things are psychological – like promoting maternal mobility or making the woman comfortable. For example, if a woman with diabetes is in labour, she needs IV therapy of glucose and insulin (called sliding scales), also continuous electronic fetal monitoring. Her blood sugars would be checked hourly, as well as other vital signs. At the same time she does not have to labour supine in bed – I observed a case when the woman was upright in the armchair basically until vertex was visible. After that she did transfer to the bed, but was sitting almost upright and pushed spontaneously, on her own. So although she needed intervention, she had a normal birth.

        Another aspect of promoting normality is to offer a mild intervention to avoid a more serious one. For example, to encourage a woman to drink and pass urine to avoid IV drip or catheter in the second stage? Or providing IV fluids if ketotic before maternal fatique affects labour or fetal wellbeing?

        • Okay, so what does this have to do with the fact (and it is an irrefutable fact) that babies and women died because some midwives did not monitor them properly?

          How will they know if there’s a problem if they don’t look for one?

          • nata

            Nothing, because genuine promotion of “normality” should not imply neglect or lack of care. Mothers and babies died because they were given inadequate care, for many different reasons; unfortunately, ideology is the least of our problems.

          • EllenL

            You said a normal birth is an uncomplicated vaginal delivery.

            To the extent that midwives believe they can and should promote uncomplicated deliveries, that is a problem. That is ideology driving decisions rather than reality.

            There are many, many naturally occurring complications of pregnancy and delivery. You can’t wish them away. When you try, tragedies result.

          • nata

            You can’t and you shouldn’t and it has never been the point. The point was in trying to reduce complications and trying to normalize some aspects of care.
            Another example would be if the woman chose vaginal delivery of a breech baby. The obstetric team would expect her to push in lithotomy position so that they could assist with delivery; however, with good midwifery support she could and should be able to move freely in the first stage. This way the first stage of labour would be normalized despite of a complex birth.

          • moto_librarian

            Can you prove that mobility during labor actually shortens delivery time? This is preached chapter and verse, but I haven’t seen any compelling evidence that it makes much of a difference. And if a woman wants an epidural, she should have it as soon as she is admitted because we know from research that it does not increase the likelihood of a c-section. Pain relief is desired by most women during labor. Why aren’t UK midwives committed to that?

          • Dr Kitty

            And if she wants and epidural at 3cm and to sleep through the first stage until she is ready to push instead of walking the halls, bouncing on a ball and being in pain instead? Why not offer her that option?

            Personally, if I was planning to deliver a baby vaginally (which I’m not) I wouldn’t care about normality if I could trade it for comfort and safety.

            And I say this as something with anatomy that is very much not the factory default. Which is the way I prefer to describe my congenital spinal abnormality.
            Normal is loaded with value judgements.
            Routine/typical/ average/ common/ median/ frequent- those are less loaded.

            If someone describes my X-rays as “atypical”, “unusual”, “uncommon”, “interesting”, “rare” that is very different to them describing them as “abnormal”. Even if the literal meaning is the same, the implicit meaning is different.

          • Eater of Worlds

            This is actually a thing in the disabled world that we’ve been fighting for at least 25 years, from before the ADA was a thing. It’s why people are called disabled and able bodied, not disabled and normal. A little person or someone with dwarfism and someone of average stature, not normal sized. It’s a constant battle to fight ableism and it just seems to be getting worse lately in the US.

          • Azuran

            Why are you comparing pushing with the OB team to the first stage with midwives? It’s not the same thing at all.
            Unless walking around causes some sort of problem for breech birth or the woman needs constant monitoring, women in the first stage generally can move around whether they are followed by an OB or a midwife.

          • Why do you think that this post has anything to do with the promotion of “normality”? And if you think that promotion of normality can lead to substandard care, which it sounds like you do, then why are you defending it?

            I would argue that ideology is NOT the least of your problems. When you fetishize “normal”, you stop looking for indications that things aren’t going well. When you stop looking, you stop finding. And when you stop finding, people die. It’s as simple as that. There is nothing wrong with monitoring, interventions, or needing a bit of help to get a baby out- before modern obstetric care, people died if they didn’t get those things. Now that we have them, a lot less people die. The fact that you think “normal” birth is an uncomplicated vaginal one, when 10% of babies and 1% of mothers die in when forced to try for it (ie, in places with no modern medical care), says that you don’t understand that labor and delivery is normally deadly. Normal sucks. We can, and should, do better.

          • Why do you think that this post has anything to do with the promotion of “normality”? And if you think that promotion of normality can lead to substandard care, which it sounds like you do, then why are you defending it?

            I would argue that ideology is NOT the least of your problems. When you fetishize “normal”, you stop looking for indications that things aren’t going well. When you stop looking, you stop finding. And when you stop finding, people die. It’s as simple as that. There is nothing wrong with monitoring, interventions, or needing a bit of help to get a baby out- before modern obstetric care, people died if they didn’t get those things. Now that we have them, a lot less people die. The fact that you think “normal” birth is an uncomplicated vaginal one, when 10% of babies and 1% of mothers die in when forced to try for it (ie, in places with no modern medical care), says that you don’t understand that labor and delivery is normally deadly. Normal sucks. We can, and should, do better.

          • nata

            99% of my original post was not about promotion of normality. It developed in the discussion. I only mentioned “promotion of normality” originally, because there was a previous post in this blog about RCM’s campaign with similar name. Originally, I meant that although there is a campaign, there are famous mws on twitter, writing about normality, etc.. the reality of labour ward is very different. So claiming that UK midwives sacrifice maternal or fetal health in the name of normality is very wrong. When all things are good, normal is fine, if you need help – you need help. Good night 🙂

          • So claiming that UK midwives sacrifice maternal or fetal health in the name of normality is very wrong.

            The list of neonatal and maternal deaths listed in this post, and numerous other reports, suggests that this is false.

          • nata

            This is the difference – you read news reports and I live it. How would we view American health care system if we relied only on news reports of the cases that went to court or through investigation?

          • Lilly de Lure

            Well I have also lived it, from the patient’s side of the aisle and from bitter experience I can state that for me, UK midwives (and junior OBs) sacrificing fetal health in the name of normality was absolutely what happened to me.

            The problem is that for all the pious homilies abour intervening if there is a problem the midwives were too sold on the whole “NCB is wonderful” shtick that they refuse to acknowledge to themselves that a problem has developed even in the face of clear evidence that all is going far from well, delaying treatment and endangering both the mother and the baby.I don’t think anyone here is suggesting midwives are deliberately endangering mothers or babies, merely that their belief that “natural is best” is, in a worryingly large number of cases, preventing them from seeing problems and if you can’t/won’t see a problem you can’t fix it.

          • maidmarian555

            I am not the only British mother who comments here. We live this too. This is not just about midwives, this is about us and our care, and the care of our children. A number of us have had some pretty awful experiences under the care of midwives in the UK so you’ll have to forgive us if we see parallels in our own lived experiences and these awful cases being reported in the news. Every year another of these scandals breaks and yet another Trust is exposed as being responsible for the preventable deaths of both mothers and their babies. Where are the learned lessons? How can we trust and believe that action is being taken when we can see the Twitter feeds of the leaders of midwifery in this country and their abject refusal to acknowledge that their own pushing of the ‘natural at all costs’ mantra is at the very least a contributory factor in these terrible outcomes. This shouldn’t be happening. It’s not just an isolated incident, it keeps happening again and again.

          • Lilly de Lure

            ^This^

          • nata

            I am sorry about your experiences. Unfortunately, I cannot answer for the public figures in midwifery or the other trusts…
            From what I see, things are changing – however, like everything in this system, they are changing slowly… For example, in my trust a midwife can work more independently (like triage or MLU) only after working for at least 2 years in obstetric led unit. Believe me, after participating in high risk care and seeing what can happen no-one would delay transfer of care.
            In addition, the new generation of midwives are constantly reminded about their responsibilities and consequences if they make a mistake – for families as well as for us.
            I chipped in to comment just because this post (just even the title) offends the majority of the profession who care.

          • maidmarian555

            Well it offends me that maternity care at Telford and Shrewsbury, despite multiple problems and inquests into preventable deaths, has not been subject to a full investigation until some of the parents went to the BBC. These problems have been going on there since at least 2009 and nothing has been done and no action taken- certainly no action that has actually worked. If this sort of thing is not going on at your Trust, and they aren’t regularly sweeping preventable deaths under the rug then I don’t see why this article would offend you. I’m sorry but someone has to speak about this and the RCM (who represent YOU and your profession) are, once again, conspicuous in their silence. You may not like Dr T’s tone, but she’s merely pointing out what’s happening here. Rather than taking offence at the tone, you should really look at the content and try and understand how terrifying it is to be a pregnant woman in this country at the moment. We need reassurance from midwifery that we will not have necessary interventions withheld during birth and that our concerns will be taken seriously. That’s not happening at the moment.

          • momofone

            “Believe me, after participating in high risk care and seeing what can happen no-one would delay transfer of care.”

            Yet they do.

          • The Bofa on the Sofa

            Exactly. The coroner reports mentioned above say exactly that.

            I fear that nata is really skirting the edge of gaslighting here. We have reports of people’s experience, and her response is “no one would do that.” Yes, they do. It’s being said right here, this is what happened.

            Accept it, admit it, and fix it.

          • Charybdis

            Repeatedly and doggedly they do. Maybe some hubris is involved as well.

          • Christina Maxwell

            All the bloody time. It’s been a real problem in my health board area.

          • Daleth

            I chipped in to comment just because this post (just even the title) offends the majority of the profession who care.

            I can see why the title would offend you, since it just says “UK midwives” instead of “some UK midwives,” so you could logically think it might mean all midwives in the UK.

            But once you read the article, don’t you understand that she’s not talking about every midwife in the UK? She’s mentioning a number of specific tragedies in specific hospitals, and she’s talking about the Twitter feeds of two specific UK midwives (i.e., what those two midwives post on Twitter and the responses they get from other UK midwives).

            And what she’s talking about are people’s deaths, tragedies for families, and evidence (from the Twitter feeds) of a number of UK midwives apparently not caring at all. Shouldn’t THAT be far more offensive to you?

            It’s not Dr. Tuteur who’s making your profession look bad–all she’s doing is reporting on what’s been done and said by certain members of your profession. Those bad midwives are the ones making your profession look bad.

          • The Bofa on the Sofa

            It may not be talking about everyone midwife, there is still a problem with the culture, and indeed, those who are silent are complicit.

            I have no problem with them being included in the criticism. They need to stand up and be heard. If they aren’t they are just letting it happen.

          • Christina Maxwell

            Frankly I do not care that you are offended. Stop defending the indefensible and LISTEN to the women who are telling what has happened (and continues to happen) to them.

          • Linden

            How about people who have lost a child or partner? Are they not “living it”? Why are your experiences more to be regarded than theirs?
            How many actually have to die before you think, well maybe there is a problem here, even if I haven’t seen it in my daily work?
            Investigations happen so mistakes don’t get made over and over. This is not just to save babies and mothers, but to protect people like *you*. Don’t put your head in the sand and say, “pah, sensationalist headlines!” This is YOUR PROFESSION being discussed.
            If I were a midwide, I’d be VERY invested in these investigations, to make sure such a loss never happened under my watch.

          • Christina Maxwell

            Time you took off your rose coloured spectacles. many of us have lived it and watched those we love live it too. It’s not good enough and if you are excusing it you are a part of the problem.

          • Well, you’d probably have a pretty decent idea. The American health system sucks, and we all know it. Watching it at its failure points tells you a lot.

            NHS overall seems pretty decent. The infiltration of the woo into maternity care, on the other hand, is killing people. That’s not okay.

          • momofone

            Priorities are set based on ideology. I would argue that ideology is a huge factor in these deaths, especially the idea that there is such a thing as “normal birth.”

        • Roadstergal

          “she had a normal birth”

          What does that mean? What’s an abnormal birth?

          • nata

            Uncomplicated vaginal delivery. There’s not such a thing like an abnormal birth.

          • You do realize that if you call one thing “normal”, you are by default calling all things that are not that “abnormal”, right?

            It’s a very simple logical construct. [Only] if A, then B. If not-A, then not-B. [Only] If uncomplicated vaginal birth, then normal. If not uncomplicated vaginal birth, then not normal. That’s what you’re saying, whether you mean it that way or not, and that is how people are understanding you. The implied ‘only’ is very, very clear.

          • nata

            the phrase “normal delivery” just meant that although some aspects of her care were high risk, we made an effort to keep other aspects of her labour care regular, normal, routine

          • No, that’s not what you meant. You meant she had a vaginal delivery, which is normal, which means all other forms of birth are abnormal. We can all read between the lines here.

            You might not realize that’s the message you’re sending, but it is very much the message you are sending. You think that c-sections are abnormal. You think that pitocin augmentation, induction of labor, epidurals, and other interventions are abnormal. You further think the goal should be to have a “normal” birth as you define it and to avoid all those interventions, because they aren’t normal. That’s really not okay, since those interventions save lives and prevent pain.

          • nata

            I think just like you cannot say “abnormal care”, you cannot say “abnormal birth”. Interventions and pain relief are not natural, but important and often life saving. You know very little about me, my personal life and work experience. One phrase “normal birth” can trigger this reaction only on dr A’s platform :).

            Right now it well after midnight in my place. I am going to bed. Will check on the thread tomorrow.

          • Oh, I think the lack of proper monitoring was abnormal care, or at least I hope it was!

            I’m also going to say that natural and normal are not synonymous. It’s not natural to get painkillers for a broken leg, either, but I surely hope it’s normal.

          • Sarah

            You’re wrong to say the phrase normal birth triggers this reaction only here. You can agree or disagree with the objections to it, but this is a discussion that has been had many times online in many fora. Fact.

          • Daleth

            I think just like you cannot say “abnormal care”, you cannot say “abnormal birth”.

            If you just mean routine, why not say routine? That would keep people from thinking that you’re judging somebody for how they gave birth.

            So let’s just call an uncomplicated vaginal birth a “routine birth” or “routine vaginal birth.” Then you’re saying what you mean without sounding judgmental.

            Logically, if you can’t say “abnormal X,” then you shouldn’t be saying “normal X.” If you don’t mean “the opposite of abnormal,” then “normal” isn’t the word you want.

          • Roadstergal

            You said “normal birth.” Your words.

            You could have said ‘standard care’ or ‘routine care,’ and ‘vaginal birth.’ Your choice of words is telling, and is reflective of the way my friend was treated by the UK midwives. Her C-section was a tragedy – by implication, it was abnormal, wrong, to be avoided. Disempowering. She swallowed all that the midwives fed her on that score.

            She gave birth to a perfectly healthy baby that she took home and EBFed, and it was ‘abnormal.’

            She was encouraged to have her healing, empowering VBAC. Her ‘normal birth’ was traumatizing in the moment to the extent that she can’t bear the thought of having any more kids, the baby was in the NICU for weeks, and she was in pain and bled for even more weeks.

            And yet, the latter was charted as normal, desirable, proper.

            Words matter. You’re perpetrating the ‘vaginal uber alles’ mindset, and it’s hurting women.

          • nata

            not always “normal” also comes with “abnormal”. For example, in maternity we use “normal intrapartum care” – meaning routine care in case of uncomplicated pregnancy/labour. You can’t really say “abnormal care”. Though I understand your point that the actual phrase “normal birth” can sound that other ways to birth are abnormal.

          • There is a big difference between “normal care” and “normal birth”, I would argue. If you mean standard care, I would use care instead of birth. It’s a lot less loaded.

          • AnnaPDE

            Um, that goes the other way round with negation.
            “If A then B” is equivalent to “If not-B then not-A”. Nothing can be said about the “If not-A…” case. The [Only] in your description makes a massive difference – that can’t be in “imagine it for yourself” square brackets.
            Depending on whether we assign the value “normal birth” to A or B (and “uncomplicated vaginal delivery” to the other variable), this doesn’t need to be discriminatory.
            “If uncomplicated vaginal then normal” does not preclude anything else from being normal, too.

            Sorry for the nitpicking, and I’m completely with you on how annoying I find all the talk about “normal” (and pretending that “normal” implies “good”), but as a mathematician I can’t leave imprecise logic uncommented.

          • That’s fair, and why I added the [Only] in there. But she never said it outright, just implied it, so I didn’t think it was fair to put it in without the brackets. Mixing logic and rhetoric doesn’t always work out in the best ways lol.

          • Roadstergal

            If a normal birth is defined only as an uncomplicated vaginal delivery, than any other way of having a baby is by definition abnormal.

          • Sue

            This is the point: the emphasis on delivery route as ‘normal’. In reality, having a birth with IV glucose and insulin is far from ‘normal’ – but it may be successful.

    • Mel

      In the US, the vast majority of L&D wards have an integrated system where attending OBs, resident OBs, CNMs, anesthesiologists, and RNs are working in teams.

      When my son was delivered, a RN-level nurse was in charge of routine monitoring of Spawn’s fetal trace. If anything changed, the RN would begin basic interventions (checking Spawn’s position, having me move) and if he didn’t recover within a short time period, there was at minimum a resident OB available for consultation on the trace. Because my delivery was high-risk, my attending OB requested to be notified immediately if anything changed since I was in the middle of a complication that could have life-threatening outcomes for myself and my son. A CNM was my first contact when I reported to triage and the two I met during my time in L&D managed to place 2 IVs in my increasingly difficult to manage veins. When my BP didn’t go down after delivery, my attending OB informed the resident OB assigned to me and my nurses that the attending should be the first call for changes in drugs.

      Yes, OBs do trust nurses to contact them if anything changes. Do nurses make mistakes? Of course, but the system in the US has ever-increasing levels of redundancy to reduce the severity of the errors. There is also a culture of erring on the side of caution when it comes to passing patients to a practitioner who has increased skill levels.

      Also, the US has some options by which patients can request immediate review of their treatment by practitioners with higher skill levels. For example, if I had had concerns that the RN on my case wasn’t reacting to a change in my condition, I could request to discuss my care with the charge nurse. I could also request access to the patient ombudsman. My husband could also literally find an OB on the floor if all else failed.

      By comparison, several of the GB deaths occurred when patients were kept by the equivalent of RN or CNM providers when they should have been passed on to an OB. The patients didn’t seem to have any way to request that a neutral third party like an ombudsman or someone from the OB section review their course during labor and delivery.

      • nata

        I cannot say about all the UK. In my trust if you end up in an obstetric unit with a high risk pregnancy/labour, care is similar. Continuous fetal monitoring is observed and maintained by the midwife, the trace is officially assessed hourly or half hourly; however, in labour the midwife is always in the room, so she would notice very quickly if something is wrong. It is also displayed on the screen in the staff room so if the midwife does not come out to consult a senior midwife or a doctor, someone would soon knock on the door to ask what happened. Getting doctor’s review in case of a abnormal trace has never been a problem.

        I think you are right that part of the problem is that midwives failed to refer to obstetric care when things started to go wrong.

    • EllenL

      My two pregnancies were overseen by a surgeon in the first case , and an OB in the second.

      Both times, obstetric nurses were caregivers during labor. But, and I think this is important, the doctor came in at times throughout the labor to confer with the nurses, and to discuss with me how things were going and answer my questions. I felt there was close supervision, even though my labors were uneventful. Doctors delivered my babies and performed stitching, etc. Follow up care, in the hospital and six weeks later, was by the doctor.

      I appreciated the compassionate care of nurses, and I absolutely relied on the expertise and experience of skilled doctors. I would want nothing less for my daughter, and my granddaughter.

      I should add that prenatal care was also handled by my doctors. Being RH negative, this was very important and reassuring to me.

    • Sue

      nata – the investigations of these adverse events has shown a culture within UK midwifery that seeks to “protect” women and babies from the “interventions” of doctors.

      Nobody is saying that this reflects the attitudes of all UK midwives.

      As you say, good maternity care relies on teamwork – with skilled midwives noticing the NEED for interventions. Unfortunately, there are pockets of poor culture – as reflected in some of the investigation reports.

      AND, opinion leaders within the profession, who are vocal on social media, are not reflecting a culture of quality improvement.

      Finally, despite this article, I don’t think Dr Amy is saying that midwifery in the US is ‘better’ than the UK – on the contrary – many so-called midwives in the US – especially in the home setting – don’t have the training of UK nurse-midwives.

      Many of us here are puzzled about why more competent UK midwives don’t rail against the poor practice and ideology of this fringe of the profession.

      • Christina Maxwell

        I would suggest two main reasons. 1) they are busy getting on with their jobs and 2) more importantly, they are scared. Scared of backlash, scared of being seen to bring midwifery into disrepute, scared of a power shift back to OBs, scared they will be bullied by their seniors. The fringe of the profession is vocal, loud and very much has the ear of the media.

      • Lilly de Lure

        To be fair it’s not just midwives in the UK any more – it’s spread to OB training so you will find junior OBs spouting the same crap at you and reacting the same way – certainly my near-miss was a joint effort between midwives and a junior OB. There’s no doubt it started amongst midwives though.

        • Christina Maxwell

          I suspect the junior OBs could be scared too. They are also in danger of being bullied by a herd of rampaging midwives! But seriously what would happen to a junior OB if their hospital’s midwives refused to work with them? I have often wondered.

    • Dr Kitty

      Nata-
      UK midwives monitor uncomplicated deliveries. Women with low risk pregnancies may NEVER see an OB from their first booking appointment, throughout pregnancy, labour and delivery and in the Postnatal period. The people who determine whether an OB opinion is required are MIDWIVES.

      This means that MWs are responsible for monitoring foetal heart rate during labour either intermittently or by CTG.
      It is therefore the responsibility of the midwives to call an obstetrician if they detect a problem with the foetal heart beat or they think the CTG is not reassuring.

      It is the responsibility of the midwife, if she is the lead professional, to do an appropriate antenatal risk assessment and ensure that her patients are appropriate for midwife led care in pregnancy and labour, and that an Obstetrician doesn’t need to be involved. If she categorises a high risk patient as low risk, bad things can happen.

      It is the responsibility of a midwife to monitor the baby after delivery and ensure it isn’t hypoxic or septic or dehydrated or seizing, and to call for paediatric support if she has concerns. If she doesn’t call a Dr to see the baby soon enough, bad things can happen.

      Actually, what Furness and many, many other coroner’s inquests and inquiries have shown, repeatedly, is that midwives are failing in these duties.

      They don’t recognise when normal, low risk situations become high risk.
      They don’t refer quickly enough (or sometimes, at all) to doctors, meaning that interventions such as CS, Antibiotics etc aren’t started quickly enough to prevent death or damage.

      If a midwife fails to recognise an abnormal CTG at 11pm, calls in obstetrics at 2am only for foetal bradycardia and the baby is delivered flat at 2:20- the 20 minute delay is on the OB… the 3hour delay is on the midwife.

      If a baby is hypothermic and grunting for 4hours before a midwife calls a paediatrician and antibiotics and aggressive resuscitation are started 30 minutes after the paediatrician sees the baby, the 30 minutes is on the paediatrician…the 4 hour delay is on the midwife.

      I work in the UK.
      I do know how it works here. Are you sure you do?

      • nata

        x I also work in the UK. If CTG is performed in labour, the woman is already under the obstetric care. So the obstetric team would be initially involved. The trace is hourly fresh-eyed by another midwife. On top of this, the trace is displayed on the screen for all colleagues, including the obstetricians to see. This is what happens in the trust where I work. The same situation was in the trust where I trained.

        x If the mother is poorly in labour, there was mec at delivery, etc – the baby would be closely monitored – vital signs would be taken and documented every 2 hours, peds are called if abnormal. In case of maternal infection in labour the baby would be screened and treated in the first hour of life.

        x From what I’ve seen the bigger issue is that midwives are stretched, overloaded and overworked – this is when most tragedies happen. The issue of burnout is much more serious, occurs much more often than some midwives’ wrongful attempts to normalize the abnormal.

        Dr Kitty, you mentioned you work in the system – as an obstetrician. In your workplace you have to rely on midwives who perform all the duties you mentioned. Do you trust your co-workers midwives to provide safe care? Or would you also call them killers who care more for natural birth than maternal and fetal well-being??

        • Dr Kitty

          Not an obstetrician.

          I do work with midwives, and yes, I’m afraid some of the ones I have met appear to be more concerned with NCB ideology than maternal wellbeing.

          In my practice I have come across the following:

          Midwives who refused to ensure adeqaute analgesia to women postnatally because they were breastfeeding, and exclusive breastfeeding rates
          and eliminating small risks to babies mattered more than maternal comfort and pain relief. As in, refusing to call doctors to prescribe opioids and discharging women with paracetamol alone when they have severe pain.

          The midwives who try to push VBAC on women (like me) who don’t want one, because it is “better”.

          The midwives who don’t consider fully the history of the woman and misclassify high risk situations as low ones (and seem to suggest that they have been trying to do the woman a favour when called on it).

          The midwives who wait until babies have lost more than 12% of their birthweight before seeking any medical advice, and who tell mothers that under no circumstances should the baby be fed formula if they want to be able to continue breastfeeding.

          Women who are “encouraged” to deliver at free standing MLUs without being told all the risks (such as the fact that our local unit has had several deaths of babies due to prolonged transit time to the obstetric unit 20miles away), and as there is a MLU in that very same hospital, which is closer to my patients than the FMLU, delivering at the FMLU makes no sense (other than economic).

          Some of the midwives seem to be eternal optimists- everything is fine, everything will be fine, nothing will go wrong…and just can’t see problems developing because they are minimised until a crisis develops.

          Some are individuals who do whatever they can to make less work for themselves (and as I usually work on my days off and into the evenings unpaid and do whatever I need to do to keep my patients safe I have limited sympathy for the “workload crisis” argument).

          Some are ideologues who genuinely believe that NCB is “best” for women…regardless of what the woman actually wants herself.

          Some midwives are excellent, and I have good working relationships with them. Some aren’t, and I do everything I can to avoid working directly with them and follow up patients under their care especially closely myself, precisely because I don’t trust them.

          • Christina Maxwell

            Thank you Dr. Kitty. The situation is much the same where I live. The only thing I take issue with is the idea that FMLUs make economic sense. They do not, at least not round here. With each midwife handling an average of 25 births per year they cannot. There are 4 FMLUs in this area and one attached to the single ‘proper’ hospital which serves an enormous geographical area. The midwives in the actual hospital are on the whole hard working, sensible and to be respected. The others never seem to stop complaining about their workload (those 25 births a year).

          • Dr Kitty

            Yep.
            The FMLU is struggling to keep their numbers up. Women here just do not want a 30minute journey on country roads to get there and another 30 minute ride in an ambulance if it goes pear-shaped, when there is an all-singing, all dancing maternity unit 20 minutes away on main roads with a MLU with birthing pools and birthing balls on one floor and a consultant led unit with epidurals and operating theatres and machines that go ping one floor up, and a NICU just down the corridor.

            So now they are telling women they can have their antenatal appointments at the FMLU (quieter, easier to park, appointments are longer) but actually deliver the baby at the hospital. I believe the hope is that women will grow so attached to their midwives, or be worn down by constant exhortations to choose it, that they’ll decide to go for the FMLU and ignore the risks. So far it is not working. Not one of my patients who has opted for antenatal care at the FMLU has chosen to have her baby there, and my practice has had one planned home birth in the last 5years.

            My patients want quick, easy, safe labours that are as painless as possible.
            FMLUs and HB does not appeal to them, and they get quite annoyed after being repeatedly told what they are supposed to want.
            The last birth plan I saw was for a third pregnancy.
            It said “All the drugs, as soon as I arrive- natural birth is not for me, I’ve already had two, I don’t want a third”.
            I don’t imagine it was written with midwifery assistance.

          • Sarah

            And yet the stats I’ve seen say FMLU is cheaper per birth than hospital delivery. This is because they’re not factoring in all the empty capacity, though. Not much of that to be had in your average CLU or even hospital MLU!

            Like both of you two, I live in an area with an underused FMLU. The one for Greater Manchester is in Salford and it isn’t being used as much as was hoped when it was built. And that’s even with it being the only birth facility of any kind within the City of Salford, so some women will feel a motivation to give birth there for that reason and the others unless homebirthing will need to travel.

        • Sarah

          Overloading is absolutely an issue and resources are part of the problem. Yes. But that and ideological resistance are not mutually exclusive.

    • nata

      Thank you everybody who answered/participated in discussion. I think I’ve said everything I wanted to say. I am not going to monitor this thread anymore partly because I don’t have much to add and because I really cannot afford to spend so much time online x. It was nice talking to everyone, have a good day.

  • Ken S., As Seen On Watch Lists

    It really is sickening how these inhuman scammers will happily victimize mothers and babies, to the point of taking their lives, for a bit of cash and the attaboys of their depraved colleagues.

  • evidencebasedbreastfeeding

    anyone following the IMUK business? do you know if they are still attending births (they are not supposed to be – I think they were going to be removed from the register as per EU law saying all MW’s (and HCP’s in general) had to have an approp level of cover in case anything goes wrong. The NMC seems fairly sensible over this one.

  • Sarah

    Has Milli Hill not weighed in recently? Usually none of these articles is complete without a heartless quote from her.

  • Roadstergal

    “Oliver Smale – 2015. He died after his shoulders became stuck during a natural birth after his mother was refused a Caesarean section”

    Midwives are the ones who respect women’s bodily autonomy!

    As long as they make decisions the midwives approve of, of course.

    Sure, I have to consider the possibility that the baby would have died anyway if the woman had gotten her desired C/S. Forgive me for putting it as pretty low.

    • nata

      only that refusing a ceasarian was not a midwives’ decision

      • Lilly de Lure

        Not in practice but refusing to refer the patient to an OB who can make that decision (or the decision to put the patient at the bottom of the OB’s list of patients so they won’t see them for hours by which time (with any luck) they will have delivered anyway) IS.

        • Sarah

          Yep.

      • SporkParade

        It’s possible that the midwives refused to refer to an OB when complications arose. It’s also possible that the trust denied a requested C-section (there are many situations in which a mother might feel C-section was the best option despite it not being standard wherever she is giving birth).

      • Sarah

        Sort of depends on your definition doesn’t it? When an obstetrician has been involved and made the decision to perform a CS, midwives can’t veto it, but they can most certainly try and prevent the involvement of anyone other than midwives in the first place. This isn’t a matter of opinion.

  • shobbie

    These women must be literally mentally ill to act this way. It’s almost sociopathic, their reaction to the preventable deaths of babies and mothers.

  • TsuDhoNimh

    Way back when I was a med tech, every death during labor got a full investigation.

    And the only three questions were: how did this happen, is it preventable, how can we prevent it in the future.

    • mabelcruet

      In the UK, maternal deaths are reported to the Coroner-they are independent judicial officers who have the power to investigate the causes and circumstances of death, particularly if they are not natural deaths (basically, they have to answer a few questions-who died, where did they die, how did they come about their death). But the system depends significantly on the way the death is reported to the Coroner-so if a death is reported and the clinician reporting the death says that it was infection, or haemorrhage, i.e. a ‘natural’ cause of death, the coroner may well decide that the death can be certified and can issue a death certificate without doing a full inquiry (so any unnatural contributory factors like inadequate monitoring may never be uncovered properly). Maternal deaths are also collated by MBRRACE-UK-this is a national surveillance program that looks into all maternal deaths, but that’s more from a national viewpoint rather than individual cases. Each hospital where a maternal death occurs is required to hold an investigation as part of a mortality review, but the standards vary hugely. There is a review body, CQC, which monitors performance and will look at the standards of local investigations, and certainly the local investigations into the deaths in Barrow-in-Furness were criticized by CQC as being too superficial and inadequate. But overall, it is still a rather disjointed system, and that’s why all these reviews uncover the same issues time and time again.

  • maidmarian555

    According to this slightly more recent report from the Guardian, they are now investigating the deaths of 15 babies, 3 mothers and a further 10 cases where patients survived but were injured. It’s horrifying.

    https://www.theguardian.com/society/2017/apr/21/nhs-maternity-units-testing-shrewsbury-telford-trust-hopeless

    • 4700 deliveries a year, 15 dead babies (with 10 injured) and 3 dead mothers. This is … not good. Not good at all.