Preventable deaths are the inevitable result of the radicalization of midwifery

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Ideas have consequences.

Bad ideas about childbirth have deadly consequences.

That’s the take home message from the shuttering of the UK Campaign for Normal Birth. Midwives promoted process (normal birth) over outcome (healthy babies and mothers) and, inevitably, babies and mothers died.

It wasn’t always this way. There was a time when midwives were guardians of safety.

Midwives never intended for anyone to die, but deaths became acceptable collateral damage.

Midwifery is often referrred to as the “second oldest profession.” Ever since our ancestors acquired the ability to walk upright, human childbirth has been fraught with extreme risk to both mother and baby. The first midwives were those who recognized that assistance in childbirth can minimize those risks.

They understood that something as simple as massaging a woman’s uterus after childbirth could prevent life threatening hemorrhage and that different fetal positions like breech posed specific problems that could be overcome with specific maneuvers. They acquired knowledge of the pharmacologic properties of certain plants and gave extracts to women with the intention of starting labor or stopping bleeding.

Outcome, whether mothers and babies live or die, was the MOST important goal in midwifery. It isn’t the only goal, of course; safe care can and should be accompanied by compassionate, comfortable care. But it was the sine qua non.

Despite profound changes in the human condition, midwifery changed very little … until the advent of midwifery theory. That’s when midwifery became radicalized and, as a result, babies and mothers died preventable deaths that midwives could have prevented but didn’t. Don’t get me wrong: midwives never intended for anyone to die, but deaths became acceptable collateral damage in a relentless campaign to promote process over outcome and midwifery autonomy over everything.

Don’t believe me? Consider this paradigmatic academic paper Including the nonrational is sensible midwifery, by Jenny A. Parratt, and Kathleen M. Fahy. Yes, you read that right; it is an exhortation for midwives to apply the nonrational to the care of patients.

The authors attack rationality itself:

We expose the limitations of pure rationality in the context of childbirth and use the concept of safety to exemplify the limitations that pure rationality imposes. The paper draws on philosophical and spiritual theory to present an analysis of ideas about mind, body, soul and spirit… This revised conceptualisation provides a theoretical basis that allows for and promotes more possibilities and thus more holistic ways of knowing in midwifery.

Both premise and conclusion are stunning: Many principles of midwifery are not supported by science. Rather than modify midwifery to reflect scientific knowledge, scientific evidence should be abandoned in service to midwifery autonomy.

For the treatment of postpartum hemorrhage, the authors suggest:

…[W]hen a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking… [T]he midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage… Imposing a pre-agreed standard care protocol is irrational because protocols do not allow for optimal clinical decision-making which requires that we consider all relevant variables prior to making a decision. In our view all relevant variables include nonrational matters of soul and spirit.

In other words, scientific evidence mandates technological intervention to treat postpartum hemorrhage, which isn’t compatible with the privileging of process over outcome. Rather than modify midwifery practice to reflect scientific knowledge, scientific evidence should be abandoned in service to midwifery autonomy.

There is a direct line between radical midwifery theory and the deadly Campaign for Normal Birth. In a Royal College of Midwives “analysis” published about the same time, the RCM insisted:

Care based on robust evidence probably has the highest profile it has ever had within midwifery. However, if policies, protocols, guidelines and pathways of care are too rigid and are unable to be applied flexibly, then there is a risk that midwives are unable to feel empowered to practice the art of midwifery. They need to use the intuition that experience and knowledge brings, to sense when a problem may or may not be occurring.

The RCM uses an example, too. A woman whose baby was breech was encouraged by the midwife to have a vaginal birth. The lesson midwives were to take from this:

Most midwives base their antenatal care on national guidelines … and local policies. ‘Trusting your intuition’ promotes these tools to be used flexibly …The intuition that Angharad would benefit from an extra visit at home enabled her to have the space and time to make informed choices that were right for her. Angharad made a choice that did not follow the current recommendations, i.e. the ‘safest way to have a baby in the breech presentation is by elective caesarean section’.

In other words, scientific evidence indicates that technological intervention (C-section) may be safer for breech babies, but that isn’t compatible with the privileging of process over outcome. Rather than modify midwifery practice to reflect scientific knowledge, RCM encouraged midwives to ignore scientific evidence in service to midwifery autonomy.

It’s not difficult to imagine why so many babies and mothers died as a result of such “reasoning.” In nearly every case, patients died because midwives ignored scientific evidence in favor of their intuition. This is a betrayal of the fundamental ancient goal of midwifery, putting patient health at its heart, and replacing it with a radical, contemporary imperative, putting midwife control at its heart.

Why did the UK National Health Service allow this deadly, self serving ideology to flourish? NHS made a Faustian bargain with midwives in exchange for the promise of saving money; midwives are less expensive than obstetricians. But it turns out that dead and injured babies are more expensive than both.

The radicalization of midwives has turned them from life savers to purveyors of and apologists for preventable deaths. That is unethical, immoral and completely unacceptable.

  • Sue

    OT: Aus AMA releases a position paper in infant feeding…full of mixed messages
    https://ama.com.au/position-statement/infant-feeding-and-parental-health-2017

    • Ozlsn

      Hm. A lot of hedging going on there. I’m glad they’re supporting mothers who are using formula but a bit surprised at the “Perceived insufficient milk supply is commonly cited as a reason for the cessation of breastfeeding, though the number of women who actually experience this is relatively low ” statement. I notice no numbers or citation, so… how do you know? And what is “relatively low”? Preeclampsia is roughly 5%, or 1 in 20, is that low? I can’t imagine variations in breast milk supply are going to be much rarer.

      • Empress of the Iguana People

        it is, thank the gods. but that’s a long way from rare. There were 3 lefties in my 8th grade (roughly 50 kids) and I the only girl, but no one thought we were weird.

  • CSN0116

    Just consulted (formula feeding consultation) with an OB/GYN resident with a 9-day-old baby and 15% weight loss (her baby). Baby won’t stop crying. No, shit. Sigh……

    • I am not a doctor. Or a nurse, or any sort of medical professional. But I would venture a guess that maybe the baby is hungry? I know I also get inconsolably grumpy if I can’t eat …

    • Empress of the Iguana People

      The -doctor’s- baby? *shakes head* We’ll assume she’s gotten the same load of baloney and is too sleep deprived to not operate by rote.

    • Heidi_storage

      Holy cats. They’re lucky the baby is still strong enough to cry, at 15% loss. I hope the critter is okay.

    • Merrie

      That’s terrifying… I hope you got food into the poor kiddo.

      • CSN0116

        I always do 😉

  • guest

    I’m very pregnant, and people keep asking me if I am having a water birth. “Oh, you simply must have a water birth!”

    When I say no, they get super judgey and argumentative.

    That sounds terrifying to me. Why on earth would I want to have my baby underwater? Isn’t there threat of the baby aspirating water? How clean are those birthing tubs, exactly?

    Also, why is water birth so trendy right now that random strangers approach me to ask about it? How did the idea become so popular?

    • swbarnes2

      FYI: Science-basedMedicine’s take on water births.

      https://sciencebasedmedicine.org/water-birth-again/

      And yeah, you are right, babies can aspirate water, and keeping tubs clean can be an issue. Some women find that the water eases their contraction pain, but of course, other women allow themselves to be talked into thinking that a water bath will be miraculous at easing their pain, and then discover that it doesn’t help much at all.

      • guest

        Thank you for posting that article. I liked the breakdown of the PubMed finds.

        The one benefit I could see would be the weightlessness of the water and the warmth from resting in a tub briefly during certain stages of labor could be comforting and soothe sore muscles. I can’t imagine any benefit to the baby, though.

        I joke that instead of a water birth, I would like to have a taxi cab birth, a labor so quick and easy and without complications that it was done on the way to the hospital (this actually happened when my Aunt Tanya delivered her first!)

        People don’t find that very funny, though.

        • Sue

          Interesting about the “weightlessness” point – the early experiments had women fully immersed in deep water and therefore buoyant – not in a plastic wading puddle on the loungeroom floor.

          Having said that, it;s not clear that weightlessness helps the excruciating pain of uterine contractions against cervix and pelvis….don’t the Natcheral Birthers say that gravity assists birth? SO confusing!

        • The Bofa on the Sofa

          The one benefit I could see would be the weightlessness of the water and the warmth from resting in a tub briefly during certain stages of labor could be comforting and soothe sore muscles.

          Maybe. Then again, an epidural can help that, too.

          • Azuran

            I think it does help with general comfort. I was taking long warm baths everyday at the end of my pregnancy because my back and legs were just in constant pain. The weightlessness made pregnancy bearable for a little while. So being in a bath during labour probably feels better than a non medicated VB in a bed, even if it doesn’t help with the contractions themselves.
            But epidural beats a hundred warm bath, it’s just not comparable.

          • swbarnes2

            But hot water is pretty low-tech…if it was really effective, we’d see reports of ancient people giving birth in warm water tubs…but we don’t.

          • Azuran

            It ‘could’ be because while ‘low tech’, getting a hot bath can be pretty complicated without technology.
            A river or lake would be cold and dirty. To make a bath you need a basin large enough for an adult woman to be comfortable, then you have to fill this tub with buckets and heat it up over a fire. And then empty it with buckets again…
            Trying a water birth without plumbing and a water heater wouldn’t have been easy and probably only available to the very rich.

            And I’m not even saying it’s noticeably effective for labour. Just that floating around can feel good when you are basically feeling like a beached whale.

          • swbarnes2

            Ancient Romans had the technology. There were plenty of Romans who would have been rich enough to build a bath just for the purpose of having babies in it They don’t seem to have wanted to do that.

            And I imagine in some climates, you don’t have to heat up the water much, just leave it out in the sun. Women are constantly having babies, if you had a tub set aside just for woman giving birth in your family, you’d get a lot of use out of it. Especially if families shared them.

            If water births were wonderful, people would have found a way to make them happen wherever it was remotely feasible. But no one seems to have done that.

          • Who?

            Also anywhere with a hot spring. Many cultures enjoy a soak in hot water, most of them don’t suggest giving birth in there.

    • Ozlsn

      “Not a dolphin so no. Land based mammal. Might have a shower though.”

      Also no idea why this is suddenly so popular. I was all in favour of seeing if a bath/shower helped with labour pains but I didn’t want to give birth in water.

      • Kelly

        Hot showers helped get rid of the pain of contractions when I was in early early labor. At some point though, I did start to feel them and now matter what, they would not get rid of the pains I was feeling. So, yes a bath or shower can be soothing but I would not want to be in water while actually giving birth.

  • Roadstergal

    OT – California time!

    I forgot to bring my good camera with the EVF to work, so this is a shitty cell phone pic.

    https://uploads.disquscdn.com/images/55ea7fe7f1d98c94c90fb64cf91692ad0be6d9255ac5814b489183bb800cc44e.jpg

    • I saw it (I got glasses) and it looked very similar from Dallas, though the crescent was more down and less to the side. Couldn’t get any pictures, though- that one is fabulous.

      • MaineJen

        Yes, that is how it looked in Maine, too. 🙂 I didn’t have glasses but I did make a pinhole viewer. We will be in the path of totality for the next one in 2024! Woohoo!

        • swbarnes2

          I’m thinking more Mazatlan than Maine in 2024…wonder if it’s too early to book a nice resort?

        • Me too! Can’t wait to see the totality 🙂

    • Russell Jones

      Awesome photo, shitty cellphone camera or not! We got about 92% here. Our office is on the top floor of an eleven-story building, and the view was spectacular. The weather cooperated as well, which was significant in light of the stories I heard on the radio about people who traveled to the eclipse’s path in Nebraska only to encounter thick cloud coverage.

      It got somewhat darker here, but the most striking aspect of the whole thing was the drop in air temp.

    • Nick Sanders
      • Roadstergal

        Totality!

    • Empress of the Iguana People

      We got 83% here. Went to the park to see a friend and we used Demodocus’ Braille paper with a pin hole in it. Boybard thought it was very cool. Girlbard thought the grass was more interesting. And tasty. *snort*

  • Empress of the Iguana People

    OT, but you guys are my parenting group. How long is it appropriate to forbid a 3 year old chocolate milk after he spilled nearly a half-gallon of it on the floor? (That wasn’t just an accident. It took effort. He’s always pouring stuff on the floor.)

    • MI Dawn

      Don’t forbid the chocolate milk. That just makes it forbidden fruit. Instead, tell him that since he’s not a big enough boy to pour the milk, he has to ask you for it for X weeks.

      • Empress of the Iguana People

        I think I’m going to have to enforce “just at the table until you learn not to spill, no exceptions.”
        Unfortunately, his tendency to pour any and all liquids on the floor is a major trigger for my rage at this point. Stupid PMDD and PPD are not helping.

        • MI Dawn

          That’s an excellent choice. Only at the table – maybe with a bib and a sippy cup until you can learn not to spill.

          ETA: my own kids would have been mortified to be reverted back to sippy cup and bib, but other kids wouldn’t care. YYMV.

          • Empress of the Iguana People

            Well, no, he’s not actually spilling. He’s intentionally pouring. He’s currently enamoured of his sister’s sippy cups.

          • MI Dawn

            Ahhh…In that case – he may be doing it for the reaction.

            Try a version of things I used (learned from my kids’ daycare teachers when they had kids experimenting with dirty words): No reaction, except to take the child by the hand and lead them to someplace where they can do the activity (they took the boy into the bathroom every time and told him he could shout the words there). Put your son into an empty bathtub to drink and let him pour away. Pouring where it’s allowed gets boring. And, if you replace the spilled milk with water only to drink, he’ll soon learn that not only are you not going to react, but he doesn’t get more to drink.

          • Empress of the Iguana People

            Might try that. TY

          • Busbus

            If it was intentional, I personally would totally put away the chocolate milk for a while – several days at least; some time period he’s going to notice. But I know I never would have done that with my oldest – it took several years and a couple of kids to cure me from being too nice (or to make me so mean, depending on how you look at it ;-))…

          • Who?

            Natural and inevitable consequences of choices-I like it!

        • Kelly

          I hear you. My kids love to play with water and I find pools of water all over my house. It drives me insane. I make them get towels and clean it up. Which in this case too, you could get him to get a big towel and clean it up himself. He isn’t old enough to do it properly but at least it helps you and it helps him learn that his actions have consequences.

          • Empress of the Iguana People

            I did.

          • Kelly

            Ugh. I am so sorry. This is a battle I have been fighting for awhile too.

        • swbarnes2

          Sippy cup like a baby until he stops deliberately making a mess? I always feel silly giving discipline advice, since my kid so far is super compliant, and doesn’t want to do weird destructive stuff.

    • Kelly

      How often does he get it? I got so sick of my kids asking for chocolate milk and also dealing with the subsequent messes that I made an arbitrary rule that only their father can give them chocolate milk on Saturdays. It works, they stopped asking me.

      • Empress of the Iguana People

        He only gets chocolate milk and water.
        eta he will also drink juice but this is my apple-vore and he gets more than enough fruit without juice. He refuses any other kind of drink.

        • Kelly

          You can do what MI Dawn suggested or I would take it away for a day and just give him water.

        • Kq

          Omg my kid was obsessed with apples forever too. He still loves them at nearly 7…

    • Box of Salt

      Empress:
      would you be asking the question if the milk weren’t chocolate?

      • Empress of the Iguana People

        yes, but i was too mad to not be specific

    • Who?

      I’m sorry you’re struggling with this. Toddlers can get you down, they are expert at knowing our foibles. You’ll trial and error it and come up with something that works for you. You have a more developed brain and an eye on the long game, which means you can prevail.

      And all my sympathy on the cleaning up milk: what a horrible job, and chocolate would be so much worse!

    • Dr Kitty

      Do you have any outside space where you could set up a water/sand table where he can safely pour things?
      Or some toys like watering cans and waterwheels that he can use in the bath?
      Do you have plants he can help to water?

      Ignore if he’s the kind of child that struggles with “OK to do that here/not OK to do it there”.

      I’m currently struggling with a 2 year old who is in the “You no help. Me do it” phase, and I feel your pain.

    • Kq

      May I suggest a small wading pool and a small pile of river rocks to throw into it? My little engineer used to pour and dump like crazy, but “clunking rocks” satisfied a lot of that. Between that and an assortment of cups (combined with the dissolving color pills you can get at most grocery stores) pretty well solved it.

    • MaineJen

      No advice. But 3 year olds are the WORST. Solidarity.

    • Nick Sanders

      6 years.

    • Kelly

      So, my three year old just dumped a huge cup of milk inside my refrigerator today. I thought she had spilled it on the floor and so I told her to go clean it up. I came into the kitchen where she had removed half of the stuff out of the refrigerator and started to clean it up. I was pretty proud that she was doing it without complaint and for a 3 year old she was doing quite well. I did end up finishing it since it was everywhere and I guess it was a good opportunity to clean it out.

  • Cat

    OT, but I left my 18 month old with her grandparents to go to a wedding over the weekend. They have her three days a week when I’m at work and she adores them, but this was my first overnight separation from her (I’m a single mum so I don’t get away much). By all accounts, she took it in her stride – she gave me a massive hug when I got home but she was fine in my absence, with no tears or tantrums at all. The rational part of me is delighted and feels that I can’t be a total disaster as a mother if my child is so secure in the knowledge that I’ll always come home. And I love that she feels so safe and happy with other family members. However, there’s a tiny, tiny, irrational bit of me that worries that her failure to have a single tantrum in my absence is a sign that we have Failed To Bond (because I didn’t breastfeed long enough, push her out of my vagina, babywear etc etc). It didn’t help that another mum at the wedding had left her toddler of a similar age with her husband and was freaking out because her kid gets very distressed if he can’t breastfeed during the night – again, rational part of me thought “you poor woman, you must be fucking exhausted”, but the little irrational voice said “ah, her baby loves her and yours doesn’t love you”. Any reassurance would be massively appreciated! (Even if it’s just “all kids are different” )

    • maidmarian555

      I have these wobbles with my son. He’s only been left with friends/babysitters a few times and has never once cried for me. When his Dad is working an evening, he will loudly shout for his Daddy at bath time but has never once shouted at his Dad for Mummy. I know that this is a Good Thing, that he is a happy, well balanced little boy and I am doing the best I can. It also stirs up wildly irrational feelings that I am somehow a Bad Mum, that he doesn’t love me, that I didn’t give birth or feed him properly when he was new and that He Knows. It’s mad.

      It sounds like you’re doing a fab job with your little girl, I think we all have these monkeys on our backs that occasionally surface. If it’s your first night apart, it’s completely normal to feel a bit fragile about it. And it’s also a good thing (for both of you) that you can actually have a break every once in a while! Try not to worry (easier said than done sometimes, I know).

      • Cat

        Thank you so much for your lovely comment. I think, in replying to people’s comments, I’ve realized that this has a lot to do with the particular monkeys on my own back: my mother had a series of health crises when I was a young child and, the last time, I heard her get taken away in an ambulance at night and was too frightened to get out of bed. She survived, but I developed severe insomnia and OCD afterwards, especially when she was away from home (my father was also verbally and emotionally abusive, which didn’t help much). So I think I don’t have much of a model for how secure kids deal with their parents being absent. And then there’s this whole natural parenting industry out there that’s designed to prey on your fears that your bond with your kids isn’t up to scratch, which really really doesn’t help. Thanks so much for listening – you guys on here really are the best! 🙂

    • Sheven

      Tell that irrational part of your brain that if you didn’t bond with her at all, or she with you, you have 16 1/2 years left to bond with her before she’s even considered legally an adult. If she’d never set eyes on you before you picked her up from her grandparents house, you’d still have plenty of time to fully bond with your child.

      • Cat

        That’s a great point – thanks! My relationship with my parents is still evolving now, so it’s not as though my relationship with my daughter is going to be set in stone at 18 months.

    • Dr Kitty

      I’ve left both of mine overnight with grandparents since before they were a year old (and while I was still breastfeeding them).
      They both behave immaculately, sleep perfectly and don’t appear to miss either parent when we’re away.
      They save the acting out and back-chat for their parents.

      My daughter still comes into my bed for a morning cuddle and my son spends most of everyday between 6pm and 7pm on my lap on the sofa.

      Secure kids code switch- when you’re there, you’re their focus, when you’re not there the caregiver of the moment is, and that’s cool with them, because they never doubt that you’ll be back soon, and they’re so happy with other people because they’re happy with you so they don’t question the ability of others to care for them.

      Sounds like you’re doing everything right.

      • Cat

        “they’re so happy with other people because they’re happy with you so they don’t question the ability of others to care for them”

        What a lovely comment – thank you!

    • Empress of the Iguana People

      *hugs* My first born is perfectly happy to have a sleep over at just about anyone’s house. He’s always up for adventure. He spent 3 in a row with our pastor (who he seems to think is his grandmother) and cried when it was time to go home. He also has been known to cry because I’m going to a meeting without him. You’ve bonded just fine. 🙂

      • Cat

        Aw, thank you for the (virtual) hug – I needed that!

    • MI Dawn

      My kids were left at grandparents houses also. I imagine you left her with a smile, hug, and kiss, which reassured her that even though you were gone, you loved her. And, more importantly, *you came back*. Kids internalize and remember that. Also, as pointed out below, kids usually save the bad behavior for mom and/or dad, because they feel more secure.

      My sister used to have major drama scenes (tears, hugs, kissed, leave, return, lather, rinse, repeat) when she would leave her kids. My parents dreaded taking them on trips because they’d act out so much. They got my kids for a visit and went nuts because “your kids didn’t cry or act out or anything”. yeah, well, daddy and I gave hugs, kisses, said good bye and left. They knew from routine we’d be back.

      • Cat

        Thank you – and yes, I’ve always tried to make my leaving in the morning into a light-hearted thing, even if I feel like making it a tear-filled drama that particular day. Usually, I dance down the path (sometimes in a silly hat) whilst my daughter waves me goodbye through the window, which is why my conservative elderly neighbours think I’m batshit insane! 🙂

    • Box of Salt

      Cat,

      Failied To Bond? No. A decade from now you’re going to be having rational conversations with your well adjusted child, and enjoy each other’s company. You’re going to be wondering when the other shoe drops and she turns into a rebellious teenager. I don’t yet know how that part turns out.

      You didn’t Fail to Bond – you are the right kind of mom for the kid you have. And trust that you will continue to be.

      • Cat

        “you are the right kind of mom for the kid you have”

        Thank you – I need to write that down somewhere and read it when I start doubting myself! : )

    • Amazed

      Amazing Niece is also 18 months old and yesterday, she went home after 3 days with my mom and me. She had been left with my mom for 3 days a few times and her reactions varied widely. The first time, she did not cry at all, only went to the front door a few times to ask, “Mommy? Mommy?”, only to be properly distracted by her grandparents. This time, she cried for mommy and daddy a lot in the afternoon of the second day and woke up a completely happy toddler. She went mad with joy when they arrived to take her – and then wailed uproariously when her grandma went out of the room. Toddlers have minds of their own and no one knows how they work, even toddlers themselves.

      For the record, Amazing Niece was born as naturally as they come, exclusively breastfed until she started biting and whatnot. Still isn’t dejected to a bag of tears for her mom when she isn’t in the right mood. What matters is how happy she is to see her when SIL returns.

      • Cat

        Thank you (and “Toddlers have minds of their own and no one knows how they work, even toddlers themselves” is the truest thing I’ve heard today!).

        • Amazed

          A little truer now than it was when I wrote the comment. Today, my mom found herself babysitting for a few hours. The kid would not go to her – she was busy wailing for her mom. She watched her cartoons and played with her dolls all right but she would not touch Evil Grandma Who Took Her from Mommy. End of story.

          You can never tell with toddlers when you’ll find yourself in the greatest favour or the deepest disgrace.

    • guest

      As a parent of a kid who would completely lose it when we left her as a baby and then by 2 would never even ask for us, take the win that she is secure enough to not miss you. It is a horrible feeling to know your child is so miserable without you. When I leave her now and hear she never asked for me, I am ecstatic because it means she wasn’t miserable. No one likes to see there kid suffer and feel like they caused it.
      Also, I think some of a kids reaction is just personality or developmental stage and has nothing to do with how attached they are.

      • Cat

        Thank you – I know you’re completely right. My mother had a life-threatening illness when I was quite young and, after that, I was a complete wreck if she was ever away in the evening – anxiety, insomnia, OCD symptoms, the works. That probably lasted up until I reached my early teens, if I’m honest. I’d be utterly devastated if my daughter was going through that particular hell, so long may her security in my absence last!

        • Kq

          I feel you.

          My parents divorced by my first birthday and my dad immediately married my stepmom who was emotionally abusive as hell. I was the most miserable desperate child when I had to be away from my mom.

          My kid has never known anything but secure love and care and couldn’t give a crap when I leave him anywhere. Sometimes I feel like he must not have bonded right (especially since I rarely miss him when we’re apart!) But he’s so securely attached that he’s never felt unsafe or abandoned and so has never reacted fearfully at my absence. And he’s definitely still attached – he wants mom all the time when I am around and is still such a cuddle bug…

    • CSN0116

      I’d interpret it as you have a superior bond to her. You have instilled deep security wherein she trusts you immensely. High five!

    • Anion

      FWIW, I bonded with my youngest like CRAZY. We called her “the barnacle baby,” because when she was a baby she wanted All Mommy, All The Time. I breastfed her for 17 months (she had one formula bottle a day so I could make dinner etc.). We co-slept, because I believed the propaganda that it was safer for breastfeeding babies to do so.

      I signed her up to go to daycare/nursery school two mornings a week when she was about your baby’s age, because she seemed ready to play with other kids/very eager for more stimulation etc. The first day there, they told me to stick around because some kids freak out when their mom leaves. She didn’t. I literally sat there, ignored, while she got her play on with the other kids and teachers. They finally told me after an hour and a half or so that I could go home, lol, because she was doing so well.

      She’s almost 13 now, and is still Mommy’s girl, despite her indifference to my leaving her at nursery school, lol. She comes to me for everything; we are very close. Seriously, this is not something to worry about at all, IMO–you’ve made her so strong and secure that she can handle, and is eager for, outside stimulation. (Doesn’t mean there’s anything wrong with babies who aren’t, of course.)

      Some babies are just ready for other experiences, that’s all. It sounds to me like yours is. As others have said, that’s a good thing, a thing to be proud of, not a negative. It doesn’t mean you don’t have a great bond or that she doesn’t love you; it means she’s just the type of kid who’s okay with some separation.

      (Now that I think of it, when she was about five months old I left her overnight to go to my best friend’s bachelorette party, and she did great then, too, with my husband. Again, we had a great bond then and still do. All kids truly *are* different!)

    • Mariana

      The way I see it your kid is so securely attached she knows in her bones you are coming back to her. She feels so loved by you and her grandparents that is is fine being with them for a weekend. It is not a bad thing.

    • The Bofa on the Sofa

      Be grateful that you can have your child stay with their grandparents and not have a meltdown. It is great for them and for you.

      When our kids were little, I so WANTED to let them go to other places and be under the care of other adults and play with other kids. It is how they learn. I didn’t want to be the only to teach them. I could teach them everything I know, but that is way too limited. I want them to learn what other people know, too.

  • Dr Kitty

    https://www.theguardian.com/lifeandstyle/2017/aug/19/fine-talk-abortion-dont-mention-elective-caesarean

    Hadley Freeman, telling the truth in the Grauniad, with highly predictable comments, I’m afraid to say.

    • Sarah

      I was going to post that here myself! Makes me wonder if Hadley might be familiar with this page.

  • mabelcruet

    In the medical world, doctors talk about a sixth sense, or having a little voice on your shoulder. In my speciality, I sometimes get cases that I ‘instinctively’ know aren’t quite what they seem, or there’s something ‘off’. But this isn’t magic, or intuition, what it is is many years of training and experience supported by many years of basic sciences that means my brain sometimes makes diagnostic leaps before my conscious brain catches up. I ‘know’ the diagnosis because my neural pathways are connecting the dots but if you give me a minute I could explain logically, rationally, and precisely why it is X and not Y. This may seem like intuition, but it’s not. It’s not ‘non rational’ knowledge, it’s knowledge that can be explained rationally, even though to someone who doesn’t know, it can seem inexplicable.

    All specialities are like this, every profession which requires training, expertise and specialist knowledge is like this. My boiler got serviced last week-its been making funny noises. Once opened it looked like the insides of the space shuttle, but my plumber got it fixed in no time. He seemed to instinctively know what it needed. Now I’m an intelligent woman, I’m sure I could have fixed it myself if I communed with the boiler and invoked my special ways of non rational knowing, maybe I could have intuited the reason for the funny noises. Well, maybe. Maybe if I’d done a 3 year course in plumbing, then qualified as a gas engineer, then spent years as an apprentice under an expert tutor and finally qualified as a master plumber, it would be as easy as Mr Boucher made it look. He didn’t guess, he didn’t have ‘special’ ways of knowing, he didn’t have ‘non-rational’ ways of knowing-what he had was a wealth of knowledge and training which meant it looked like he could have done the job in his sleep.

    The whole concept of ‘non rational’ knowledge is demeaning, undermining and disrespectful to patients. You are undermining your professional training and professional qualifications. As a doctor, or any other health care provider, every patient you deal with touches you in some way, you leave a mark on each other-healthcare is a partnership. Some patients have a bigger impact than others, but we learn from patients, and we grow and develop our professional skills in conjunction with them, each interaction adding to our experience. By saying that there are non-rational ways of knowing, what you are actually saying is that you didn’t need all that training, you didn’t need all that conventional knowledge, you didn’t need all that experiential learning from all those hundreds of patients you’ve seen because you didn’t learn anything from them-you’re saying your ‘special’ way of knowing, your instincts are better than that.

    Quite frankly, any midwife who bases the care she provides on ‘non-rational’ knowledge is acting unprofessionally. Any midwife who invokes this woo-infested, mother earth goddess, let’s gather your baby’s soul from the stars fuckwittery shouldn’t be left in charge of a labouring gerbil, never mind a labouring human.

    • Empress of the Iguana People

      aye. On a far lesser skill, someone just posted one of their first quilt blocks on facebook. I could tell at a glance that her (?) seams were off. Looking at the back would confirm it but she hadn’t posted a picture of that. I’ve been quilting for 27 years.

      • mabelcruet

        It’s exactly the same-when you have that level of experience you immediately know what the issue is, but it’s not guess work, intuition or instinct, it’s 1000s of hours spent piercing paper or whatever quilters do!

        • BeatriceC

          Similarly I can tell in seconds if a particular lesson is bombing and can switch tactics seamlessly, even in a class of 45-50 7th graders (the size of my biggest classes). And while not as good, I can size up a misbehaving and/or sick bird fairly quickly and know what to do, which sometimes means get the bird to the vet, because the vet is the real expert.

          • Mac Sherbert

            45-50 7th graders!!!!!!!!!!

            As a former special education teacher I can see kids out in public and just kind of know which ones would have been my friends. For example, I once overheard a parent talking about their child’s reading problems to a teacher and I thought oh that sounds like dyslexia. Two years later the kid was finally labeled dyslexic. I think what we often call intuition is actually just former experiences we have buried in our subconscious.

            Now when it comes to medicine, if my doc says my gut is telling me this more than xyz I’m probably going to agree with whatever they say. If however my doc was to say my gut says this not an issue even though you have these symptoms, I’m probably going to find another doc with a better gut.

          • BeatriceC

            I taught in an inner city neighborhood in a very large urban district. We were a tad bit overcrowded.

          • Mac Sherbert

            That’s crazy. Most teachers I know would have walked out in tears.

          • BeatriceC

            It gets worse. A friend of mine is a former Clark County (Las Vegas, NV) high school teacher and she had up to 60 kids in her classes. She literally had kids sitting on the floor because she couldn’t fit enough desks in her room. It was a flat out fire hazard. She wound up going back to school to certify in a non-classroom area after years of classes that size.

          • mabelcruet

            Dear heavens, that sounds like hard work! I love teaching, but I only do occasional undergraduate and post grad level in very selected areas. A huge class of hormonal adolescents sounds like a very tough audience to keep interested and engaged. You’re a physics/maths/stats teacher, aren’t you?

          • BeatriceC

            I taught full time 7th grade math and taught math and statistics at the community college level. I don’t do physics. You’ve probably got that stuck in your head because I’ve mentioned MrC’s Ph.D. is in biophysics. And I absolutely adored my 7th graders. They’re really fun to teach. I spent a lot of time at the beginning of every year focused less on getting lessons done and more on getting behavior under control, and that served me well. I found if I spent two weeks or so teaching a little less in order to take the time for behavior issues, I got a whole lot more done in the long run, as I didn’t have to deal with bad behavior very often. Once you have their attention and respect, they’re really quite wonderful people.

        • Dr Kitty

          Yup.

          I did a seminar called “recognising the sick child” which taught all the signs to look for and what observations and values to check- but the take home message was “if your gut says they are sick, act accordingly”.

          This wasn’t about “non rational knowledge” or “special ways of knowing” or “communing with the parent within us all” it was basically- “you’ve seen thousands of kids, most of whom *aren’t* sick. If your feeling is that this child is sick, even if all signs point otherwise, you’re consciously missing something and should act on your subconscious”.

          • Dr Kitty

            Note- the seminar NEVER said “if all the signs are abnormal, but your gut says they’re fine, feel free to ignore the signs”.
            Which seems to be the entire message of radical midwifery.

        • Empress of the Iguana People

          Fabric mostly. You’re a doctor; you already know how to sew 😉

          • mabelcruet

            Actually, confession time. I really, really hated clinical medicine and I fainted every time I stepped foot in an operating theatre. As a junior house officer I managed to swap every single theatre session I was scheduled for with one of the other juniors who wanted to be a surgeon (it was ‘you do the theatre list and I’ll admit your 27 acute admissions). I have sutured several oranges (as a medical student), and dead people (when we reconstruct the bodies).

            I’m pretty good at blanket stitch, but machine sewing I can’t get the tension right and it always goes loopy on me.

    • Gene

      Interesting topic. This was recently discussed in an online Peds ED group. The “art” of medicine or “gut feeling”. That feeling of “something ain’t right” or “no, take a closer look” is sometimes described as “physician gestalt”. There is pushback on that, and rightly so. When a resident asks me WHY we are going to run a certain test or perform a certain procedure in the ED, I need to be able to explain why it is necessary for patient care. Not “because I said so” or “dunno, just a feeling”. It’s where the bruise is, the mechanism of action of the injury, the recent travel history, the unusual symptom, the distribution of the rash, etc. How can we teach if we can’t give a rational reason?

      • mabelcruet

        Exactly, but you will be able to explain your gut reaction if you step back and take a second to consciously think about it. You’ll be drawing threads from basic physiology, basic pathology, haematology, from patients that you were taught about in your first paeds attachment, a lecture you had from a visiting radiology fellow, a quick chat over coffee with a surgeon who mentioned an unusual case, and all of this can come together into one giant ‘Ta-da!! This is the diagnosis’ moment. And then you do the necessary tests to confirm it. If we were all Sherlock Holmes with the ability to arrange our mind palaces in such a way that these threads can be immediately pulled up from the depths, it would make life easier, but the knowledge is in there, buried, and we can dredge it up. I worked in a very small team, we were 2 for a long time, then 3. Consequently we worked very closely together, and a lot of our conversations about complex patients were along the lines of ‘Ooh, it reminds of that little boy we had with the thingie, but it’s a bit more like that wee girl with the other thingie’. Team working at its best! (thingie obviously isn’t a proper pathological diagnosis, in case anyone is wondering…)

        • mabelcruet

          I suppose in perinatal pathology a significant proportion of my work with dysmorphic babies is gestalt recognition. I know the baby has syndrome X because she looks like she’s got syndrome X. If I really wanted, I could do all the measurements like intercanthal distance, philtrum length etc and consult the tables to prove she has hypertelorism, or whatever, but a lot of dysmorphology is once you’ve seen it, you’ll recognise it again. I can appreciate things are a little different in clinical medicine.

          • Dr Kitty

            Even lay people have gestalt recognition of T21 and achondroplasia.
            You’ve had a chance to get familiar with more syndromes than the average Joe.

          • Empress of the Iguana People

            Don’t a lot of girls with Turners have an unusual neck-to-shoulder connection? A little like Cardassions in Star Trek? I had a roommate in college with it and saw a little girl with a similar frame when I was subbing.

          • mabelcruet

            Yes, they are also usually a little shorter than average, have a broad shield shaped chest and an increased carrying angle at their elbows, which means when they hangs their arms by their sides, the hands don’t touch the thighs but are bent outwards. Sometimes though it goes undiagnosed until they present in their teens with amenorrhoea.

            It’s an odd condition-the vast majority of babies with Turners are spontaneously miscarried-commonly due to hydrops (waterlogging, they become swollen and fluid collects in the body cavities). But a very small percentage go on and have a basically normal lifespan (sometimes needing cardiac surgery because they get problems with the aorta).

    • BeatriceC

      I think this is also at the heart of a lot of what gets called “mom instinct”. When you’re with a particular kid all day every day you can subconsciously pick up on small changes that your conscious brain hasn’t been able to identify.

      • Empress of the Iguana People

        My grandma could do it with her kids straight into their 50s.

        • Kelly

          My mom did it with me when I was dating. She called two relationships without me saying much or meeting either of them. I did end up marrying one of them 9 months later after she told me not to go to fast. It was uncanny as I never told her much if anything about my relationships but she just knew.

    • Platos_Redhaired_Stepchild
    • Kq

      Featured comment pls

    • Melaniexxxx

      This is an excellent explanation.

      and OT, but this:
      ‘As a doctor, or any other health care provider, every patient you deal with touches you in some way, you leave a mark on each other-healthcare is a partnership. Some patients have a bigger impact than others, but we learn from patients, and we grow and develop our professional skills in conjunction with them, each interaction adding to our experience.’
      has really helped to revive me and make me feel a little gratified and human again after a long burny week dealing with difficult people and very sick patients on ED nightshifts x

    • yentavegan

      Wow. Brilliant. Well written. Thank you.

  • Ozlsn

    So this ties in with a blog post I read this morning (https://thebirthhub.co.uk/2017/08/16/hunting-truth-birth-age-fake-news/) which ended up with:

    “There is a reason midwives have been burned at the stake, literally and metaphorically, since the dawn of time: They can perform magic.”

    Seriously, is there any other nursing speciality this far up its own arse? Are there neonatal nurses publishing blogs about calling premmies back to their bodies? Mental health nurses casting out demons? Trauma nurses detailing how the laying on of their hands faith healed their car crash victims?

    Birth is magical and wonderful when it all goes well, yes. But when it doesn’t you want someone who is going to save your baby and you via means that work – not effing magic.

    • mabelcruet

      The comments left on that particular blog page are uncalled for, and particularly vicious, insinuating James Titcombe has endured this campaign for personal financial gain.

      • Ozlsn

        There weren’t any comments when I read it (and promptly saw red)… for the sake of my blood pressure I am not going to look. For some reason it really does not surprise me at all that they would insinuate that.

        • Chi

          It appears that the article has now been removed. Don’t suppose anyone has managed to save a cached version?

          • Ozlsn
          • Chi

            OMG the comments are disgusting.

            “I understand why you would do so as, like many others, I have seen what happens when anyone goes up against James Titcombe and is subject to abuse/intimidation from his followers.” – I get the feeling this person fails at reading comprehension and doesn’t realize that the natural birth advocates have been doling out much more abuse and intimidation than Mr Titcombe.

            And this charming comment from ‘Doulamaddie’:

            “My main beef is with Mr Hunt, who should know better than to have his views impacted by one person, particularly, as you say, by a person who has no wide experience of birth or training in the maternity arena. User views are crucial, of course, and Mr Titcombe’s views are valid as part of a wide consultation of user views. But allowing one person to dictate policy is shortsighted, unethical and ultimately dangerous.”

            So what…the other deaths at Morecambe Bay were what? Made up to start a witch-hunt of midwives??

            How fucking stupid and ignorant can these women BE???

          • Dr Kitty

            “One person’s views”…
            Ignoring that there were multiple inquests and an independent report by an expert in healthcare.

            The coroners and Kirkuk listened to testimony and sought the views, not just of the loss parents and the bereaved loved ones of the women who died (I don’t really think “service users” is appropriate in this context), but of the midwives, obstetricians, paediatricians and Trust bigwigs.

            Titcombe is not a jumped up nobody or a squeaky wheel demanding oil, he’s someone who has been screaming into a void for years. Upon full investigation by the appropriate bodies, has been found to be CORRECT and is finally getting some recognition.

            The fact that Mr Titcombe has a background in organisational risk management is not irrelevant either.

            For people who believe birth is normal and spiritual and full of sparkly rainbows, then obviously having checklists and partograms and endless, endless protocols and flow charts is obviously not going to sit right.

            But sisters- you cannot have it both ways.
            If you want to be treated as healthcare professionals and not quacks you need to act like modern healthcare professionals- protocols, checklists, root-cause-analysis and all.
            If you want to act like mediaeval wise women and shaken without professional standards and accountability, you don’t belong in the health service and don’t let the door hit you on the way out.

    • maidmarian555

      “B. Fake News (Midwives are committed, by their code of conduct, to following women’s wishes, facilitating informed decisions about mode and manner of birth and educating themselves to become and remain, the experts in birth the way humans evolved to do it. When pregnancy or birth veers away from this default physiology, their duty is to involve doctors in a woman’s care.)”

      I call horseshit on this. I’m currently based in the UK and having to fight tooth and nail for an elective section. The hospital sent me a load of websites to look at in order to help me make an ‘informed decision’, every one is anti c-section, here is a delightful example of the “non-biased” information I’ve been given:

      http://www.vbac.co.uk/stories/story.php?s=carolines

      I don’t care what their code of conduct says, I have spoken to numerous friends who have been forced to jump through hoops and fight if they want anything other than an all-natural drug-free delivery. Conversely, if you want a homebirth in a fucking paddling pool in your front room with scented candles and a choir, you can get that signed off quicker than you can get the words out to ask for it. They are only ‘with women’ who go along with whatever they’re peddling. Go against that and they’ll make you life hell because obviously you’re misguided and not ‘educated’ enough. God forbid any woman look at the risks and benefits and reach a different conclusion to the one that they want her to make and ask for a doctor. I’ve never dealt with such naked misogyny in my life.

      • Madtowngirl

        I couldn’t even read that website. The instant I clicked the link and saw the late-90’s website background, I knew I couldn’t take anything in there seriously. It’s shameful that a hospital would use such a resource as “valuable information.”

        • maidmarian555

          It’s basically a large collection of testimonials from women who had a c-section (which the vast majority hated) who then go on to have a ‘healing’ natural birth. Most of which are homebirths. If they’d actually read my notes or looked at my previous birth, they’d know I suffer from a general anxiety disorder and that I’m terrified of doing anything that might harm my baby. So a VBAC at home is literally *the worst* way I could imagine having my daughter. I have no idea why they recommend this site for people like me, it’s beyond inappropriate.

          • Martha G

            Completely agree MM. Will you be sending in a complaint? I’m sure we could help you out with one – not that you need it, you have a great turn of phrase 🙂

          • maidmarian555

            Yes, I will be. I’m waiting to see if they’ll sort my c-section out this week or whether they’re going to try and continue delaying things. If I don’t get a fixed date then I’m going to be transferring to another hospital as I can’t actually cope with being dangled along any longer. I think regardless of all that I’ve got to say something formally about the information I’ve been sent regarding VBACs. Even the stuff from the hospital (aside from their recommended website list) is heavily biased and clearly geared to steer women towards attempting vaginal birth, rather than just giving them the facts and allowing them to make their own decisions. I thought that after my traumatic experience last time, that this time would be better. I was sadly mistaken. It shouldn’t be a battle to be ‘permitted’ to make decisions about your own body. The only thing that’s kept me from completely despairing is that I’ve got a *lovely* community midwife, who is 100% supportive of my decision and has been really helpful. Shame they can’t all be like that!

          • Dr Kitty

            Glad that you seem to be getting somewhere.
            And absolutely complain, citing Montgomery Vs Lanarkshire and the fact that as the patient it is up to you to weigh relative risks for yourself, not for the hospital to influence your deicsion into what they feel is best.

      • Martha G

        Good luck with getting the care you’re entitled to – you’ll get there. But I just wanted to echo your point about the attitude towards home birth. If, when I’m up the duff, anyone pipes up about my preference for a section I would simply point out that nobody choosing to labour at home gets put through ‘counselling’ despite it being by far the madder option. And I’m sure you’ll do just as good a job sticking it to ’em if anyone tries to talk you out of it.

      • Cat

        A friend of mine who has a minor heart defect was repeatedly encouraged by her midwife to have a home birth with her first baby. She pushed back in favour of a hospital water birth because she felt that her house was too far from the hospital. I’m far from being an expert but I still can’t work out how things went from her GP telling her at the initial appointment that labour could put a strain on her heart and she might have to consider an elective c-section, to “oh, go on, go on, have a home birth – it’ll be so beautiful!” . By contrast, I had to fight my midwife every step of the way just to get an appointment at the hospital to discuss the mere possibility of a c-section with a registrar. I know of other local women who begged in vain for induction or c-section sooner than 12 days past their due date because they thought something was wrong with their babies’ movements, and who ended up having stillbirths. The idea that pregnant women in the UK are universally pressurised into medical interventions for the hell of it couldn’t be further than my own and my friends’ experiences.

        PS Bit worrying that the woman in that link is supposedly home educating four kids and she can’t even spell “immensely”.

        • maidmarian555

          The homebirth thing does seem to have suddenly become a wildly popular option with certain midwives. I had a friend who, despite repeatedly saying that she wanted to be in the hospital where the doctors are, was badgered relentlessly by her community midwife to the point where she was insisting she should have a homebirth kit in her house ‘just in case your labour comes on too fast’. She had to seriously put her foot down to get the woman to shut up about it (which is good as it transpired same woman had failed to notice the baby was breech so being in hospital was definitely the right place for her to be). I’ve also heard that the local birth centre is now regularly admitting first-time mothers, when previously they strongly recommended FTMs use the alongside midwifery unit at the hospital.

          I was refused an induction until I was 12 days overdue with my son. I am so grateful every day that we are both still here. I am still angry that nobody warned me of the dangers of going post-dates. Even now, even with my second there is literally nothing in all the crap I’ve been sent by the hospital warning of those dangers. Plenty about c-section risks though *sigh*.

          • Cat

            I’m really glad that everything turned out ok with your son! To my horror, a friend of mine was planning on refusing an induction with her second if she got as far as 12 days overdue, because she’d been given a load of “information” at her hypnobirthing classes about the risks associated with inductions and the benefits of letting babies choose when to be born. I was so relieved that the baby actually came on time so the question of induction never came up.

            All the best with your second child too – I hope you get the right care for you!

          • maidmarian555

            Thank-you. My OH stupidly promised me if the NHS lets me down that we’ll go private. I pointed out that the closest private maternity hospital is the Portland, (and then watched the blood rapidly drain from his face whilst he did the mental arithmetic lol- we watched a documentary about it when I was pregnant with wee man so he knows how ridiculously expensive it would be).

            My son’s head was too big to get through my pelvis. This was only established after several days of having my induction fail. Had we not been induced, he would never have come out. I didn’t even know CPD was a thing until it happened to us. If they’re going to tell women the ‘dangers’ of induction, they should be warning them of the dangers (and possible reasons) for going post-dates. Not just pretending everything will be fine!

          • Ozlsn

            Yes. Until they start handing out information on the risks of vagibal birth and post date delivery the same way they do c-sections they are not providing for an informed choice.

      • Hannah

        Ugh yes! I was fighting from I think 24 weeks? or thereabouts, and I still didn’t get booked in until I was over 37 weeks. With several unnecessary appointments before then. I assume the appointments were to try to talk me out of it, and at least one definitely was (they kept banging on about increased stillbirth risk for future pregnancies, I kept pointing out that I’m asking for it based on increased stillbirth risk for THIS pregnancy, and THIS pregnancy is my main concern). Interestingly, it was the consultant midwife who gave me the most thorough honest discussion on it; I wasn’t expecting that, considering I got the appointment when I requested section and they said I’d have to go to a ‘birth options’ appointment first. Interestingly, she’s the one who gave me the ammo to use to get the consultants to officially sign off on it 🙂

      • Ozlsn

        I read that part of the article and rolled my eyes. Codes of conduct are only worth the paper they’re written on if they are followed and breaches investigated and action to prevent it again taken. If you aren’t giving full information or are pushing one agenda you are not following the code of conduct.

        That vbac website… seriously, what the hell? What else did they give you, the whole “trial of labour or the baby goes to NICU” sites? How is this even remotely helpful?

        I just had an exchange on another site where a midwife was claiming that reducing “unnecessary pain relief” was beneficial. Excuse me?! Who gets to decide what is unnecessary, the person in pain or the midwife?

        (Also I cringed a bit at the vbac author having a HBAC 19 months after her first birth. That is quick. I maybe talked to too many women with interesting birth stories including uterine rupture in NICU.)

        • In what other situation is pain relief considered unnecessary? Broken bones? Post-surgery? Gallstones and kidney stones? If someone is in pain and wants it to stop, then pain relief is by definition necessary. *Angry laser glare at the midwife*

          • Ozlsn

            Now we have someone arguing:

            “Saying the most important thing is a live baby, is a partial truth. Birth is everything about the mothers perceived experience. ”

            Did she seriously just say that a dead or disabled baby is less important than the mother’s birthing experience?!

            Article and comments here:

            http://www.dailytelegraph.com.au/rendezview/forget-natural-childbirth-live-birth-should-be-the-priority/news-story/c9c06b9071f14360de6f66e382647207

          • Empress of the Iguana People

            “birth is everything about the mother’s perceived experience”?
            A) That is a very awkward sentence.
            B) No, I quite disagree. The first and foremost part of birth is getting that enormous creature out of your abdomin.

          • Well, I’d say it’s a live baby and live mother, but still. What the ACTUAL fuck?

          • Dr Kitty

            http://blogs.bmj.com/bmj/2017/06/22/mary-higgins-maslow-and-maternity-care/

            Mary Higgins (an Irish OB) wrote about this very well.

            When you think about Maslow’s hierarchy of needs, birth is only an opportunity for self actualisation, if all of the other, more basic needs in the hierarchy have been met.

            “Women who feed back about “obstetric violence” because their babies did not have delayed cord clamping due to the need for neonatal resuscitation have had their baseline needs met. If this is the worst thing that happens in the birth of their child, then let us still learn from this valid experience, change, and move on.
            What I have learnt from all these experiences and reflections is what a privilege it is for me to have had a pregnancy in the developed world, where maternity care is safer and we can concentrate on the higher levels of hierarchy. This sense of comfort is balanced by the humility of knowing that at any time nature can bring a woman right down the hierarchy of needs to the fundamentals: pregnant women facing homelessness, women and partners newly unemployed, an abruption, an intrauterine death, an eclamptic fit.”

    • Heidi_storage

      “The reason that Granny Weatherwax was a better witch than Magrat was that she knew that in witchcraft it didn’t matter a damn which [plant] it was, or even if it was a piece of grass. The reason that Magrat was a better doctor than Granny was that she thought it did.” –Terry Pratchett, Lords and Ladies

  • Sheven

    You begin to bleed and your caregiver’s response is to “call you back to your body”? That’s terrifying.

    • Ozlsn

      Well the whole “focus on supporting love between the woman and her baby” pretty much sums up what Gaye Demanuele and Melody Bourne did while Caroline Lovell quietly bled to death. I mean, can’t interrupt the magical bonding hour to deliver the placenta or check the mother’s most basic vital signs.

      Terrifying sums it up perfectly. There is literally no other situation where this would even be considered – no one during cardiac surgery is saying “well we were only going to do this minor thing, let’s ignore the bleeding because it wasn’t part of the optimum protocol that we told the patient was what was going to happen.”

      Things like this make me think midwifery should be returned to being a subspeciality of nursing, because if you’re not going to be useful in an actual emergency when you are actually needed then you may as well be a doula and leave the actual midwifery to someone who is trained to know when they need to call in the big guns.

      • KeeperOfTheBooks

        Exactly.
        I have several family members who are nurses. None of them specialized in OB/L&D. However, they are fantastic nurses, very skilled in their field (by some coincidence, all went into ICU-type jobs), and in the insane and unlikely event that I went into labor and had to pick between one of them and a CPM as my health care provider, I’d want one of those ICU nurses, thankyouverymuch, because their response to a hemorrhage wouldn’t be “she’s not in touch enough with her body, better breath cinnamon breath on her,” it would be “holy shit, way too much blood, GET A DOCTOR NOW” while doing whatever they could to keep baby and me from crashing.

        • Dr Kitty

          In my bag of stuff I have never yet had to use and never want to, along with the stuff for anaphylactic shock, status epilepticus and terminal pain and agitation, I carry misoprostol and Syntocinon.
          If I ever attend a delivery it will be some sort of unanticipated emergency event, and the chances of a PPH will be higher.
          I have the stuff, hoping to never use it, because rather that than need it and not have it.

          Mostly, it just causes stress when I realise it’s all about to go out of date and I have to get more, and get dinged by the prescribing advisor for ordering expensive drugs.

      • I’ve never thought that anyone without a nursing qualification should be admitted to a midwifery program, or licensed to practice. Indeed, that was the way it was when I studied in the UK. There were no direct entry midwives back then, and the profession was entirely governed and supervised on a national evel.

        • Martha G

          IS this any possibility we might go back to that? It seems like the only way to restore sanity.

          • It would require a huge effort of will, and from my vantage point [far away and long ago], no one either in the NHS or the government in the UK has the guts to really do it. It’s not just opposition that would result; there is also indifference.

            Israel had something of a similar situation some years ago: our “practical nurses” were very badly trained, an emergency measure really, in the early days of the State, yet were allowed to do virtually everything a registered nurse could do. Some PNs were, taught by experience, quite good, but their knowledge base was lacking. The Ministry of Health set a date by which all PNs had to “upgrade” to RN or they’d lose their licenses, and then provided courses designed for women who needed to work and raise families as well as study. Some women needed fully several years at least. The result is that there are NO PNs in Israel any more, and indeed, diploma-graduate RNs are being encouraged to get academic degrees in much the same way.

            This is, IMO, the only way these “independent” and poorly-trained DEMs in the NHS could be brought to heel, combined with a very clear set of standards of practice, and loss of license if disregarded [in the 70s we had a booklet of at least 70 pages which we had to know COMPLETELY, which covered every situation]. At the same time, anyone who wants to study midwifery, should have an SRN [RN in the UK means Royal Navy] before applying for the course.

    • Zornorph

      Kind of reminds me of a scene in Clan of the Cave Bear, that famous novel about sex among the cavepeople.

    • Martha G

      It’s bonkers.
      Do we know who wrote it?

      • mabelcruet

        It’s linked in Dr T’s piece, it’s a paper from 2008 by 2 Australian midwives, Jenny Paratt and somebody Fahy. And they really did say that midwifery care should be spiritually based and encompass the soul of mother and baby.

        • The Bofa on the Sofa

          “Blow cinnamon breath on them!”

  • Russell Jones

    From the summary of the Parrat/Fahy paper linked above:

    “Our thesis is that midwives and women need to take conscious account of nonrational knowledge and power during the childbearing year.”

    What the actual hell. Nonrational knowledge. Is that in Aisle 5 next to the square circles? Is that the sort of thing that leads some people to conclude that vaccines are chockful of autism and Sandy Hook was a hoax perpetrated by the Obama administration to justify a nationwide confiscation of firearms? Sometimes it seems like the whole world’s gone off the rails.

    • The Bofa on the Sofa

      What the hell is “nonrational knowledge” in the first place? How does it differ from “made up bullshit”?

      “It’s not what we don’t know that is the problem. It is what we know that isn’t so.”

      • Russell Jones

        >What the hell is “nonrational knowledge” in the first place? How does it differ from “made up bullshit”?

        Those are some damned fine questions.

      • Roadstergal

        “What the hell is “nonrational knowledge” in the first place?”

        An oxymoron.

        • Who?

          Moron being the operative two syllables

      • Ozlsn

        Well, you know, it’s the vibe of it all…

      • Spamamander, pro fun ruiner

        “Alternative Facts”

  • RudyTooty

    Oh geez! As I started reading your post today, I thought you were referring to this article in the most recent issue of the Journal of Midwifery and Women’s Health.

    http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12620/abstract

    Which, honestly, I haven’t brought myself to read because I can’t keep my eyes from rolling back in my head.

    Bottom line – midwives are so enamored with ‘natural’ and ‘physiologic’ birth that they keep reaching for rationales to avoid using interventions that work!

    “Prophylactic oxytocin may not confer the same benefits to women undergoing spontaneous labor and birth compared to women with oxytocin infusion.”

    ^shall we unpack this drivel?

    • RudyTooty

      I’m committing myself to reading this article now. And I have to stop every 2 paragraphs to eye roll. It’s slow going.

      “The tension between evidence-based research on prophylactic uterotonic administration, women’s desires to have individualized birth care, and the less explored realm of physiologic blood loss can cause conflict for practitioners.”

      No, this is not a conflict. The conflict arises from adhering to a flawed ideology that glorifies ‘natural’ birth. Then the practitioner has to justify why it’s OK to have some of their patients suffering needlessly from extra blood loss.

      JMWH 2017.
      ffs

      • Dr Kitty

        “The less explored realm of physiologic blood loss”
        FFS

        What that means is that because many women lose more than 500mls, they want to redefine “normal blood loss” to a higher number, so they can justify not actively treating PPH.

        Common does not mean normal.
        Defining anything over 500mls as a PPH is convenient, because anyone who loses more than 500mls is usually symptomatic.

        As a thought exercise- imagine I redined “normal” BP for the over 60s as 160/80, because so many of them have hypertension that it could be considered a “variation of normal”.
        Sure, I’d have many fewer hypertensives and I’d prescribe a lot less blood pressure medication and do a lot fewer monitoring blood tests, but people would be more likely to die of heart attacks and strokes.

        TL:DR- The stupid, it burns.

  • JDM

    The passage you quoted with the “but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking” statement is horrifying. I’m not a woman, but if I was, say, in surgery, and unexpected bleeding started, I’d damn well want ONLY “rational ways of thinking” applied. I don’t see any conceivable reason why women shouldn’t be able to expect the same. That statement is quite literally insane. And incredibly misogynistic to apply that lack of concern for reality to actual, real-life women who have placed themselves under one’s professional care.

    • kilda

      It is pretty crazy. Would anyone want their dentist to respond to their clinical situation with “nonrational ways of thinking”? Or their cardiologist? How about the person who fixes your brakes, or wires your house?

      They’re basically saying rationality is overrated. And it really, really isn’t. Particularly where people’s lives and health are at stake.

  • Mel

    A system where “normal” birth is prioritized over “healthy” birth is only ethical when the women involved can give informed consent – which requires the ability to opt out.

    Spawn’s birth was entirely abnormal – but it was healthy. Being alive and healthy to enjoy my sweet little Spawn-baby is far more important to me than having a unmedicated, vaginal birth ever was.

    • Tiffany Aching

      I’m due in February and I already had to listen to too many people explaining to me that OBs do too much c-sections because they only think of going home for dinner / playing golf / cashing the additional (and entirely fictional, given the fact that I will give birth in a public teaching hospital where doctors get a salary, not fees) money etc. and that I should be well aware of that and very distrustful of any intervention they might want to do… I tell them that I don’t give a fuck how I give birth and the only thing that counts is the baby and me being alive and healthy at the end. That usually shuts them up.

      • Empress of the Iguana People

        Well, of course obs want dinner. Who doesn’t?
        My 1st was born after 18 hours of labor, at 630 pm, with a serious case of pre-e. My 2nd was induced at 1030 pm because my bp was getting scary. She was born at 120 the next afternoon.

        • Tiffany Aching

          This is another thing I don’t get about people who want to have the same healthcare providers during their whole delivery : who wants to have someone taking care of you after 18h straight hours of work ? Hooray for shifts.

          • Kelly

            I almost had someone from another practice deliver my second because my OB was in surgery. I had actually never met her before and really would not have cared who delivered my baby at that point. I just wanted baby out. The only time I would want to go with one doctor is if the doctors practiced very differently than the other OBs in the practice.

        • KeeperOfTheBooks

          I would really, REALLY like my OB to not have his blood sugar crashing while he’s making important decisions about my care, thanks!
          (As an aside, his junior partner, who assisted during DS’s CS, is Muslim. DS was born during Ramadan. The conversation going on during the CS–must have been a nice, boring CS–was actually kind of interesting, as she explained that she would get up before dawn, as I understand it, to have a fairly large meal in part to make sure she could get through the day and make sound decisions while fasting. My OB and the anesthesiologist weren’t Muslim, but were curious about how all that worked, logistically, with shifts and such. Quite educational.)

        • BeatriceC

          I really don’t understand how some surgeons pull off those extremely long procedures. When YK was ten he underwent an 8 hour marathon hip and pelvic reconstruction. During that time I ate twice, went to the restroom who knows how many times, and took a nap. I still can’t imagine how his (incredible and amazing) surgeon stayed focused while standing in one spot for so long.

          • Dr Kitty

            I occasionally get home at 6:30 and realise I haven’t eaten, drunk or used the bathroom since I left the house at 8:30.
            Neuropathic bladder and too many shifts as a junior doctor FTW.

            My admin staff usually bring me chocolate biscuits after 2pm though, because apparently “Dr Kitty will forget to eat” is well known.

      • BeatriceC

        I had way too many people berate me for having an “unnecessary” CS. Ummm, no. I asked for a CS because I could not mentally handle another vaginal delivery. My track record was horrible, and the only live baby I managed to deliver was born barely alive after a bad shoulder dystocia. Not a chance in hell I was taking that risk again. My other CS was a crash section to save my life when I was only 24+1. The fact that the baby managed to survive was a bonus. So nope. Both CS were very much necessary.

        • Kq

          I’ve been told to my face I didn’t give birth because I had a c/s.

          No regrets. I’ve never been as sick and miserable in my life as I was carrying my living son. And all that matters to me is that he was born alive and rudely healthy.

          But when he’s a teenager and whines that he never ASKED to be born I look forward to telling him he WASN’T.

          • BeatriceC

            Yup, I’ve heard that line too. I generally respond with some sort of smart ass comment about how I wasn’t actually born either (I was born via the escape hatch), so it’s all good.

          • Zornorph

            You were a butt birth?

          • LaMont

            On the plus side, he can totes kill Macbeth, which is a bonus

          • Roadstergal

            I can actually imagine some of these anti-CS types having a “CS day” for their kids rather than a birthday, with a moment of silence instead of a cake. :p

          • BeatriceC

            Well, I do have “hatch day” celebrations for my birds, since technically they were hatched and not born.

          • Tiffany Aching

            “I’ve been told to my face I didn’t give birth because I had a c/s.”

            To which you could reply “OMG WHOSE BABY IS THIS THEN ?”

          • FormerPhysicist

            Well, then, he can kill Macbeth. Not sure how else if matters.

            ETA: I see someone else posted that first. Good job LaMont.

        • Tiffany Aching

          As c-sections became safer, it seems obvious that the risk/benefit ratio changed, and I think it also depends on the situation of the mother. This will be my first (no elders to take care of) and probably my last (I’m 36) child, I have a good support system, I’m French so I have access to very good healthcare and a long maternity leave, there is no reason not to be quick on opting for a c-section if things start to go awry.

          • Empress of the Iguana People

            I had my first at 36, too, and my 2nd at 39. My need for a second child outweighed everything else.

          • Dr Kitty

            My question to my OB during my second section about whether my lower segment looked ok for a third section was entirely hypothetical, but she was quite clear that there were minimal adhesions, everything looked good and there was no reason I couldn’t have another, but maybe not for a year.

            My mother had four CS (first at 32, last at 38) before her OB told her to stop, and he had told her that he’d done 8 on one woman and would let know when he didn’t think another would be advisable.

            My SIL was told in no uncertain terms at her second CS that her scar was paper thin and not to attempt another pregnancy- she did and all was fine. It varies from person to person.

          • Empress of the Iguana People

            I’m sorry if I implied otherwise

          • MaineJen

            A friend was trying to decide between a repeat c section and a VBAC for her second baby…she opted for the c section, and it’s a good thing she did, as her OB told her the same thing as your SIL, that her incision site was thin as tissue paper. A VBAC attempt may have caused a rupture!

          • BeatriceC

            In my mother’s case it was a matter of CPD and a macrosomic baby. She weighed 89 pounds pre-pregnancy and I was 10 pounds, 9 ounces. In the 70’s they were still doing vertical incisions, so my sister was a CS as well.

          • rox123

            Same for me. I am 33 and don’t plan to have a second child, husband is involved. It seems choosing a C Section makes a woman one of bad morals.

          • Busbus

            Yes. I believe someone mentioned that upthread, but I would love if there was a way to clearly indicate your preferences when it comes to taking risks: such as “vaginal birth yes, BUT C-section at first indication of trouble, especially in the face of any risks that could lead to an instrumental delivery.” That would actually be a good way to use those silly birth plans for once. My hospital offers a pre-printed birth plan, but does it ask any of the big, important questions? No. It’s all about “would you like to use Lamaze breathing? …a birth ball?” Kind of infantilizing… Ugh.

          • rox123

            Yes, that sounds about right.
            I live in a ‘developing country’ (not exactly third world but ex communist eastern european block) and there are -since forever- complaints from women that feel pressed to have c sections against their will. That sounds really bad to me – if it’s only for the convenience of the doctor – so now there’s a reversing of that trend (especially on the internet, probably less in hospitals? ) and I hear left and right about starting to ‘support natural birth’ – but it really sounds that they – the supporters – are struggling to make it impossible to get.

            Oh, same with the breastfeeding. I am afraid nurses will come into my hospital room trying to milk me or uncover me without choice .. I hope this is just my anxiety and not reality.

      • Azuran

        And it’s really just a stupid and untrue argument anyway. Most labour wards will either have an OB who is on ‘shift’ meaning they are there no matter what, and when their shift ends, are replaced by another OB coming in to do their shifts. Or the OB is on call, and no OB would be stupid enough to book a round of golf when they are on call.

      • BeatriceC

        I forgot to add in my previous comment:

        Ironically, with my middle child, my primary OB came in on his day off to perform a CS because the on call OB refused to do it even though I was only 32 weeks and had a history of traumatic delivery and the decision for a CS to begin with was all about my own mental health.

    • Cat

      My mother reckons that she can recognise other mothers who have suffered stillbirth and neonatal losses from a look in their eyes, if she talks to them long enough. She’s usually right, too. We’re talking about people who shattered so badly that the pieces never went together in the same way again. I was stunned when I first realised, from reading Dr Amy and other blogs, that there are people out there whose priorities are so skewed that they talk about stillbirth as “just one of those things, no biggie” but think that an “abnormal” birth is a disaster.

      Spawn is a legend (and, without a doubt, infinitely more valuable than a drug-free vaginal birth)!

  • Empress of the Iguana People

    I had 2 thoughts as I read this:
    1) I accept the idea of someone calling someone else back to their body when I read stories but even fantasy writers usually have a point of no return. Either it’s impossible or it’s necromancy and evil, and it’s still fantasy.
    2) This is the illogical extreme of the idiom “The ends do not justify the means.”