Why did the Royal College of Midwives campaign for “normal birth”?

IMG_3130

Promoting normal birth is always and only about promoting midwives.

Many years ago, when I first heard the phrase “promoting normal birth” I was confused. Why would a healthcare professional be promoting any set of procedures or any particular approach to a health issue?

You won’t find any real medical professional who insists that he or she “promotes” one treatment over another. An ethical medical professional recommends whatever is safest for the patient, not whatever is most lucrative. Ethical medical professionals promote health and promote safety, not the opportunity to line one’s pockets.

The endless efforts of UK midwives to promote themselves have culminated in reflexive defensiveness and stone cold heartlessness in response to the cries of bereaved mothers and fathers.

Normal birth has nothing to do with normal and nothing to do with birth. The definition of normal birth is simple and straightforward: If a midwife can do it, she calls it normal. If she lacks the skill to provide the needed care, she insists that the birth is not normal even if it results in a healthy mother and a healthy baby. “Normal birth” and “midwives” are interchangeable. “Normal birth” is nothing more than a marketing term.

Once you realize that, it is a lot easier to understand the Campaign:

The RCM Campaign for Normal Birth (Campaign for Midwives) declared that “promoting normal birth key to cost savings” (Promoting midwives a key to cost savings.) That’s especially ironic in light of what actually happened: the number of preventable injuries and deaths soared and liability payments skyrocketed. The NHS paid £1.2 billion last year alone!

You can look high and you can look low, but wherever you look, midwives or their advocates are behind every attempt to promote “normal birth” (i.e. market midwifery). Indeed, the leading textbook of the radical midwifery theorists is Promoting Normal Birth – Research, Reflections and Guidelines best understood as Promoting Midwives – Research, Reflections and Guidelines.

The editor Sylvie Donna has the grace to be abashed at the use of the word “promoting.” She starts the introduction with the following:

You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should normal birth be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions, especially cesareans — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women…

Even on its face, it’s a pretty inane explanation, but it is far worse when you substitute what is really meant:

You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should midwives be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions (most of which midwives cannot do), especially cesareans (which midwives definitely cannot do) — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women… not to mention the safest and the most highly desired by mothers.

Promoting normal birth is about one thing, and one thing only: promoting midwives. It has nothing to do with what is safest. The words safe or safety don’t even appear in the entire introduction to the midwifery textbook, which is fitting since safety is entirely irrelevant to the project of promoting midwives. As far as I can tell, using Google to search inside the book, the word safety doesn’t even appear until page 177 and then only to be used pejoratively (“An obsession with safety is characteristic of our age …”).

Insisting that women be cared for by midwives because midwives want employment and professional autonomy isn’t particularly persuasive. Insisting that women be cared for by midwives because only they can provide them with a “normal” birth (who wants an abnormal birth?) sounds a lot better. The key, of course, is to invest “normal” birth with a cachet beyond the word normal. That’s where all the stuff about birth warriors, empowerment and experience comes in.

Most women don’t fall for it. British women resent the fact that access to obstetricians is severely curtailed. They despise the fact that such practices have led to preventable injuries and deaths of babies and mothers. They are not alone. Dutch women go to other countries to give birth rather than settle for the midwife led care (and higher perinatal mortality rate) that is a feature of the Netherlands. The high mortality rate has led to a precipitous drop in homebirth, now down to only 13%. And the majority of American women, regardless of the availability of midwives, choose obstetricians. Indeed, there are not enough practicing obstetricians to accommodate all the patients who want them.

The fact that normal birth is a marketing term to promote midwives also explains the reflexive defensiveness of the RCM and their stone cold heartlessness in response to the cries of bereaved mothers and fathers.

As the Guardian notes:

The response of many in the midwifery profession has been characterised by defensiveness, rather than an open commitment to finding how far this problem goes and rooting out dangerous practice. The Nursing and Midwifery Council, responsible for regulating midwives, spent £240,000 on getting lawyers to redact information in response to a freedom of information request from Titcombe.

That is startlingly unethical behavior.

Even as it ends the campaign, its chief executive has denied there may be a link between it and the sort of dangerous practice seen in Morecambe Bay. One of its honorary fellows [Sheena Byrom] has announced she will launch her own “normal birth” campaign as a response to the RCM moving away from this language.

Regardless of who is injured, how many babies die, and how many mothers are left with empty arms, UK midwives will persist in promoting themselves. It’s hard to imagine anything more morally repugnant.

  • Roadstergal

    “The answer is simple. Other forms of birth — those involving plenty of interventions, especially cesareans — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women…”

    And midwives think birth should be difficult and terrifying, dammit.

    • Juana

      It’s not a proper normal birth if it doesn’t scare the shit out of you?
      (…often, quite literally…)

  • Dr Kitty

    A Huffington Post UK article about tokophobia
    https://www.google.co.uk/amp/m.huffpost.com/uk/entry/uk_59886d8be4b0cb15b1bfb6c7/amp

    The article quotes a midwife who specialises in counselling women with tokophobia.

    ‘Houghton said consultant midwives will generally work with women to support birth without resorting to surgery.
    “This is not purely because caesarean birth is associated with significant risks to women, their babies and the health of society generally,” she said.’

    Well, if she’d tried to counsel me she’d have been facing an NMC complaint for providing biased, untrue information, that’s for damn sure.

    • Dr Kitty

      Should also point out that there is recent case law in the U.K. that informed consent is about how the patient weighs risks, not about how the care provider weighs them- and the case was specifically about mode of delivery.

    • mabelcruet

      I don’t understand the rationale for advising women to feel more in control by writing a birth plan. Surely if you have a detailed birth plan but end up needing various interventions and fail to stick to the birth plan, that will make you feel even less in control and create far more upset?

      • maidmarian555

        My bog-standard-fill-the-gaps NHS birth plan that I did last time was mostly a pointless exercise but it did include a couple of important things such as confirming consent for the Vit K shot beforehand. I think for things like that it’s potentially useful because you might not be capable of giving consent later.

      • Dr Kitty

        I think the only way you can give someone control over birth, which is inherently chaotic, unpredictable and dangerous, is to actually control it as much as possible- i.e. MRCS.

        • Roadstergal

          Yeah, it seems like pre-labor MRCS is maximum control, with a scheduled induction second?

          A ‘natural’ birth has the least control – not just in terms of timing and outcomes, but in terms of how in-control you are at the moment. Are you going to be a lucky one who has reasonably bearable pain, or are you going to be in so much agony that your agency is gone?

          • Hannah

            Yes, that’s why all women with anxiety who request this procedure should not only be allowed to have one, but probably recommended to have one at the first instance even if they don’t ask.

      • Merrie

        I think that having thought through in advance what might happen during birth, and what might be the possible ways that the medical providers would deal with it, and what choices I might make in various situations, helped me feel more comfortable with the process. I would have felt more nervous and out of control going in blindly. Others may feel differently and figure they’ll take it as it comes. Of course, I did end up with a somewhat obscure complication during my second birth, but overall being familiar with the road map helped.

        • Roadstergal

          So more of a birth flowchart?

          • Dr Kitty

            My birth plan with # 2 was very simple, was not so much a plan as a declaration and it went something like:

            “VBAC is an unacceptable outcome.
            Should I arrive in spontaneous labour I would like an epidural and an Emergency CS arranged ASAP.

            I will consent to continuous foetal monitoring in labour, but not AROM, labour augmentation, instrumental delivery, nor other intervention, the purpose of which is to facilitate a VBAC. ”

            It got some raised eyebrows and side-eyes from the midwives, but IDGAF.

            The ones who really really pushed it were told that I have seen firsthand a UR at attempted VBAC which ended in foetal demise and hysterectomy, and there was no way in hell I was taking that risk.
            No more pushback after that.

            Thankfully, I got my ERCS at 39w0d, I have yet to experience the “joy” of labour, and managed to have two children without ever having a vaginal examination, which I consider a win.

          • Daleth

            That’s a great birth plan. Keeping it in mind in the unlikely event I ever have another child.

          • Heidi_storage

            But but but you didn’t REALLY give birth–ah, never mind, that looks obnoxious even when it’s clearly meant to be sarcastic. Ridiculous that people a) assume everyone wants the same “birth experience”; b) equate vaginal delivery only with birth (where do they think those kids you have came from–the stork?) and c) have the nerve to comment so rudely upon your body and your children.

          • mabelcruet

            Yep, you should wear your prolapse and incontinence like a badge of honour to show your true commitment to the cause!

      • swbarnes2

        In retrospect, it might have been nice to have in writing “I am risk-adverse. If you think there is a 10% chance of me needing a emergency C-section in the near future, I want to start a non-emergency C-section”. It seems like “how far does the patient want to push for vaginal delivery” is the kind of thing a doctor might like to know in advance, where there is range of medically acceptable preferences.

      • Dr Kitty

        The whole idea that by supporting MRCS for tokophobia rather than trying to talk the woman into a VB is harmful because it validates the phobia is…odd. If someone WANTS to work through a phobia by immersion, that’s one thing, but to try and get people who don’t want to do that to sign up for it because you think it’s better for them…odd.

        Think of it this way.
        I have a hypothetical patient who has a phobia of flying.
        She wants to go from Ireland to France for her holiday.

        She could get CBT and force herself to fly.
        Or, if she doesn’t mind the extra travel time and cost, she can get a ferry.

        If she tells me that she’d rather take the ferry and either way she gets to her destination, why would I insist she has to conquer her phobia and sign her up for CBT? Sure she’s avoiding her fear, but she gets where she wants to go, on her own terms.

        Giving birth is something most women will do two or three times in their lives and for many women with tokophobia it will be a once in a lifetime experience.

        Why do they *have* to overcome the phobia by immersive exposure to the thing they fear, when there is a safe option, which doesn’t involve that?

        I wonder if Houghton has any phobias herself, and whether she has overcome all of them by exposure, or just avoids them when she can?

        Does she have pet mice, and a closet full of clowns?
        Is her bedroom 6’x6′ and her breakfast table only reachable by a 10′ ladder?

        • Hannah

          The thing is though, I would probably be diagnosed with ‘tokophobia’ i.e having an irrational ‘phobia’ of birth, but my actual reasons for wanting to avoid natural birth are not irrational – they are based on my knowledge and observations of various factors, including the way maternity care is handled in my home country (the UK), my size and age, and various other factors that I think contribute to it being the safer option. I also dislike pain (I know, crazy huh?) and I believe that this is a sane, not an irrational, response to being presented with a set of options for achieving an outcome.

          I do, separately, suffer from anxiety, but based on what I know objectively about how anxiety works, I have reached the conclusion that a caesarian would be better for me and a natural birth would be very, very bad for me, because anxiety is to do with control.

          So I’m very grateful that the UK system will ‘allow’ me to have a CS (if i jump through sufficient hoops), but I am bloody unimpressed that I have to portray myself as mad to make a case for it.

      • Tigger_the_Wing

        Whenever I was asked by the birth team “Do you have a birth plan?” my reply was always a variation on “Yes. I plan to do whatever you suggest, and get this baby/these babies out as safely as possible.”

        I’m not daft. I know that birth is dangerous and rarely goes according to a plan. Not having a plan did make me feel less at sea – the midwives and OBs knew what they were doing, anything that was new to me would be something they’d seen before, and we all had the same goal – a healthy, live baby and a healthy, live mother.

    • Martha G

      Me too, Dr K, me too. I’d love to see her try with either of us.

  • CSN0116

    As an American, I would have never known anything about RCM or UK midwifery if it weren’t for Dr. Amy’s careful dissection. It puts things into perspective.

    While US CNMs seem polar opposite of RCM, both in ideology and practice (they are very medicalized here), CPMs and the whole “natural birth movement” in the US _does_ mirror RCM, borrowing rhetoric and everything.

    So, UK legit midwives are comparable to US non-legit midwives. So… does the UK have any legit midwives? With OB access limited in the UK this seems terribly troublesome.

    • Emilie Bishop

      I have some friends who’ve used CNMs, but they gave birth in a hospital where help was literally down the hall if something went wrong. It wasn’t my cup of tea as I knew I wanted an epidural asap, but they weren’t putting themselves or their babies at risk. As you said, it’s all very medicalized. I think that’s what the European models were originally going for, but they seem to have gotten too deep in the woo to be effective anymore.

      Also, if I never hear the word “warrior” applied to anything outside ancient armed men again, I will be much happier. I find it very telling that my L&D nurse never called me a “warrior” even though she started her career IN THE US MILITARY DURING THE VIETNAM WAR.

      • oscar

        In relation to the woo in the Netherlands, it may be of interest to understand how this unusual situation evolved. As a Dutch speaker, I was able to do some research on it a little while back. It seems to me that it largely derives from two events.

        First, in the Netherlands, up until the 16th century, birth was the domain of midwives (“vroedvrouwen” or wise women). It was from all accounts a miserable time for women. Before 1800, 1.3% of births ended with the death of the mother. The vroedvrouwen had little means to help apart from prescribing herbs and blood letting.

        In 1500, the profession of obstetrics was born in NL with the first recorded CS: the wife of Jacob Nufer, a pig butcher, was in labor for days and Nufer, unable to bear his wife’s suffering, asked for and received permission from the mayor to cut out the baby. The woman and baby survived and his wife went on to have five more children. This led to the rise of university-educated (male) obstetricians in NL: these early obstetricians were called “vroedmeesters”, meaning wise masters. They weren’t any better than the vroedvrouwen but would, when the birth went wrong, call in the surgeons, who were mostly barbers and who would remove the child with scissors, hooks, and tongs, thus giving the mother a chance to survive. Eventually, the vroedmeesters trained in the necessary surgical practices themselves. They may also have learned to some degree from the vroedvrouwen: in 1701, the father of gynaecology and obstetrics in NL, Hendrik van Deventer, whose wife was a vroedvrouw, wrote seminal books on gynaecology and obstetrics that were translated into German, English, and French.

        The rise of the obstetricians in NL, as happened elsewhere, meant that the autonomy of midwives became increasingly circumscribed: by the late 1600s, they were forbidden to prescribe medicine or to use instruments. These limitations naturally meant that they could only perform natural childbirths: they had to call in a vroedmeester when complications arose.

        The vroedvrouwen, like midwives elsewhere, were not part of a guild. Moreover, by the 19th century, technological advances meant that the gynaecologists and obstetricians were able to offer their clients significantly more than midwives. For example, in 1850, the Scottish gynaecologist James Young Simpson started using chloroform and ether as a pain relief during birth. This situation would have caused the severe marginalisation of vroedvrouwen (as happened to midwives in other West European countries) had it not been for the fact that in the late 1600s, individual Dutch towns started demanding that midwives complete an exam, undergo regular theoretical training, and work for 4 years as a student. This had the (perhaps unintended?) effect of establishing midwifery as a legitimate profession in NL. Importantly, it also meant that when the first clinical schools dedicated to training midwives were established in the Netherlands in 1865, they were largely run by other vroedvrouwen. By contrast, the educational clinics for midwives that were established in other West European countries around the same time were hierarchies with obstetricians at the top. So, the unusual situation in the Netherlands probably in part reflects laws and attitudes that were established in the late 1600s.

        Another likely key – and much more recent – factor is the outside influence of the leading obstetrician in the Netherlands in the 1970s, Gerrit-Jan Kloosterman. He was an extremely charismatic Amsterdam professor who straddled the field of obstetrics in the Netherlands and frequently engaged in public discussions about various gynaecological matters (including abortion) in a sharp but courteous manner. He was a giant in the Netherlands. He viewed birth “als een normale gebeurtenis” (a normal event) and believed strongly that “een normaal verlopende zwangerschap niet met een bevalling in de ziekenhuis en niet bij de gynaecoloog moet eindigen” (a normally progressing pregnancy should not end with a birth in the hospital and not with a gynaecologist). He died in 2004. The vast majority of the older gynaecologists in NL probably trained directly or indirectly under him. Perhaps the questions that are currently being asked in NL about home births are because Kloosterman’s influence has waned since his death and more skeptical views can be aired without significant professional consequences.

      • oscar

        So I replied to this but it got seen as spam. I’ll try again…

        In relation to the woo in the Netherlands, it may be of interest to understand how this unusual situation evolved. As a Dutch speaker, I was able to do some research on it a little while back. It seems to me that it largely derives from two events.

        First, in the Netherlands, up until the 16th century, birth was the domain of midwives (“vroedvrouwen” or wise women). It was from all accounts a miserable time for women. Before 1800, 1.3% of births ended with the death of the mother. The vroedvrouwen had little means to help apart from prescribing herbs and blood letting.

        In 1500, the profession of obstetrics was born in NL with the first recorded CS: the wife of Jacob Nufer, a pig butcher, was in labor for days and Nufer, unable to bear his wife’s suffering, asked for and received permission from the mayor to cut out the baby. The woman and baby survived and his wife went on to have five more children. This led to the rise of university-educated (male) obstetricians in NL: these early obstetricians were called “vroedmeesters”, meaning wise masters. They weren’t any better than the vroedvrouwen but would, when the birth went wrong, call in the surgeons, who were mostly barbers and who would remove the child with scissors, hooks, and tongs, thus giving the mother a chance to survive. Eventually, the vroedmeesters trained in the necessary surgical practices themselves. They may even have learned to some degree from the vroedvrouwen: in 1701, the father of gynaecology and obstetrics in NL, Hendrik van Deventer, whose wife was a vroedvrouw, wrote seminal books on gynaecology and obstetrics that were translated into German, English, and French.

        The rise of the obstetricians in NL, as happened elsewhere, meant that the autonomy of midwives became increasingly circumscribed: by the late 1600s, they were forbidden to prescribe medicine or to use instruments. These limitations naturally meant that they could only perform natural childbirths: they had to call in a vroedmeester when complications arose.

        The vroedvrouwen, like midwives elsewhere, were not part of a guild. Moreover, by the 19th century, technological advances meant that the gynaecologists and obstetricians were able to offer their clients significantly more than midwives. For example, in 1850, the Scottish gynaecologist James Young Simpson started using chloroform and ether as a pain relief during birth. This situation would have caused the severe marginalisation of vroedvrouwen (as happened to midwives in other West European countries) had it not been for the fact that in the late 1600s, individual Dutch towns started demanding that midwives complete an exam, undergo regular theoretical training, and work for 4 years as a student. This had the (perhaps unintended?) effect of establishing midwifery as a legitimate profession in NL. Importantly, it also meant that when the first clinical schools dedicated to training midwives were established in the Netherlands in 1865, they were largely run by other vroedvrouwen. By contrast, the educational clinics for midwives that were established in other West European countries around the same time were hierarchies with obstetricians at the top. So, the unusual situation in the Netherlands probably in part reflects laws and attitudes that were established in the late 1600s.

        Another likely key – and much more recent – factor is the outside influence of the leading obstetrician in the Netherlands in the 1970s, Gerrit-Jan Kloosterman. He was an extremely charismatic Amsterdam professor who straddled the field of obstetrics in the Netherlands and frequently engaged in public discussions about various gynaecological matters (including abortion) in a sharp but courteous manner. He was a giant in the Netherlands. He viewed birth “als een normale gebeurtenis” (a normal event) and believed strongly that “een normaal verlopende zwangerschap niet met een bevalling in de ziekenhuis en niet bij de gynaecoloog moet eindigen” (a normally progressing pregnancy should not end with a birth in the hospital and not with a gynaecologist). He died in 2004. The vast majority of the older gynaecologists in NL probably trained directly or indirectly under him. Perhaps the questions that are currently being asked in NL about home births are because Kloosterman’s influence has waned since his death and more skeptical views can be aired without significant professional consequences.

    • Christina Maxwell

      Yes, lots of legit ones. They are the ones quietly getting on with the job, co-operating with doctors, working hard etc. The noisy ones are leading the RCM, shouting about ‘normal birth’, whining about having more offsite birth centres and generally messing things up for everybody else.

      • The Bofa on the Sofa

        Unfortunately, I can’t say much in favor of those “quiet” ones. They are the ones that are letting their colleagues (and I say that loosely) screw around and make things look worse for them all. I count on the “good ones” to take a stand against the crud.

        It is like the ACNM here. As CSN0116 notes, CNMs are generally highly medicalized and do it right. However, the ACNM’s silence and implicit acceptance of the homebirth fringe of the CNMs and, more importantly, CPMs is an absolute sign of failure, and deserves condemnation.

        That the ACNM can be so passive in the face of CPMs, and even consider trying trying to collaborate and accommodate them is an abject embarrassment. CPMs are not at all qualified to be CNMs, and the ACNM should make it clear that they will not accept such a lower standard. CNMs are what midwives should be, and they should not be willing to consider imposters.

        Yet they do.

        • mabelcruet

          Yes, it’s a recognised problem that the Kirkup report went into in detail. Unfortunately, the NHS isn’t good at dealing with bullying or mobbing behaviour, and despite whistle-blower policies, if you have a dominant cabal on a ward, they can make working lives a misery for those who don’t toe their line. You end up with a small group who dictate behaviour and the silent majority keep their head down so they don’t attract attention. It works on a national level too-witness the spiteful and vicious attacks on anyone who voices a concern about RCM and their leadership and policies. It takes a very strong person to go up against them directly, and I’d have no doubt that if moderate midwives spoke up, they’d be facing trumped up disciplinary charges or something similar.

          • Christina Maxwell

            I agree, that is absolutely what would happen, unfortunately.

          • Who?

            It happens everywhere.

            I’m just coming out the other side of a workplace as you describe-dominant cabal and, just to add extra flavour, management who loved the cabal. As an example, when I went to HR to report the abusive and incompetent behaviour of my ‘assistant’, the HR staff member declined to get involved herself, and told me to be more firm with her. Subsequently turned out HR person and ‘assistant’ were best friends.

            Just as I was ready to leave-having quietly sorted out a major scandal, which due to my not being briefed about it before I started had my name all over it by the time I had unearthed the nature and extent of the problem-a new manager came in.

            New manager took about a week to realise what was going on, and has spent the last six months assiduously cleaning house.

            The leaders of the cabal are gone; I have a lovely promotion and payrise and a nice new job to end my career in.

            It’s been a treat to watch.

          • Mishimoo

            I was going to ask how your job is going! Sounds like hell for a bit, but I’m glad it’s sorted now. You definitely deserved the promotion and payrise!

          • Who?

            It’s been bracing, for sure. It’s extraordinary how badly some people behave when given too much room to wriggle and no boundaries.

            I’m very glad the worst seems to be over, and very excited about the new role-I was lucky stars the new manager arrived when she did, and that the cabal were so arrogant that they thought no one could touch them. Had they been a bit smarter, they’d still be running the show.

            How is your job? Hope you’re still enjoying it! And did I read the other day you’ve all been sick-half the world around here has the flu at the moment. If so, hope you are all well on the mend.

          • Mishimoo

            Lack of boundaries seems to be a major issue, and you’re right: people will behave terribly if they think they can get away with it. It’s wonderful that your new manager is professional and has sorted it all out.

            Unfortunately, I had to leave the cafe job due to their insistence on underpaying me by $5 an hour during weekdays, and $20+ per hour on weekends. Not surprisingly, the business closed shortly after I left!

            I’m currently dedicating my time to studying/volunteering/parenting – the volunteer position is great because it’s in a research library and it provides various experience opportunities. The rest of my household is better, thankfully, but I’m still dealing with a bit of sinusitis and conjunctivitis while finishing three assessments.

          • Who?

            Sorry it worked out that way-there is way too much of that going on.

            Feel better soon and good luck with those assessments!

          • EmbraceYourInnerCrone

            Glad things have gotten better. Congrats on your promotion! This sort of thing is part of the reason I am not friends with people I work with outside of work and I am not too friendly inside of work. Sometimes it seems like middle school all over again and I get really annoyed at people who are too friendly with people they manage. I’ve been burned to many times.

          • Who?

            Thanks! It’s been quite the learning curve for me-I’ve been lucky enough previously to not have this kind of nonsense to deal with.

            It’s given me a proper understanding of how bad a toxic workplace can be. And a confidence in my own judgment about such things that I never had-or needed-before.

            The undermining continues in certain quarters but I have turned off my kind eyes and ears for the purpose of calling out their toxic crap.

            And I’m enjoying mentoring and supporting the young staff who are entitled to some proper professional management and to not be affected by the nonsense that remains.

        • RudyTooty

          “CPMs are not at all qualified to be CNMs, and the ACNM should make it clear that they will not accept such a lower standard. ”

          I ask and ask ACNM leaders – “Why should we accept a standard of midwifery practice that is beneath the ACNM’s own standards?”

          I feel like I lone voice. I feel like I’m spitting into the wind. It is not a popular question. It does not engender fondness towards me. I get round-about responses {paraphrasing} “play nice in the sandbox” “this is the only way” “to criticize one type of midwife is to criticize all midwives”

          I believe that the overwhelming majority of CNMs are completely ignorant about what CPMs do. The CNMs that work within our healthcare system – who are busy and working their butts off to provide safe and effective and appropriate science-based care to their patients are really unaware of the reality of CPM practices.

          The ACNM leadership knows better. Or they should know better. And their ‘we’re all midwives’ rhetoric is dangerous and reckless.

      • Dr Kitty

        I have to say, the community midwife who provided my care in my second pregnancy was WONDERFUL.

        She was incredibly sympathetic when I told her that I felt judged for not wanting a VBAC, asked me if I wanted to formally complain, told me that whatever I decided about how I wanted to give birth was ok, and that she respected my choice.

        She told me how she herself had given birth by emergency CS after two long labours, and how her daughter, also a midwife, had just had an emergency CS after a long, unproductive. postdates labour.
        She told me she wanted everyone to have the birth they wanted, and if mine was an ERCS, that was fine by her.

        She told me that even thought my SFH was on the 90th centile, she’d bet money that it was because I’m so short that my baby had nowhere to go but out,, and that my baby wouldn’t be much over 6lbs (he was 6lbs 5oz at 39w).

        She told me that if I thought my water had broken or I was having real contractions, not to phone labour ward, because they’d try to get me to stay home,, but to “get up the road like a rocket, girl” and demand an epidural and CS and refuse to leave until I got them.

        Between her and the consultant who basically screamed down the phone at the person in charge of the theatre list until I was booked in for my ERCS on the day I wanted, I was very lucky.

        • mabelcruet

          It’s typical though, the health professionals who are actually ‘with’ women and are respecting women’s choices are not the ones who do all the shouting about it. Byrom et al sound off constantly about respect, but undermine and disrespect women every time they open their mouths to tell women what they really want, and gaslight those who’s experience they deny.

    • mabelcruet

      Yes, we have legit midwives, very much so. The midwives here have to be fully qualified (most are nurses prior to training as midwives, newer ones are direct entry midwive-they are all professionally trained and degree qualified, it’s illegal to act as a midwife without proper qualification so we don’t have any of the USA type CPM, all ours are the equivalent of yor nurse midwives). The vast majority of my midwife colleagues are amazing-I’m quite vocal on here about the RCM, but it is important to note that most midwives do a great job in what is nationally an underfunded and understaffed area. Unfortunately, the leadership of the RCM is out of step with most of their members from what I can see-most midwives stay out of politics and get on with the job. But the RCM leadership spout absolute nonsense, and as the case in a lot of medical politics, the sensible level headed reasonable folk just want to keep their heads down and get on with it, which leaves the vocal ones free to vocalise.

    • Empress of the Iguana People

      Unfortunately, my nurse friend who got her CNM a couple years ago got a full dose of the nutso rhetoric.

    • Sarah

      Yes, definitely. Not all midwives are dodgy, not by any means. Unfortunately, enough of them are to cause us a problem.

      I don’t believe I’m the only UK poster on here who’s experienced both appalling and fantastic care from midwives. We have a very wide spectrum and, unfortunately, the ones making the most noise are the NCB heads. Hopefully the tide is turning.

      • The Bofa on the Sofa

        Not all midwives are dodgy, not by any means

        Bofa’s Law

        Unfortunately, enough of them are to cause us a problem.

        Yep.

        • Roadstergal

          As John Oliver noted, the saying is “One bad apple spoils the whole bunch,” not “One bad apple is no big deal.”

          • Christina Maxwell

            And a fish rots from the head down.

          • mabelcruet

            I’ve mentioned this before, but I heard Cathy Warwick being interviewed on ‘Woman’s Hour’ on radio. There was a listener call in, and virtually every caller was a woman complaining about their midwife-about how they felt ignored, bullied, or undermined. And each time her response was ‘that midwife wasn’t behaving professionally, that midwife isn’t representative of who we are and what we do’. Now I know it’s a fact that people are more likely to complain about poor service than praise good service so maybe it was a self selective audience, but by dismissing their concerns by saying it was a one-off and not accepting the validity of their experience is simply another way of undermining women.

    • I am undoubtedly badly out of date, but in my time in the UK, 1) all midwives were also registered nurses, and 2) we had extremely clear and precise standards of care and protocols. Within the correct parameters we were virtually autonomous but once a “red line” was crossed, we were legally obligated to work under MD supervision. The system worked well — we worked WITH , not subordinate to, doctors. When I called in an OB, he knew it was for a valid reason, and responded promptly, but trusted me to do my job properly otherwise. There was respect on both sides.

      Somewhere along the line, however, it seems that UK midwives, once direct entry midwifery was allowed, began to resent medical supervision and felt there was some kind of stigma to being held to certain restrictions and set out to show they didn’t need them. I am reminded of the inferiority feelings that spurred the change in nursing education in the US that made three-year diploma programs give way to BSN academic programs without any real improvement in care, but made nurses with a string of initials after their names feel more the equal of doctors.

  • Sarah

    We raised the issue on the other thread of a birth with gas and air being considered ‘normal’. They don’t have a very consistent approach to which drugs are ok.

    • EmbraceYourInnerCrone

      I don’t get this, gas(laughing gas?) would directly affect the fetus one would think, while an epidural would not…..doesn’t gas mean the baby gets less oxygen?

      • Daleth

        Yup, laughing gas goes straight to the baby. I am at a total loss as to why people think that’s ok but epidurals are “interventions.”

        • Charybdis

          Because the mother can move around, change position, get in and out of the tub or shower, and remain uncomfortable for the duration of the labor and birth. Plus, mom stops feeling the effects very soon after she stops breathing in the gas and air. And midwives can administer it.
          It astounds me to think that *they* think that a very small amount of numbing medication and pain medication administered directly to the nerves involved and does not affect the baby at all is OMG SO MUCH WORSE than using gas and air, which does affect the baby. Unless homeopathy comes into it somehow, because the amount of medication used in an epidural is very small and if any manages to get into the mother’s bloodstream, voila! You have OD’s your baby, via homeopathy.

          • Juana

            Only if you pound your back ten times towards the center of the earth, otherwise it’s not a proper homeopathic dilution.

          • EmbraceYourInnerCrone

            NO thankss on the moving! I would have enjoyed my epidural if I had gotten it earlier but with contractions that went from nothing to a couple minutes apart OMG (precipitous labor) and back labor “better living through chemistry” for the win!

      • Sarah

        I don’t know, to be honest, I huffed it out of desperation. Despite it doing sod all. But either way, I can’t see why it counts as normal birth and an epidural doesn’t. Neither of them are ‘natural’, if you’re into that type of description.

        • Busbus

          You are absolutely right. I always have this suspicion that, at least subconsciously, they WANT women to suffer in labor. If it takes away all your pain, how could you be a “warrior”? And if being a warrior wasn’t so friggin important, it would diminish their own “accomplishment.”

          The more I think about it, the more I think that it’s really about the pain. A woman with a well placed epidural does not suffer; she can be relaxed, chatty, whatever she feels like during labor. She doesn’t need a midwife/doula holding her hand, wiping her sweat, and telling her how well she’s doing. I think that really rubs then the wrong way. Pseudo-pain management that may or may not take the edge off but still leaves you panting and grunting in pain, well, fine, if you really must…

          • Tigger_the_Wing

            You’re right. Pseudo-pain management it is. And, like all pseudo-science, it is not only ineffective, but far more dangerous than modern alternatives.

            For my first, I was given gas-and-air and immediately had a bad reaction to it. So, no pain relief for the rest of that labour, or either of the next two (this was in the early eighties); including the breech.

            But, for the twins (early nineties) I got an epidural. Utter bliss! And it didn’t even work fully! I could still feel enough pain to know what was going on, and could push (or not) following instructions, but I wasn’t in agony or stressed out. And that labour, at four-and-a-half hours, was my longest by far. I have no idea how anyone labours for hour upon hour without pain relief and doesn’t come out of it with PTSD.

            I used to be impressed by my midwives (most of them; there were exceptions). I’m seriously disappointed at the way British midwifery took a dramatic turn into crank land this century. This is what happens when people with Cluster B personality disorders worm their way to the head of an organisation, and that lot look like poster children for narcissism. They couldn’t care less about anyone except themselves. They’re in it for the power and the glory. Every mother they keep out of the clutches of their imagined enemy is a win for them, regardless of whether she or her baby survives the ordeal.

          • Hannah

            Yes, it’s a power trip isn’t it?

  • Sarah

    Snort. They try to clean up all the turds in the garden and brush them away quietly, only for Sheena Byrom to loudly drop a massive smelly one right on the front doorstep.

    • mabelcruet

      I need some brain bleach to get that glorious analogy out of my head!

  • Sheven

    A chart of what midwives can do and what they can’t do compared with what they consider “normal” and “not normal,” might help to show it clearly.

  • mabelcruet

    You need to add a second row of images: Soo Downe, Milli Hill (not a real midwife but certainly an enabler of poor practices) and Laura Godfrey-Isaacs (not quite as well known as others, but she’s certainly picking up speed with the aggressive and bullying tactics against RCM critics and is a vocal member of RCM’s cheerleading squad)

  • Amy Tuteur, MD
    • Charybdis

      None of them look like anyone I’d want to care for me.
      Although, I doubt you can call what they do “care”.

  • MLE

    Yeah those options are the least frightening not because I’m a weak woman as they suggest but because I’m afraid their unbending loyalty to an ideology is going to KILL me.

    • The Bofa on the Sofa

      And I have to ask, what’s wrong with choosing options because they are the least frightening? I mean, assuming they work and you get the same results, why choose a more frightening option?

      And what’s wrong with it being more convenient?

      • Young CC Prof

        It is strange that so many people are opposed to birth being “convenient” in any way. Sure, don’t put convenience AHEAD of safety, but when choosing between two different safe options, you don’t get a cookie for deliberately choosing the one that’s less convenient.

        And of course, sometimes the inconvenient option actually is less safe. For example, inadvertent roadside birth.

        • Empress of the Iguana People

          mmm, cookies…

        • AnnaPDE

          Of course have to do the self-sacrificial inconvenient one if you want a proper mommy badge. Everyone else are just selfish princesses.

      • Sarah

        The interesting thing is, the one woo-esque midwife I met during pregnancy was clearly pleased when I expressed a preference for the convenience of the low risk midwife clinic in the community rather than having to take more time to travel to the hospital for antenatal appointments. It’s ok to factor in the mother’s convenience sometimes, it seems.

        • Busbus

          Logic has nothing to do with it. “Convenience” that leads to NCB-approved choices = transgressive and celebrated (“you go, Mama!”). “Convenience” that leads to non-NCB-approved choices = “uneducated” and/or selfish.

          There is no logic. It’s just about what suits them.