UK midwives’ deadly contempt for obstetricians

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I recently came across a slide from a UK healthcare conference that offered a truly horrifying fact: The UK National Health Service is now spending more on maternity negligence claims than on maternity care! It’s hard to imagine a greater indictment of UK midwife led maternity care.


If you want to understand why this tragic situation has come about, you can’t do better than to watch this video clip from a midwifery conference.

It’s from a question and answer session after lactivist Prof. Amy Brown has just finished bewailing the fact that the UK has the lowest breastfeeding rate in the world (while ignoring the fact that it has one of the lowest infant mortality rates in the world). The retired midwife* who is speaking is explaining the “cause” of low breastfeeding rates. It’s obstetricians, midwives’ favorite target.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]There’s nothing more natural than a dead baby.[/pullquote]

The midwife is repeating the ideological cant that she has been taught by other midwives and it is this: obstetricians have “ruined” childbirth and have thereby “ruined” breastfeeding, too. She claims the problem for women is:

Their physiologic processes and being messed about and that’s to do with the fact that there are too many obstetricians and the fact that we are dominated by obstetric practice…

Get rid of half the obstetricians. That money could actually produce zillions of midwives and it would be safer for God’s sakes!

She continues:

Doctors are hopeless at childbirth! They are surgeons …

The ignorance on display — both ignorance of history and ignorance of human physiology — is truly astounding. It seems never to have occurred to this midwife and the others in the room cheering for her that there was a time when all birth was physiological and midwives were the exclusive providers for women and in that glorious past gone by perinatal and maternal mortality rates were HIDEOUS!

Midwives had thousands of generations in which to improve childbirth outcomes and they failed. It took obstetricians less than 100 years to reduce the neonatal death rate by 90% and the maternal death rate by more than 95%.

Why did women die? Because childbirth is INHERENTLY dangerous. Anyone who forgets that — and UK midwives seem to have utterly forgotten it — is not fit to provide care to pregnant women and their babies.

Childbirth is and has always been, in every time place and culture, a leading cause of death of young women and THE leading cause of death of babies. Pretending that childbirth is safe is like pretending that nearsightedness doesn’t exist. Eyes have evolved to see, but more than 30% of people are nearsighted. Women have evolved to give birth, but more than 1% of them as well as 7% of babies are doomed to death in childbirth.

There is nothing more “natural” than a dead baby.

Yes, obstetricians are surgeons; that’s why they can save the lives of mothers and babies who would inevitably die if the baby was too large to transit the mother’s pelvis. But obstetricians save maternal and infant lives without surgery because they are non-surgical physicians, too. Obstetricians save lives by preventing, diagnosing and treating pre-eclampsia and the concomitant high blood pressure and seizures that may result. They save lives by giving blood transfusions since hemorrhage is a major cause of maternal death and they save lives using antibiotics to treat and prevent infections in mothers and babies. They save lives by managing pre-existing chronic conditions in mothers, conditions that are becoming ever more prevalent as the age and weight of pregnant women continues to rise.

This graph below, which I have shared before, shows maternal mortality before and after advances in obstetrics:


If you graphed neonatal mortality over time it would show a similar trend.

The left side of the graph, the side with appalling mortality rates, occurred when midwives were in charge of childbirth. The right side of the graph, where mortality has dropped to a tiny fraction of “natural” mortality, is presided over by obstetricians.

Obstetricians didn’t “ruin” childbirth; they made it safe. They were and remain laser focused on OUTCOMES of childbirth — healthy babies and healthy mothers — and recognize that nature can and should be improved upon. Midwives remain laser focused on PROCESS, obsessing about C-section rates and intervention rates as if childbirth is a piece of performance art and midwives are the directors who can craft the best performance.

It’s not hard to imagine how babies and mothers are being injured and allowed to die in a system where process is valued and outcome is basically ignored. When midwives wrongly believe childbirth is inherently safe they wrongly conclude that “physiological birth” is safest. They blithely (and fatally) pretend that obstetric complications are “variations” of normal and risk factors should be ignored. That’s why babies and mothers died at Morecambe Bay and a host of other locations where midwives promoted normal birth instead of healthy outcomes.

What’s most shocking is that they’ve learned nothing from the debacle they have precipitated. They’ve accepted NO responsibility for maternity disasters like Morecambe Bay and they’ve accepted NO responsibility for the massive growth in maternity liability payments. Indeed, they seem to have utterly ignored them.

UK midwives’ contempt for obstetricians, so clearly articulated and cheered at this conference, reveals them to be blinded by a failed ideology. Tragically, mothers and babies are injured and dying as a result.

*Addendum: I’ve just learned that the midwife, Caroline Flint, was found guilty of serious professional misconduct in the death of a baby, making her comments particularly chilling.

A FORMER president of the Royal College of Midwives was found guilty of serious professional misconduct yesterday after she mishandled the delivery of a breech birth which left the baby girl dead and the mother collapsed and bleeding on the floor.

Caroline Flint, a pioneer of natural childbirth who founded the first private “birth centre”, in south London, escaped with a caution after the disciplinary body, the UK Central Council for Nurses Midwives and Health Visitors, found she had failed to recognise maternal collapse in the third stage of labour and had failed to make adequate observations and keep adequate notes…