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.

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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.

There’s nothing more natural than a dead baby.

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:

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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…

  • Courtney Turner

    I’d be interested to hear your thoughts on the rise of maternal mortality recently, especially in Texas and Louisiana in the US. Is it really because hospitals are paying more attention to the babies, short hospital stays, or is it something else?

  • Eater of Worlds

    So she bitches about how many midwives could be funded by the money saved if they used half the number of OBs they do now. I wonder how many OBs could be funded if they didn’t have to pay out billions of dollars for mishandling births which seem to be primarily mishandled by midwives and secondarily by overworked OBs.

    • AnotherOor

      I don’t think there’s a shortage of midwives, is there? But halving the number of OB’s would certainly create an OB shortage. What she’s talking about is forcing women into midwifery care that they most likely don’t want.

  • Ozlsn

    What I want to know is why the woman talking in the clip went to doctors for her cancer treatment. I mean surely the oncology nurses knew far more and could have encouraged her to trust her body to heal? After all her body wouldn’t produce cells that would kill her, and nurses used to do all the care back in Nightingale’s day. She could have pushed through the pain and blood and then trusted the palliative care nurses for end-of-life care.

    I quite honestly think that midwifery should not be a stand alone degree (no other nursing speciality is, why this one?) but if it is then it needs to have a pretty strong historical component included. It needs to send students to work in low resource environments (under supervision obviously). It basically needs to make midwives aware of the risks of normalising a situation when there is actually a problem, and aware of what their limitations are.

    As for low breastfeeding rates being linked to obstetric care – tell me again how a dead mother or a dead baby improve breastfeeding rates exactly? I’m dying to hear.

    Obstetricians here (Australia) need to be cautious of pathologising a normal situation (in the public sector they tend to see the higher risk women), midwives here (who tend to see the lower risk women) need to be cautious of normalising a situation that is starting to go pear shaped. And both groups need to work together to ensure best possible outcomes for the mothers and babies.

    • Anna

      Same reasons anti-vaxxers will trust a Dr to do emergency surgery on them after an accident but not trust them on vaccines! I tend to agree that midwifery should be a nursing speciality but I think the sheer numbers required, the years of study and the pay make that harder. I think getting the Homebirth midwives and woo-fuckers out of the universities would be a great help. As would your suggestion for some more historical component and and they could easily drop some of the fluff to fit that in. Maybe some videos too of women bleeding out, stillborn babies, eclamptic seizures, entrapped breechs etc to show just how much birth trusts us.

    • Kim

      “I quite honestly think that midwifery should not be a stand alone degree (no other nursing speciality is, why this one?”

      In the UK, student nurses now specialise from the outset in one of four areas: adult nursing, paediatric nursing, mental health nursing and learning disability nursing. So if you’re a mental health nurse, for example, you can’t practise as an adult nurse.

      • Ozlsn

        How bizarre. Is there any specific reason for the change? To the best of my knowledge the nursing degree here is the same course for most of and you start specialising towards the end – I think they still encourage graduate year rotations through at least three areas before specialisation. The young NICU nurses were pretty much all doing postgraduate qualifications in neonatal and pediatric nursing, having done one rotation in grad year, liked it and then worked a year or so in the Special Care and pediatrics wards.
        Also does learning disability nursing cover both adult, pediatric and mental health?

        • Kim

          I don’t really know. I suppose the logic must be that the more specialised you are, the more skilled you are in that specialism. It does cause difficulties because, suppose you’re a community mental health nurse, then you’re not in a position to help if, say, your patient also has a chronic physical illness.

      • Tara Coombs Lohman

        As I nurse, I don’t understand this at all. Nurses tend to change their areas of interest, especially because of the stress and the tendency to burn out after awhile. By covering everything in nursing school, you can go to another area of work and just need an orientation. I wouldn’t want to be locked in to just one area forever.

    • Cait

      Interestingly, the Nursing and Midwifery Council is currently consulting on whether the standards for UK midwifery education should be altered.

      I also think midwifery should return to being a specialist nursing qualification. Nobody should be working in obstetric care unless they have seen pathophysiology close-up and personal; nobody should be attending a birth who is not completely aware of how quickly someone can become critically unwell, and the fully unnatural measures we take to pull them back from death.

      But midwives aren’t into that, apparently.

      • lsn

        One of the (many) things that shocked me in the Coronial report into Caroline Lovell’s death was that the junior midwife (Melody Bourne) had attended such a low number of deliveries (from memory it was under 30). I remember thinking there was no way I would want someone that inexperienced at a homebirth, even being supervised by someone more experienced. I personally would want a lot of experience in what can go wrong, and what that looks like, and in a much more controlled setting so that if something unexpected happened it would be recognised and acted on quickly. Under 30 deliveries is very unlikely to give you enough experience.

        • mabelcruet

          It’s scary. As a medical student doing my obstetric attachment in 4th year we had to observe 20 deliveries and then deliver 20 babies ourselves. That was as a general medical student undergraduate training, not as a specialist obstetric trainee, just basic training. So most medical students who have no intention of being an obstetrician actually have delivered nearly as many babies as many junior midwives.

  • mabelcruet

    In a world with obstetricians, I would still be here, as would both my siblings-my mother was lucky (or physiologically gifted maybe). My eldest niece would be alive and well, my eldest nephew would probably be alive but with a degree of cerebral palsy. My youngest nephew would either be dead or brain damaged, and his mother dead of haemorrhage.

    • And that would be perfectly acceptable, from the point of view of continuing the human race; most of you would survive intact enough to breed. (My mother’d be dead at birth.)

    • StephanieA

      My mom and I would’ve both died without a C section, and since I’m her oldest my sisters wouldn’t be here, or our kids. Needless to say, I’m very thankful for skilled obstetricians.

  • Sue

    If obstetricians are surgeons whose only tool is surgery, how it is that Cesarean rates among obstetricians tend to run between 20 – 30 % – even up to 40%? That still means that the vast majority of the patients of obstetricians have non-operative births. But let’s not let facts get in the way of ideology.

  • Resident

    I had 3 unatural births with OBs all requiring c sections and have 3 healthy children to show for it. I have no interest in physiological birth as mine would have been disasterous. I am also continent, have normal sexual function and have been able to breastfeed and I’m thankful for that as well.

  • EllenL

    I am always amazed at your courage, Dr. Tuteur. Please keep the heat on the irresponsible leaders of midwifery care in the UK. They have a lot to answer for.

  • Abby

    Dr Amy have you read the book ‘This is going to hurt’ by Adam Kay? It’s an account of life as an obstetrician in the NHS – it’s pretty funny but also fairly scary – I’ve been an NHS junior doctor and the understaffing is endemic and horrific – it’s not just the midwives attitude to childbirth, most are not particularly woo indoctrinated but they are also chronically understaffed. This breeds a massive contempt and irritation for pregnant and labouring women who are ‘hard work’ ie don’t have a natural, easy labour and need interventions like epidurals etc – they then need one to one care which can’t be provided. It’s easier to just tell women they are shit human beings than to pay more money for more staff to look after them and to wail about the stillbirth rate than actually take a pregnant women seriously and investigate when she is ‘neurotic and anxious’ about the baby not moving…. I think there is mass burnout amongst obstetric and midwifery staff in the UK – they are so overwhelmed they end up just not caring.

    • EllenL

      Thank you for your insights, though they are depressing to read. It’s always good to hear the truth from those who have lived it.

      I think the whole attitude towards pregnancy and delivery is different in the U.S. The feeling is that this is a crucial time in a woman’s experience and there is a tremendous amount at stake – the life and health of both baby and mother. That’s the reason for all of the appointments, tests, monitoring, interventions.

      Most mothers welcome these attentions and trust their doctors. I hope this will continue to be the case. We are truly fortunate, though improvements obviously can be made.

      • Abby

        Thanks! What you have to remember in the NHS is that immediate cost saving will always win over higher costs down the line – or higher costs for a different department (eg obstetrics disasters ending up in paediatrics) In NHS administrator land the short term savings and the long term costs of these savings are not even in the same universe, they have absolutely nothing to do with each other – there is no ‘bigger picture’ here at all.
        The natural birth fanatics at the royal college of nursing and midwifery are adored by the government as they are selling cheap care as the best care. What you really also have to remember is that hospital beds and trained staff (midwives and obstetricians/anaesthetic clinicians) are in desperately short supply. So anything that reduces time in hospital and input from clinicians is a good thing for the government.
        So if you take these two facts – no big picture and beds/ staffing at a premium you can see why we have a situation where women are bullied out of an epidural ( needs more staff/longer in a hospital bed) but no one cares about the costs of treating postnatal depression/anxiety or PTSD. It is cheaper to let a women hopefully go into labour by 42/43 weeks than to admit her and induce her (increased staff and beds required) but the cost of ECMO for the severe Mec aspiration is the paeds budget, and the years of care for severe brain damage is a different budget again. After all it’s just playing the odds – most will be fine. We have high rates of instrumental deliveries which are cheaper than c section short term but the long term effects of a knackered pelvic floor are not costed. It’s cheaper to keep women at home in labour until the last minute so women give birth in car parks and hospital corridors (and traffic jams) I could go on and on……

    • Amy Tuteur, MD

      I’ll look for it!

    • ukay

      Maybe it would be better then to ban homebirths and other woo and invest the money you save in liability payouts into better working conditions and care.

      I am always impressed though how most medical staff manage to do good work under such consitions.

    • maidmarian555

      I have that book. It is excellent!

    • mabelcruet

      I think one of the problems we don’t discuss is bullying. Midwives tend to form cohesive groups and some units end up with midwives who resent medical staff and consequently make their working life a misery. The consultants are complicit in this-they have to work with the midwives full time whilst trainees rotate elsewhere, so some consultants won’t rock the boat and deal with issues. This was behind the problems in Barrow in Furness, and Bill Kirkup was under no illusions, he said outright that this behaviour was widespread.

      I’ve been involved in a case where a baby was stillborn and the midwife altered her notes-she had called the junior doctor to see the mum, and the junior called the senior. The midwife then called the senior to say that she didn’t need to come, but when the baby died, she altered the notes to say that she had asked the junior to call the senior but the junior refused so she called the senior and the senior refused to attend. God knows what she hoped to achieve, but in the end it was all put down to misunderstanding and miscommunication.

      The NHS is understaffed, under resourced and underfunded, but it’s not helped by midwives deliberately trying to score points like this and undermine the role of other professionals.

      • Christina Maxwell

        Very true. It is also not helped by the number of midwives sitting and twiddling their thumbs in off site birth units doing an average 27 births per year each. What a woeful misuse of funds!
        Provide a good, consistent, safe and kind service in hospitals and make people pay a contribution for homebirth, off site nonsense and the rest of it. Stop bleeding money into making MLUs 1000% nicer to stay in than normal wards, stop paying lactivists to make women miserable.
        I say this as a woman who has paid for private OB care twice, though I could ill afford it.
        *puts on tin hat and hides behind battlements*

  • kilda

    You know what’s really good to have around in a dangerous situation that just might require a surgery to save the life of you or your child? A surgeon.

  • The Bofa on the Sofa

    I thought the UK was the place with all that great midwife care? If OBs are to blame, why are breastfeeding rates in the US higher than the UK? We have far more OB led care than midwives.

    • Abby

      I think because British people don’t have much respect for public health messages! Middle class women breastfeed or agonise over not breastfeeding and bully and compete with each other about it – working class women have seen through all the bullshit, realise it’s much easier to formula feed so do this despite what the handwringing health professionals say! I think it’s down most of the uk population not giving a crap about wildly conflicting public health advice and doing what they want – people have very little respect for doctors here – I should know I am one! (And I hated breastfeed and fully support my patients whatever they want to do – it’s really not that important, in fact formula has more vitamin D and we are so short on sunshine we probably shouldn’t push breastfeeding at all! )

      • Sue

        Good perspective, Abby.

        If people are reluctant to take up preventive health messages due to the socio-economic determinants of health, maybe we should spend less on ideological campaigns and more on social services.

        We should also target those interventions that make a major difference to health, such as smoking cessation and other substance abuse, and inter-personal violence.

  • Empress of the Iguana People

    She makes you sound like the old barber-surgeons from long ago. You obs are surgeons, but isn’t that a relatively small percentage of your practices?
    Certainly my experiences didn’t require any scalpels, and I saw obs for the entire 18 months of my 2 pregnancies. I think they used a specialized needle to extract eggs and implant some of the fertilized ones back.

    • The Bofa on the Sofa

      Even granting a 30% CS rate, that means that OBs still do 2 vaginal deliveries for every CS.

      If they do twice as many non-surgeries as surgery, how does that make them a surgeon?

      • Ms. Sweaterfan

        True, and It’s my understanding that many OB/GYNs also perform surgeries other than c-sections, such as surgeries to correct pelvic organ prolapse. So really if they wanted to do lots of surgeries that could be conveniently scheduled around their “golf games” (or whatever they’re being accused of) they should let every mom push for hours and then reap the benefits later on! I’ve heard of one vaginal birth resulting in 3+ surgeries later in life :/

        • The Bofa on the Sofa

          I think about dermatologists. Dermatologists do surgery – they will do mole removals, for example. Does that make them surgeons?

          Of course not

        • Kelly

          I read a blog by an Ob that liked doing the surgeries so she did more of the gyn surgeries than the other Obs in her practice. There are places for Obs who like surgery and they will not unnecessarily do more c-sections just to get their fix. People are so crazy. I want an Ob because I want someone who can do whatever is needed to keep my baby and me safe. If it is c-section, I will be happy I live in a time where such a surgery is safe.

    • If something had gone wrong with my three pregnancies, I would realllly have been glad that my care provider could safely slice me up and remove the baby within minutes. As it was, my OBs didn’t “do” much at all, and not a single one said anything about getting to her golf game.

      Should I become pregnant again, I shall be over the age of 35 and will, again, happily commit my wellbeing and my baby’s wellbeing to the professionals who can actually offer All of the Interventions should such intervention be needed.

      And minor note–what’s all this nonsense about “physiologic” birth? Isn’t “physiology” just “what the body does”?

      • Amazed

        That’s what midwives like the ones mentioned in the article love doing: letting the body do his work and claiming the credit. Of course, if the body fails in said work, they don’t call obstetricians because the woman or baby weren’t meant to be and they hamper evolution anyway. All those interventions might mess up with breastfeeding! Better not bother at all. At least if the baby survives, it has better chances of being breastfed!

    • Sue

      As Dr Amy keeps saying, one of the major practical differences between OBs and midwives is that OBs can use all the same strategies, tools and medications as midwives, but can also conduct surgery. More tools in the toolbox, so to speak.

      • Anna

        There are things that midwives do that OBs CAN do but don’t have time for or it wouldn’t be cost effective. Good hospital midwives may spend hours supporting a woman, helping her breath through contractions, holding a shower on her back, encouraging her or even just chatting and keeping her calm. The key is that the midwife knows that its a team effort and knows when she it out of her depth or something may be up and calls in an OB’s skillset, even if its just to consult. When I had my youngest I found the team worked awesomely together and I felt really safe and reassured. These ideologues are mostly PPMs and academics but that means they have a concerning influence over young and impressionable midwives. Australian midwives of this ilk want total autonomy for the midwife, with midwives as lead carers and no Drs involved unless they deem it necessary. They will admit interventions are sometimes necessary but then they are against nearly every way you would know one is needed. I was reading Hannah Dahlen’s FB today and she posted the new WHO statement on intrapartum care and there were a few reasonably sane comments, then one was “but how do we stop intevetions!”. I looked up her name on the AHPRA register. Yep! Registered Midwife! Can’t even spell interventions but she knows they’re all bad and need to be stopped! It would be funny if these people didn’t have lives in their hands.

        • Amazed

          I’m still waiting for the day they announce that they have found their Harry Potter wands which will let them know when interventions are needed without them nasty tests and scientific ways to know. Because I can’t see another way of knowing if said tests and science are excluded.

          Then, of course, we have the preexisting factors which too many midwives insist are no factors at all. A regular here had her first successful pregnancy at age 39q with no GD testing, overdue and stuff. And her Canadian hospital midwife still insisted on going all natural because she (the midwife) didn’t get her (the client’s) homebirth. Fortunately, a senior midwife interfered, resulting in a healthy baby, healthy mother, and all signs of postmaturity.

          Scary.

          • Anna

            Yep. The story I was sold was we have “ways” of knowing. “There are signs that an OB would never see, that we see, changes in the woman’s behaviour, changes in her pain patterns etc that will tell us something is up”. I believed that. I thought I was safe.

          • Amazed

            In a way, you were. We’re all safely shielded from the reality of nature because we live in a very unnatural world, as proven by the fact that you, in Australia, and I, in Eastern Europe, can exchange this “correspondence” as soon as the other one gets to her computer and clicks on this site. So many of the things we take for granted, we owe to the safety of unnatural. The problem is, sometimes nature pokes its head in and turns its ugly side. I don’t know how it isn’t criminal that healthcare providers peddle this “other ways of knowing, aka trust nature and natural signs when we have other, scientific ones” crap.

            Hell, when my niece decided that a poisonous plant was the yummiest thing ever, her mom would not have noticed any signs. The doctors did not notice any visible signs. The only ones who did were the tests. Kid was totally asympthomatic.

          • Anna

            Yes. I guess hospital care is also a victim of its own success like vaccination. People no longer know several women that have lost healthy babies in labour, we don’t lose sisters and neighbors to birth complications – or very very rarely. Even though we use technology all the time to make our lives simpler we seem to romanticise nature – often totally contradicting ourselves. Homebirth midwives mainly use social media to promote themselves – not very natural!!!

          • Charybdis

            “Ways of knowing” is a giant load of bullshit. How about LISTENING to the woman who is in labor? If she says she is in a LOT OF PAIN, how about offering her some effective pain relief RIGHT THEN, not a pat on the head and a “let’s get you in the shower/tub, on a birthing ball, walking around, changing position, etc” while ignoring the woman’s pain. Or if the woman says she hasn’t felt the baby move as much as she has been accustomed to, INVESTIGATE, instead of telling her that movement decrease is normal, because baby is running out of room, is sleeping, etc.

            If they are so blinded by their ideology that they are NOT picking up on what is right in front of them, then they need to be re-educated/retrained in what to look for and how to do their jobs. Or find a different career altogether.

            I’m beginning to think that the process of giving birth to a baby needs to be thought of in the same way as a consent for sex. A person can initially say “Yes” to sexual contact/activity, but can then say “Stop now” or “No more” or “No” at any point during the sexual activity and the make-out session, heavy petting session, hot, sweaty sex session should stop right then, because consent to sexual activity has been revoked.** Saying “Yes, I want to have sex with you right now” does not mean that the answer will continue to be “Yes, I want to have sex with you” throughout the entire act. It can change on a dime, for any reason and should be honored immediately upon the utterance of “stop” or “no”.

            Just because you consent to an unmedicated trial of labor with a midwife as your care provider does not mean that you cannot change your mind at some point during the process. If you find that your labor is mind-blowingly painful, is progressing at a slow snail’s pace, or you are tired of the shower and birthing ball and would very much like to have pain meds and/or an epidural RIGHT NOW, PLEASE, then those requests should be honored immediately. You would not want your sexual partner “exploring why you want to stop having sex” or “have a chat about why you feel like you want to stop now, when we are more than halfway through and orgasm is imminent”, so why do midwives feel like you should have a discussion about your motives for requesting effective pain management or a CS? It should suffice to say that you have changed your mind based on your current labor experience and that you are now opting out on the unmedicated and/or vaginal portion of your labor and delivery.

            Wheedling, whining, berating, pouting and other passive-aggressive BS from the midwife shouldn’t be allowed and called out when necessary. It is nothing personal, it has nothing to do with the niceness or goodness of the midwife, but they take a change of mind by the laboring mother as some sort of personal insult. It’s not a vendetta, it’s the birth of a baby; SOMEONE ELSE’S baby, not the midwife’s baby.

            **This is how things should work, although I realize that it is not always so. I’m teaching my 14 year old son that when/if a girl says “Stop”, he stops immediately, and that no means no. And that the same goes for him as well; he can say “stop” and the girl should stop and that he can say no as well.

          • Anna

            Great points! and ways of knowing is also just bullshit because you might not have any pain, any unusual signs. I was labouring “beautifully” according to my midwife until it all turned to shit with no prior warning. Same thing happened to a dear friend. A CPM might genuinely not know (which is why they have NO business as lead maternity carers), but something that really shits me about trained homebirth midwives is that they DO know complications can happen and not be obvious. They DO know that infections might not produce a fever or illness, they DO know that a rupture can happen without classic symptoms – or there can be plenty of symptoms that are benign 9/10 times and you only have to be the unlucky one out ten. That stuff is not discussed at all in consultation with women in Australia. They actively ignore the knowledge and experience they have.

          • Amazed

            Something about the word “beautifully” makes my skin crawl, knowing how it ended for you. Please tell me that she told you this before your rupture (it was a rupture, yes? Or am I mistaking you for someone else? If so, my apologies.) and not after. But even if it was before, it still rubs me the wrong way because it sounds more of a doula thing to me. Something that I would expect of my mum or a friend to tell me. Someone who is there because they love me and want to encourage me. Not a trained medical professional. I don’t expect of my doctor to tell me that my hormones are recovering “beautifully”. I expect words describing efficiency, normal progress, or… lack thereof.

            Perhaps it’s me reading too much into it but it really sounds like a healthcare professional disrespecting boundaries and creating inappropriate intimacy that will serve (I’m not saying that they do it with this purpose in mind) as their “insurance”, a la Ina May’s way.

          • Anna

            I didnt have a rupture. Leads me to part of what makes me so mad about the lack of informed consent. So much focus on rupture as a risk of VBAC and almost zero discussion of other risks.

          • Amazed

            You mean in the hospital? Because from what I’ve seen of homebirth, they poo-poo eveh the risks of rupture, let alone any other risks.

          • Anna

            Well they poo-poo all risks but at least they TALK about rupture. I don’t think even the hospitals talk about the other risks that come with a VBAC or that make a VBAC riskier enough. Women think, for example, that wanting a woman to go into spontaneous labour before 40weeks is just being a meanie OB, so they need to be able to explain to women that the risks increase after 40weeks. NCB is just waiting in the wings to tell any woman that looks for info online that having a high BMI for example, or an LGA baby means nothing and is no more risky. I think it would help if OBs and hospital midwives spent more time with women talking about this stuff. I know they are busy but even some good pamphlets would help. I don’t really know HOW to stop the misinformation, but I feel strongly that hospitals and health departments need to push back. It feels sometimes like the Google University Professors are winning.

        • Daleth

          Good hospital midwives may spend hours supporting a woman, helping her breath through contractions, holding a shower on her back, encouraging her or even just chatting and keeping her calm.

          So basically, they’re doulas, except that they also know enough about medicine to recognize when an OB is needed. And, presumably, to assist the OB in dealing with the problem.

          • The Bofa on the Sofa

            I was thinking more like nurses. The description you quote sounds a lot like nursing care to me

          • Anna

            Well knowing when the shit has hit the fan, or may be going to takes a bit more than a 1week course and a lot of bravado and in the case that everything proceeds smoothly Aussie/Kiwi/UK/Canadian midwives manage the birth and the OB usually pops in and stands around in the background, or sometimes not at all. Midwives do also assist in surgery and do antenatal and post natal care which is well beyond anything a doula can do. When they stay within scope midwives take care of a lot of the essential work that would be too costly to have OBs doing. Its not within the scope of OB care to sit around with a woman squeezing her nipples or helping her change her pad. It may not be the most glamourous part of the job but its still very noble work. OBs don’t usually have much to do with the baby once its born. Midwives are the first port of call and again, if they are team players with their eyes on the right prize they will know when to pass the ball to paeds.

  • Tinkerdabble

    I’m sure many complications are “variations of normal.” As is stillbirth. Normal, normal, normal.

    What we want is something abnormal and unnatural: we want nearly all babies to survive their births.

    • Merrie

      Show of hands, who here would have survived in nature and had all their babies survive in nature?

      I think it’s decently likely I’d have hemorrhaged to death after the birth of my second kid, and my third would obviously have never been born either if that had happened.

      • Who?

        I would have, both mine came by themselves, pretty quick and straightforward labours and no subsequent birth related dramas and breastfed well enough.

        Good luck rather than good management of course.

      • monojo

        I would have, but I would have lost my mom at age 3.

      • BeatriceC

        I wouldn’t have survived my own birth without help. With access to a safe c-section (even if they hadn’t come up with the low transverse incision yet, nor epidurals good enough for surgery to be done without general), things were not dramatic at all. They determined I was not tolerating labor well, they’d estimated I was going to be “very big…at least 9 pounds” (because weight estimates were even less precise 42 years ago), and it seemed pretty obvious to everybody that my 89 pound (pre-pregnancy) mother was just not going to be able to get me out the old fashioned way, they calmly called for a c-section and I was born a very healthy 10 pounds 9 ounces, screaming my head off. I did have a bit of an indentation on my head, but that was the extent of my issues at birth.

      • Tigger_the_Wing

        I would have died with my second, unless someone had smashed his skull in. No forceps to deliver breech babies in nature. Had I survived – of course, he wouldn’t have – I would have died with my third (PPH). So my twins wouldn’t exist (and pre-eclampsia would have killed me anyway).

        But that’s all by-the-by. My maternal grandmother died of TB when my father was in his teens. A few years later, he nearly died too – but his life was saved by antibiotics. Without them, I wouldn’t exist.

      • FormerPhysicist

        Not I. My husband would have been a widower with no kids (of mine).

      • N

        My first one was breech. No idea how it would have turned out in nature. Probably with a damaged or dead baby?

        The second one did turn head down during 38th week, but didn’t find the exit. Really strong contractions but she didn’t descend, ergo no opening. In nature? Hmmm… dead by exhaustion mother and baby?

        Third one was transverse. Nature? Well, obviously it is only another variation of normal.

        But perhaps, if I had born the first one naturally, he may have died or been brain damaged, but he may have cleared the way somehow for the other two… by magic or so. And I would love them even more now.

        On the other hand, my husband would probably not have been around to make all those babies. He is very shortsighted. Glasses in nature? Nope…

      • Dabbledash

        I would probably be ok, but I have no idea if my son would have made it out alright despite signs of fetal distress. Maybe? Probably? I’ll never know because the OB on call intervened before I had to find out. And for that, I’ll always be grateful.

        (This is the same person as tinkerdabble. I just remembered how to log into disqus).

      • Gæst

        I’m not sure if I would have survived. I was a forceps baby, and afterwards the doctor told my mother that I really should have been delivered by c-section. I don’t know what the problem was. I was biggish at 8 pounds, 4 ounces, but my mother is not a small woman. Big head, I guess. Anyway, I had a bruised face but no other birth injuries thanks to a doctor who knew how to use forceps.

        As for my kids, pre-eclampsia with twins means I might have stroked out before they were born if it wasn’t for modern birth management. I also had one baby who did not tolerate labor. But all three of us are healthy thanks to interventions.

        • BeatriceC

          .,/,nm,n

          I’m gonna leave that in there. Lily the umbrella cockatoo apparently had something to say.

          • Gæst

            Ha! That was my first thought when I saw it was a comment from you.

          • BeatriceC

            Lily is a 50 or so year old Umbrella cockatoo. She is in my care temporarily because her human had an urgent situation to deal with and couldn’t take care of her for a little while. She’s going back home tomorrow, but will probably come back for a few months starting in mid-March. She really is just the sweetest bird that has ever hatched. Today she was velcro bird. I’d put her down somewhere it three minutes later she was back, landing on my arm or shoulder or climbing up my leg. https://uploads.disquscdn.com/images/8491af9e0449cbf2751ba129ccea3019c92c0d5bdd5af4e2760925329b34354a.jpg

          • Who?

            We went for coffee this morning, and sat under a big old mango tree overlooking a golf course. There were many sulphur crested cockatoos in the trees, and enjoying the birdbath. So noisy! They are really big birds. Wonderful to see them up close.

          • BeatriceC

            I am more than a little jealous that you have better wild birds than we have. We do have some flocks of various species of amazons, but they’re not nearly the social goofballs that cockatoos are. They don’t interact much with people and they’re pretty difficult to see in the trees because green birds among leafy green trees are hard to see. SoCal’s wild flocks aren’t native, but they’re non-invasive and they thrive here, so they’re left alone.

          • Who?

            We’re also welcoming the rainbow lorikeets to the annual feast at our umbrella trees, which are covered in red berries. In a couple of weeks we will have flocks of deafeningly loud birds for a couple of hours every afternoon.

          • Tigger_the_Wing

            I helped the local bird rescue one year in Adelaide, when the weather was terrible and the poor rainbow lorikeets were starving. It was so sad. They were unable to fly, and were easy prey for local feral cats.

          • Who?

            The weather is all over the place at the moment-we’re having a quite extended heatwave, and have had less than usual rain. Around here there is food in the well-tended gardens, but I don’t know how things are in other parts of the state or the country.

            Feral cats are an absolute menace, I’d suggest cats should really be indoor pets, and should be de-sexed in any event unless there is a good reason not to.

          • BeatriceC

            There’s an Australian nature photographer who’s been documenting an epic daily battle between two rainbow loirikeets and a sulfur created cockatoo at the bird feeder in his yard. David something or another, I can’t recall is full name. His instagram name is Dave.ais. He’s got even more photos on Facebook and they are amazing. He’s honestly my new favorite photographer.

          • BeatriceC

            David Arnold.

            https://www.facebook.com/1358874432

            (I think that’s the right link. My phone has not been my friend lately)

          • Who?

            It is, I’ve not seen that, thanks for sharing. We were backing the sulphur crest until we saw the lorikeet with the feather in its beak! Kookaburras are very much in evidence around here too.

            The pikelets look almost as good as mine! I serve them with fruit, maple syrup and greek yoghurt for breakfast, or jam and cream.

          • StephanieJR

            Beautiful bird!

          • namaste

            Pretty birdie!

          • Empress of the Iguana People

            You do not need to clean the cages, hoomahn. you need to snuggle -me-
            lol

          • BeatriceC

            That’s pretty much her entire outlook on life. I am getting nothing done while she’s here. I did get one of my kids to distract her long enough to clean out cages but that’s basically it. Her own human was supposed to pick her up yesterday, and then between 1-2 today. It’s 1:39 and I haven’t even heard from her yet. I’m not sure what’s going on, but her human is the last person on the planet I’d think would abandon her animal.

          • kilda

            well, hi Lily!

        • BeatriceC

          But my real response, sometimes the only problem is just weird positioning. Or the maternal pelvis doesn’t spread as much as it needs to. There’s a ton of reasons why a woman with normal to large hips/pelvis has trouble with a normal sized baby. Nature kind of sucks.

      • Juana

        #1 probably would’ve been a stillbirth around term, but I had labor induced at 37+1 because she tolerated even pre-labor contractions poorly and was suspected to have IUGR. She also might have contracted GBS if she had made it to be born alive.
        #2 possibly would have died of amnion infection after a “high rupture” of membranes at 39+5, because it took 4 days for labor to start, and that was after some hardcore labor induction for days. Don’t know how the possible infection would have affected me.

        Both are very much alive now, thanks to EFM, prostaglandins and antibiotics.

      • Empress of the Iguana People

        Mom and her babies would have been just fine. My sister and nephew would’ve been dead. My babies and I may or may not have been fine, but I couldn’t conceive them without 3rd party help.

      • Ozlsn

        Well I would be either dead or quite likely disabled from preeclampsia. My son would be dead – he was lucky to survive even now. Of my sisters one would quite likely have died of sepsis after her first child – said child was post-term, breech and had the cord wrapped around her neck when delivered. The other would have likely survived her first child, but the child may well have ended up with disabilities or dead thanks to being post-term and going into distress from lack of oxygen during contractions.

        My mother had four births with only the first needing forceps intervention. She still goes on about how the CS rate is too high. I asked her if she would prefer two dead daughters and one, possibly two living grandchildren instead of five and she shut up.

      • yentavegan

        My first baby was seriously post date..and was induced, so who knows if she would have survived without medical intervention. My third baby was an easy breezy dream of labor and birth but then I started to hemorrhage so without skipping a beat an injection of pitocin? was given to facilitate expulsion of placenta and saved my life.

      • DaisyGrrl

        Not me. I probably would have died during infancy (forceps delivery, failure to thrive, then serious diarrhea illness requiring significant medical intervention…all before my first birthday).

        Had I survived infancy, appendicitis would have killed me at 24 (my great-grandmother died from a burst appendix, so I would have followed family tradition). I don’t have kids, but if I ever do, it will be with ALL the interventions!

      • Busbus

        I and my brother would have survived, as would have my three kids – all were straight forward labors without complications. However, my mom’s mother had a deformed pelvis due to serious malnutrition as a child (she was in an orphanage for a few years) and had to have a c-section for all her children. Thus, neither my mom nor I would actually be here in the first place if it wasn’t for modern obstetrics.

      • MaineJen

        I may have survived…my kids, who knows. My water tends to break a long, long time before labor starts, and labor is pretty sluggish when it gets going. Both times, augmentation and antibiotics were involved.

        Sitting around with broken water is just asking for infection. Before the time of antibiotics, we may have gotten lucky, but maybe not. Happy to be living in the present!

      • Tara Coombs Lohman

        My mom rocked that childbirth thing and had two kids without complications. On the other hand, I…..
        #1-miscarriage. Very natural. But I sure liked having a D&C to make sure I didn’t have to walk around bleeding and cramping and hoping everything came out.
        #2-Stillbirth at 38 weeks-failure of placenta, little amniotic fluid, small placental abruption with bleeding. Because of science, could be induced and not have to wait in agony to see if I’d bleed to death before labor started. Might have died pre-science. (On the other hand, a few routine ultrasounds might have saved my son’s life, but this was 1988 and this OB didn’t do routine ultrasounds).
        #3-normal healthy pregnancy, normal healthy delivery with LOTS of prenatal testing to make sure previous problems wouldn’t repeat. Son breastfed like a champ even though I hated doing it.
        #4-Previous problems reared ugly head. Due to lots of prenatal testing, knew that placenta was failing and induction could be done 1 month early to save life of daughter. She fought the breast like a beast, had science not been available, would probably have been stillborn, and if not would have starved to death afterward unless we had a wet nurse or a cow.
        So….would only have one living child out of 4 pregnancies, if I had survived birth of first child. If not, children 2&3 wouldn’t exist. I LOVE obstetrics and obstretricians.

        • Tigger_the_Wing

          I’m so sorry for your losses.

          • Tara Coombs Lohman

            Thank you! A long, long time ago!