The UK midwifery empire strikes back

107457118 - self pity word in a dictionary. self pity concept.

I almost feel sorry for the older generation of UK midwives. They were taught by other midwives that midwifery hegemony was the key to safer outcomes, maternal satisfaction and tremendous cost savings. Faced with evidence of major failures on all three counts, they are struggling with serious cognitive dissonance.

There have been a myriad of midwifery scandals in the UK involving the preventable deaths of dozens of babies and many mothers. In nearly all cases babies and mothers died because midwives chose to arrogate their care to themselves and did not call obstetricians and pediatricians for assistance in high risk situations.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Babies and mothers have died and billions have been paid out in liability, but midwives feel sorriest for themselves.[/pullquote]

There has been an increasing outcry from women who resent the way that midwives have privileged their priority for so called “normal” birth over women’s personal priorities. Women resent that midwives promote their vision, discourage and interfere with obtaining epidurals, prevent women from accessing C-sections, and refuse to honestly inform women about the longterm risks of vaginal birth including prolapse, incontinence and sexual dysfunction.

To the horror of both government and population, maternity liability payments have exploded. They now stand at approximately £2 billion per year. Fully 20% of the annual budget for maternity care is spent on liability costs.

UK midwives have two choices:

1. They could apologize for their deadly mistakes and vow to learn from them.
2. They could insist they are being persecuted and feel sorry for themselves.

The older generation of midwives behind a new website, Birth Practice and Politics Forum, have chosen the second course.

Before analyzing what they have written, it is helpful to consider what an ethical childbirth ideology would look like. It’s relatively simple:

Her baby, her body, her birth, HER choice. Midwives’ preference are irrelevant.

Now, let’s look at the way that UK midwives ignore issues of safety, maternal satisfaction, and liability expenditures to focus on … their cherished beliefs.

Women are not being nurtured and cared for during pregnancy and birth in a way that supports and enhances their well-being or confidence in their abilities to give birth and become competent confident mothers. There is an on-going undermining of women’s rights and agency, and of the understanding that most women can give birth physiologically and without interference.

So what if mothers and babies are dying? So what if women are unsatisfied with midwifery care? So what if the government is paying billions each year to settle liability claims? In the view of these midwives the real issue is that they are being persecuted!

I kid you not.

Midwives and their support for normal birth are being unfairly attacked, if not demonised. This is preventing them from using their midwifery knowledge and skills to give women and families the kind of care they know is best and that has been repeatedly shown to provide excellent physical, emotional and psychological outcomes for mothers and babies. (my emphasis)

What about the dead babies and mothers?

The concept of risk is wheeled out at every turn. Risk and its avoidance have become so embedded in maternity care that decision-making has been all but removed from the mother and her midwife. Health practitioners’ fears of reprisal and fears of the birth process itself can and do lead to women being threatened either that their baby will die or be damaged, or with referral to social services if they do not follow medical advice.

It seems never to have crossed the midwives’ minds that the problem here is that risk and its avoidance have NOT become embedded in midwifery care and that the plethora of dead babies and dead mothers is the direct and predictable result.

Anyway there’s more to birth than a live baby and a live mother, right?

Although the rhetoric in maternity care focuses on safety and safe care, this is still largely restricted to short-term outcomes, often measuring only or mainly the survival of mother and baby…

If anyone has been ignoring the long-term outcomes of birth it’s the midwives themselves. Although they go into extraordinary detail with women about the purported long term risks of NOT having a vaginal birth, they don’t deign to mention the far more common long-term risks of HAVING a vaginal birth. For example, the absolute risk of urinary incontinence after vaginal birth is literally 10,000% higher than the absolute risk of placenta accreta after a C-section. You read that right, 10,000% higher, but midwives don’t seem to think that long-term outcome is worth talking about.

The midwives have the temerity to claim:

Maternity care is increasingly influenced by current ideological and financial considerations rather than rooted in what is best for women, babies and families.

Doing everything possible to avoid preventable deaths is not an ideology, it is an ethical requirement.
Doing everything possible to meet the stated preferences of mothers is not an ideology, it’s an ethical mandate.
Doing everything possible to reduce the liability payments for babies and mothers who are injured or die at the hands of midwives is not an ideology nor a financial consideration, it is basic medical ethics.

No matter!

We are concerned about a range of different but related influences on health care that are worsening maternity services for women, babies and families, for midwives and for other birth workers.

How could preventing perinatal and maternal deaths, improving maternal satisfaction and reducing liability payments “worsen” care for women, babies and families? It won’t; it will IMPROVE care. The real problem is that changes that improve safety and address women’s preferences will undercut the hegemony of UK midwives and therefore “worsen” their experience. But their experience is irrelevant.

Can you imagine if doctors had greeted the scientific evidence that routine episiotomy is harmful to women by insisting that the practice must be maintain to address the needs of obstetricians? Can you imagine if anesthesiologists rejected a woman’s preference to avoid medication and gave her an epidural anyway to improve the anesthesiologists’ experiences? There would be outrage and rightfully so. Patients don’t exist to meet providers’ needs; providers exist to meet patients’ needs.

As I said above, I almost feel sorry for these midwives. But I don’t for the simple reason that their happiness is not and should never be the goal of the maternity care system. The goal is patient safety and patient satisfaction, a point that seems to have utterly escaped midwives’ attention during their pity party for themselves.