Midwives and lactation professionals recapitulate physicians’ deadliest mistake

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It’s described as the “largest maternity scandal in NHS history.” That’s saying something in a system that has suffered massive maternity scandals like Morecambe Bay.

According to The Independent:

Midwives and lactation professionals are copying physicians’ deadliest mistake: believing good intentions can’t cause harm.

Dozens of babies and three mothers died on the wards of a single hospital trust, in what is being described as the largest maternity scandal in the history of the NHS …

Clinical malpractice was allowed to continue unchecked over a period of 40 years …

The investigation singles out the deaths of at least 42 babies and three mothers at Shrewsbury and Telford Hospital Trust (SATH) between 1979 and 2017.

More than 50 children also suffered permanent brain damage after being deprived of oxygen during birth, the investigation discovered, as well as identifying 47 other cases of substandard care.

How could it happen?

Because midwives are recapitulating physicians’ deadliest mistake: believing good intentions can’t cause harm.

I’ve written about the ways in which midwives have replaced the paternalism of medicine with maternalism. They rightly excoriated doctors who thought they knew what women needed better than women themselves. Now they display a maternalism of stunning hubris, assuming that they know what women need from childbirth better than women themselves. Just like doctors who pressured, hectored and misled women into doing what the doctor ordered, midwives — through campaigns promoting “normal” birth pressure, hector and mislead women into doing what midwives want.

But that’s not the worst of it, as scandals like Shrewsbury and Morecambe Bay have made clear. The worst is the refusal to acknowledge the harm they cause and the concomitant resistance to changing the harmful behavior.

Just as in the case of Morecambe Bay, the horror at Shrewsbury and Telford can be traced to the midwives:

The subsequent review identified systemic failings by the former head of midwifery Cathy Smith, and midwives who altered notes retrospectively.

A forthcoming report identifies:

— A long-term lack of informed consent for mothers choosing to deliver their babies in midwifery-led units – where risks can be higher if problems occur – which “continues to the present day”

— A long-term lack of transparency, honesty and communication with families when things go wrong. This supported a culture that was “disrespectful” to families who had been “damaged” as a result

— Failure to recognise serious incidents. Many families who had undergone horrific experiences were told they were the only ones and lessons would be learnt. The report said: “It is clear this is not correct”

— A long-term failure to involve families in investigations that were often poor and described as “extremely brief” and “overly defensive of staff”

Not sharing learning, meaning “repeated mistakes that are often similar from case to case”. Failure to learn was present from the earliest case of a neonatal death in 1979 to cases occurring at the end of 2017 …

It is important to understand that this didn’t happen because the midwives wanted to harm babies and mothers. It happened — and it continued to happen — because the midwives believed their care couldn’t possibly harm babies and mothers because they had the best intentions.

Many of them believe to the core of their being that so called “normal” birth is better for babies and mothers. They confused cause and effect. Having seen that women in labor who don’t need interventions might have better outcomes than those who do, they concluded that the absence of interventions cause the good outcomes. It’s the maternity equivalent of responding to the fact that patients in the intensive care unit die at a higher rate than those on the regular floors by closing the ICU.

Midwives pledge their allegiance to “normal” birth for the purest of intentions. They thought (and many still do) that “normal” birth is better for babies and for mothers. And because they were so sure of their good will, they refused to accept the evidence of harm from their own eyes. They refused to properly investigate bad outcomes, refused to learn from them and tried to hide them. They were engaged in a passionate campaign to keep the ugly truth from themselves: their relentless promotion of “normal” birth is killing babies and mothers.

It is no different from the behavior of the colleagues of Ignaz Semmelweis, who refused to wash their hands because they passionately believed that their good intentions meant they couldn’t possibly be carrying disease. But good intentions did not prevent bacteria from being transmitted by doctors from patient to patient. Four decades and countless deaths passed before doctors were forced to acknowledge that they could cause harm despite good intentions.

And it’s no different from the contemporary behavior of lactation professionals who refuse to recognize the harm they are causing. As a result of aggressive campaigns to promote breastfeeding, exclusive breastfeeding has become the LEADING cause of newborn re-hospitalization. Literally tens of thousands of babies are re-hospitalized each year at a cost of hundreds of millions of dollars. Lactation organizations aren’t denying this; they know it’s true. But like the midwives of Shrewsbury and Telford, they are refusing to accept the evidence of harm, refusing to learn from the harm and trying to conceal the harm. They are engaged in a passionate campaign to hide the truth from themselves.

Doctors have learned the hard way that good intentions do not guarantee good or even safe care. Good intentions didn’t prevent the tragedy of DES (a hormone that was supposed to prevent miscarriage but instead gave female offspring a rare form of cancer). Good intentions did not prevent the fact that episiotomies cause the very same harm they were supposed to prevent.

Similarly, good intentions on the part of midwives do not prevent them from causing deadly harm. And good intentions on the part of lactation professionals does not prevent them from harming babies, sometimes grievously.

Belief that good intentions must necessarily lead to good outcomes is a form of professional arrogance. It’s wrong when doctors behave arrogantly and it is equally wrong when midwives and lactation consultants behave arrogantly. It’s time for midwives and lactation professionals to acknowledge that fundamental truth before they harm more babies and mothers.

  • mabelcruet

    “Lessons will be learned” has become utterly meaningless, its a trite phrase rolled out after every health care scandal. Where is the proof that lessons were learned? It needs regular monitoring and regular audit to show that care has improved after a bad outcome. It needs data being generated to show that the outcome for patients has got better to prove that learning has happened-I’ve never once seen any follow-up reporting being done in these hospitals to show improved outcomes. Maybe the investigation process should be that Kirkup goes back to Morecombe Bay 5 years after the production of his report, and Ockenden goes back to Shrewsbury in 5 years time and they do another deep dive independent investigation on maternity outcomes. If lessons have been learned, there will be demonstrably better outcomes all round.