The ugly sin of midwives and lactation professionals: self-justification

Learn from your mistakes and used memo sticks.

There is no question that aggressive promotion of the ideology of normal birth has led to tens if not hundreds of infant brain injuries and deaths in various hospital trusts around the UK. There is no question that midwives were excruciatingly aware that they were at fault; that’s why they hid the evidence. Yet I can’t find a single UK midwifery leader willing to take responsibility for the tragic outcomes.

There is no question that aggressive promotion of breastfeeding has led to tens of thousands of newborn re-hospitalizations at a cost of hundreds of millions of dollars each year. Lactivist organizations don’t even deny it. There is no question that babies are suffering brain injuries and deaths as a result of the policies of the Baby Friendly Hospital Initiative. Lactation professionals are well aware of it. Yet I can’t find a single lactation leader willing to take responsibility for the tragic outcomes.

Mistakes were made but not by them.

The reason is simple: self-justification.

To hear UK midwives tell it, mistakes were made but not by them.

To hear lactation leaders tell it, mistakes were made but not by them.

The use of the passive voice is often a give away that self-justification is the response. In and of itself, self-justification is not harmful. But it becomes harmful when — as in the case of UK midwives and lactation professionals in industrialized countries — it replaces acceptance of responsibility, learning from mistakes, and ending the harm.

According to the book Mistakes Were Made (but not by me):

As fallible human beings, all of us share the impulse to justify ourselves and avoid taking responsibility for actions that turn out to be harmful, immoral, or stupid… most of us find it difficult if not impossible to say “I was wrong; I made a terrible mistake.” The higher the stakes—emotional, financial, moral—the greater the difficulty.

It goes further than that. Most people, when directly confronted by evidence that they are wrong, do not change their point of view or plan of action but justify it even more tenaciously…

When directly confronted by the evidence that UK midwives have harmed babies, they do not change their point of view or plan of action, but justify their allegiance to normal birth even more tenaciously.

When directly confronted by the evidence that the Baby Friendly Hospital Initiative is harming literally tens of thousands of babies each year, lactation leaders do not change their point of view or plan of action, but justify their allegiance to breastfeeding even more tenaciously.

The authors note that in many cases self-justification is more dangerous than an outright lie:

It allows people to convince themselves that what they did was the best thing they could have done. In fact, come to think of it, it was the right thing. “There was nothing else I could have done.” “Actually, it was a brilliant solution to the problem.” “I was doing the best for [those I serve].” …

Self-justification by professionals is particularly harmful:

…It blocks our ability to even see our errors, let alone correct them. It distorts reality, keeping us from getting all the information we need and assessing issues clearly… It permits the guilty to avoid taking responsibility for their deeds. And it keeps many professionals from changing outdated attitudes and procedures that can harm the public.

How can we tell when healthcare professionals are deluding themselves and trying to delude the public with self-justification? We can ask a simple question: are the principles they defend falsifiable?

Science always starts with a hypothesis and then tests it to see if it is true. The possibility always exists that the hypothesis is false. If, however, the hypothesis is viewed as non-falsifiable — there is no possibility that the conclusion is wrong since they do whatever is necessary to arrive at it — it’s not science.

That’s why religion is not and can never be scientific. If you insist that God exists and no amount of evidence can change your mind, you have made the existence of God non-falsifiable and therefore unscientific.

The bedrock principle of UK midwifery is that so called “normal” birth is best for the overwhelming majority of babies and mothers. No amount of harm to babies and mothers can change their minds. UK midwives view it as non-falsifiable. That’s not science; it’s personal belief.

The bedrock principle of lactation professionals is that breastfeeding is best for the overwhelming majority of babies and mothers. No amount of harm to babies and mothers can change their minds. Lactation professionals view it as non-falsifiable. That’s not science; it’s personal belief.

It is important to understand that midwifery does not require the belief that normal birth is best for the overwhelming majority of babies and mothers. Midwives could admit that normal birth is not best a lot of babies and mothers and still provide excellent care, be gainfully employed and act on their values. But that would mean collaboration with other health professionals and giving up control of many patients. They don’t want to do either.

Breastfeeding medicine does not require the belief that breastfeeding is best for the overwhelming majority of babies and mothers. Lactation professionals could admit that breastfeeding is not best for many and still provide excellent care, be gainfully employed and act on their values. But that would reduce their scope of influence and decrease their employment opportunities. They are loathe to do either.

UK midwives and lactation professionals in industrialized countries are hardly the first medical professionals to make deadly mistakes. But mistakes become deadlier When midwives and lactation consultants refuse to learn from them and change their practice.

Can you imagine if doctors who cut episiotomies that turned out to cause the very problems they were supposed to prevent insisted that there was nothing wrong with episiotomies and they were right to cut them? Women would continue to be harmed.

Can you imagine if doctors who prescribed postmenopausal hormone replacement therapy (HRT) to reduce the risk of heart disease and inadvertently raised the risk of breast cancer insisted that there was nothing wrong with routine HRT and continued to prescribe it? Women would continue to be harmed.

We would rightfully be horrified.

That’s why we should be horrified that UK midwives are still insisting — despite the death toll — that normal birth is still best. And we should be horrified that lactation professionals are still insisting — despite the hospitalizations and neonatal injuries and deaths — that breastfeeding is still best.

Apparently, mistakes may have been made, but not by them.

  • Anna

    Midwives insist more autonomy is the answer, but you can bet they wont want any of the accountability that comes with autonomy. I dont think the blame rests entirely on midwives. Its also an underfunded system, saving money by using midwives over OBs and making everyone so overworked they are prone to error and trying to do the “cheaper, quicker” thing. When I had my recent hozzy birth I saw OBs literally running, cramming food in their mouths, phones in each hand, regis without enough supervision and consultants “supervising” numerous regis, but not in the room.

  • Sounds like the Grand Trunk’s justification of their own poor performance in Going Postal:

    “It was garbage, but it had been cooked by an expert. You had to admire the way perfectly innocent words were mugged, ravished, stripped of all true meaning and decency and then sent to walk the gutter for Reacher Gilt, although ‘synergistically’ had probably been a whore from the start.”

  • MainlyMom

    Part of the charge to bring midwifery-led care, and the BFHI, to American hospitals was in response to the belief that more mothers would choose OOH birth if hospitals didn’t jump on the natural trend, and therefore that more babies would be harmed or die due to the dangers of home birth. I expect that the trend towards normal birth at hospitals and BFHI has in fact harmed or killed more babies than a 25% or 50% increase in homebirth ever would have, due to the very small number of homebirths overall.

    As we could have expected, the numbers are beginning to play out the same way in CAM and integrative medicine; studies are beginning to show that certain cancer patients who combine CAM with real medicine have poorer survival rates. Giving in to pseudoscience to keep small numbers of people from leaving real medicine is exposing huge numbers of people to the pseudoscience, which is probably going to cause more deaths overall. The medical community as a whole needs to wake up to this.