Parliament issues blistering critique of ideology of “normal” birth

I’ve been writing for more than a decade about babies and mothers whose lives have been sacrificed on the altar of the British midwifery’s “Campaign for of Normal Birth.” Radical midwifery theorists believe “normal” birth is birth without pain relief or interventions of any kind, even interventions designed to ensure safety.

Parliament has now issued a critique of British maternity care including the ideology of “normal” birth. Despite careful, measured language, the report is scathing.

According to The safety of maternity services in England:

Maternity care can not be safe until the ideology of normal birth has been eliminated.

Since shocking failures were uncovered at the University Hospitals of Morecambe Bay NHS Foundation Trust there has been a concerted effort to improve the safety of maternity services in England. However, major concerns have since been raised at the Shrewsbury and Telford Hospital NHS Trust and East Kent Hospitals University NHS Foundation Trust. There can be no complacency when it comes to improving the safety of maternity services and it is imperative that lessons are learnt from patient safety incidents.

There are a variety of reasons why women — particularly women of color — do not receive safe maternity care. Sadly, one of the most important reasons is because the maternity system is riddled with the ideology of “normal” birth, an ideology that prioritizes the process of birth over safe outcomes.

Referring to previous reports about the safety of maternity care, the Parliamentary report noted:

The report of the Morecambe Bay investigation describes the “pursuit of normal childbirth ‘at any cost’” Similar themes have emerged from the interim Ockenden report into Shrewsbury and Telford. When she came before us, Donna Ockenden said that the review had:

“Spoken to hundreds of women who said to us that they felt pressured to have a normal birth […] at that trust, there was a multi-professional, not midwife-led, focus on normal birth pretty much at any cost.”

Indeed:

…[W]e were shocked to hear from Clotilde Rebecca Abe that a mum she supported was made to feel like a failure by her midwife, because she opted for a caesarean section. Clotilde told us that the woman “felt like a failure because she felt that she had let the midwife down”. ‘Anecdotal evidence like this suggests that, in some cases at least, there is still clinician-led pressure for women to choose vaginal delivery, even when this may not be in their best interests.

Michelle Hemmington simply and eloquently argued that rather than the method of delivery, the outcome of the birthing process must be the focus, with all professionals working together:

“Consultants, registrars, and midwives all need to be working together and to be joined up. At the end of the day, the outcome is to have a safe, healthy, positive experience of birth and to come home with a baby. They should all be working together to achieve that.”

The privileging of process over outcome manifests in many ways but two are particularly critical: withholding pain relief from and discouraging lifesaving interventions for women in labor.

As columnist Sonia Sodha explains in The Guardian:

When it comes to childbirth, this predisposition to disbelieve women in pain and to underemphasise their medical needs has been particularly toxic, allowing an ideology to take hold that so-called normal non-medicalised birth is best, regardless of what a woman herself thinks or feels…

Despite several government reports exploring the death toll of normal birth ideology, it is still an integral part of British midwifery care:

…[W]hile the RCM formally dropped this language in 2017, it lives on strongly in some parts of the midwifery profession. There are still midwifery conferences that promote “normal birth”. The University of Central Lancashire – a major midwifery training centre – still runs a course on “normal birth”…

The Parliamentary report notes in its conclusions:

…[Maternity] organisations need to work hard to stamp out the damaging ideological focus on “normality at any costs”, which caused such huge loss and suffering at Morecambe Bay and Shrewsbury and Telford – and may exist in other trusts today. We heard that senior leaders in maternity services no longer use the term ‘normal birth’ and we urge an end to the use of this unhelpful and potentially damaging term.

When it comes to safety and pain relief:

…[W]omen must be fully and impartially informed about the safety risks associated with all birthing options. Women should also be provided with clear information about the likelihood of interventions.

Timely and appropriate pain relief is also an essential part of safe and personalised care, and we believe that every woman giving birth in England should have a right to their choice of pain relief during birth …

Finally:

We recommend that NHS England and Improvement establish a working group … to develop a set of actions for maternity services to consider in order to ensure no woman feels pressured to have a vaginal delivery and is always informed clearly what the safest option is for her birth…

Ultimately, maternity care can not be safe until the ideology of normal birth has been eliminated.

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