The Faustian bargain between UK midwives and the NHS

Today comes news that Sheffield maternity services have been rated as inadequate. This follows on the heels of the Ockenden Report that revealed the preventable deaths of hundreds of babies, and comes nearly seven years after the Morecambe Bay Report about the preventable deaths of babies and mothers.

How did this happen? The proximate cause is the midwifery cult of normal birth wherein midwives teach each other that the process of birth is more important than the outcome.

Yet that begs the question, why did the National Health Service allow an unscientific cult to take root across its maternity services?

Because they were told it would allow them to spend less on maternity care.

As MP Alicia Kearns notes:

There is a constant expectation that women’s services and care can be done on the cheap, or that because women have given birth for generations and generations they don’t deserve the support they need.

The National Health Service made a Faustian bargain with UK midwives allowing them to do whatever they wanted so long as they promised it would cost less:

– Midwives promote themselves as less expensive than obstetricians.
– They promote normal birth as less expensive than birth with technology.
– They promote vaginal birth as less expensive than C-sections.
– They promote unmedicated birth as less expensive than epidurals.
– They promote homebirth as less expensive than hospital birth.

And they may even believe it.

But what is touted to women as an ethic of care — a midwifery philosophy that empowers women and respects their choices — is embraced by the NHS as an ethic of “efficiency” — saving money by ignoring women’s choices and depriving them of pain sparing and life saving technologies.

Thus was born the Campaign for Normal Birth, promoting a single practice performed by a normative body as objective and good … and explicitly or implicitly ignoring women’s desires for more technological approaches which are framed as both unhealthy and expensive.

There are two tragic ironies embedded in the aggressive promotion of normal birth. First, although midwives sell normal birth as less expensive and therefore more efficient, it is actually more expensive because of the massive liability costs. At this point fully 20% of the UK maternity budget is spent on paying out claims for injuries and deaths.

The other irony is even more bitter. Midwives have fallen prey to the very sins they condemned in doctors. By relentlessly promoting a one-size fits all approach to birth, they have turned birthing women into widgets on an assembly line. They justify this with an overweening paternalism that imagines that midwives know better than women themselves what is good for them.

Dead babies, grieving mothers, massive liability payments. It’s hard to view the cult of normal birth as anything other than the monstrous failure of a Faustian bargain.