There’s an old saying that if you only have a hammer, everything looks like a nail. It means that if you only know how to do one thing, you will insist that is what needs to be done.

Consider, for a moment, the possibility that there was a handyman, Bob, who only knew how to use a hammer. Whenever he was called to a job, he brought his trusty hammer and banged in the nails. Imagine that a new handyman, Steve, comes to town and he knows how to use a hammer AND a screwdriver. He can do twice as much as the original handyman and as time goes by, more and more people call Steve, since many of their projects involve nails and screws.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Normal birth has nothing to do what is normal and almost nothing to do with birth. It’s all about midwives controlling patients.[/pullquote]

Bob, the original handyman, now faces a difficult choice. What should he do about jobs that involve screws? There are several tacks that he could take:

He could always learn to use a screwdriver, but that might be difficult for Bob. What else might he do?

He could insist that screws can be pounded in.
He could insist that screws are an unnecessary use of technology; anything that can be made with screws could also be made with hammers.
He could insist that Steve invented screws just to take business away from him.
He could insist that Steve recommends screws for a project when nails would have been just fine.

Or he could take the aforementioned claims to their logical conclusion:

He could insist that only things assembled with nails are normal.

All of these strategies share one thing in common. They imply that being able to use a screwdriver is unnecessary regardless of the situation.

This is not a real world situation, of course; it is an analogy. Midwives are the people with hammers. Normal (or natural) birth is nails and screws are anything that obstetricians can do that midwives can’t.

There has a been a lot of debate in midwifery circles about what exactly constitutes normal birth.

As anthropologist Margaret MacDonald explains in the Lancet, The cultural evolution of natural birth:

Natural birth has long held iconic status within midwifery and alternative birth movements around the world that have sought to challenge the dominance of biomedicine and the medicalisation of childbirth… The recent transition of midwifery in several Canadian provinces from a social movement—for which “reclaiming” natural birth was a critical goal — to a regulated profession within the formal health-care system is a unique opportunity to track changes in how natural birth is understood and experienced. Midwifery in Canada has much in common ideologically with independent or direct-entry midwifery in the USA and with radical and independent midwifery in the UK and so insights about changes in Canada have implications for maternity caregivers in a range of health systems.

Normal birth actually involves lots of technology. There is nothing natural about checking blood pressure, listening the fetal heart with a Doppler or recommending chiropractic. Other technological interventions have also become a part of normal birth:

… For example, a woman asks to have her membranes artificially ruptured after several hours of labour to “get things going” and gives birth vaginally at home… The presence of medical interventions within the realm of natural birth is a relatively common kind of border crossing.

Midwives will also recommend herbs or over the counter medications like castor oil to stimulate labor and prevent a term pregnancy from extending into a higher risk postdates pregnancy. In fact:

[If an intervention] can bring back the clinical normalcy of the labour pattern and keep it within the midwifery scope of practice, it is generally regarded as a good thing by midwives  … (my emphasis)

That is the key point. Anything is acceptable as long as it can keep the birth within the scope of midwifery practice. Normal birth has nothing to do what is normal and almost nothing to do with birth. It’s all about midwives controlling patients.

Just like Bob the handyman, a midwife faces a difficult situation when confronted with a patient who needs advanced technology like a C-section. She also has several choices, remarkably like the choices from which Bob can choose.

She could insist that the patient can give birth safely without a C-section.
She could insist that C-sections are an unnecessary use of technology.
She could insist that obstetricians recommend C-sections just to take business away from midwives.
She could insist that obstetricians routinely recommend C-sections when vaginal birth would have been just fine.

Or she could go “all in”:

She could insist that only vaginal birth is normal.

Proponents of radical midwifery theory use all these strategies. Midwives define normal birth by what is good for THEM, not what is good for women or safe for babies, and certainly not by what is actually normal.

A baby is breech and the midwife can’t do either a version or a C-section for breech. She insists that breech is a variation of normal.

A baby is postdates and the midwife can’t do a postdates induction with pitocin. She insists that babies aren’t library books and they don’t have to be born on a specific date and for good measure, she insists that pitocin causes ADHD, autism, or whatever condition you might fear.

A woman experiences severe pain during labor and a midwife cannot administer an epidural. She insists that the pain is beneficial, that the epidural has too many “risks” and that pain relief hurts the mother’s ability to bond with her baby. (Interestingly, in the UK where midwives can administer nitrous (an anesthetic) by mask, nitrous is considered compatible with normal birth.)

I could go on and on, but you get the idea. Anyone working with a midwife enamored of radical midwifery theory needs to ask herself: Are my midwife’s recommendations motivated by what it good for me and safe for my baby? Or are my midwife’s recommendations motivated by what will allow her to maintain control of me as a patient?

Does “normal birth” actually mean anything, or is it just a way for midwives to make what they can do seem most desirable?

Personally, I think the answer is clear. Normal birth has nothing to do with normal and nothing to do with birth. The definition of normal birth is simple and straightforward: If a midwife can do it, she calls it normal. If she lacks the skill to provide the needed care, she insists that the birth is not normal even if it results in a healthy mother and a healthy baby.

We’d rightly be suspicious of a handyman who asserted that assembling everything with a hammer is best. We should be equally suspicious of a midwife who insists that every woman wants, needs and benefits from normal birth.

In the last few years a deadly disorder that we thought was vanquished has begun to reappear.

The disorder is hemorrhagic disease of the newborn, also known as vitamin K deficiency bleeding. It can lead to life hemorrhage into the infant gut, and neurologically threatening hemorrhage into the infant brain.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Natural childbirth advocates were dead wrong.[/pullquote]

Why did it make a comeback? Because natural childbirth advocates declared that newborn vitamin K injections were both unnecessary and dangerous.

They were dead wrong.

From The Tennesean in 2014:

A bleeding disorder in babies so rare that it typically affects fewer than one in 100,000 is becoming more common in Tennessee because parents are refusing vitamin K injections at birth, according to pediatric specialists.

Since February, four babies with no signs of injury or abuse have been sent to Monroe Carell Jr. Children’s Hospital at Vanderbilt with either brain hemorrhages or bleeding in the gastrointestinal tract…

What happened to the babies?

All four children survived, but the three who suffered brain bleeds face challenges.

“These are kids that end up having surgery to remove the large amount of blood out of their head or they would have died,” he said. “It’s early. It’s only since February, but some of the kids have issues with seizure disorders and will have long-term neurological symptoms related to seizures and developmental delays.”

Vitamin K deficiency bleeding is remarkably easy to prevent with just simple injection of vitamin K shortly after birth. Yet on the advice of natural childbirth advocates, including some midwives and doulas, mothers began refusing the lifesaving injections.

It’s hardly surprising that natural childbirth were wrong since there was never any scientific evidence to dispute the vital role of vitamin K injection and no scientific evidence that it caused harm. Nonetheless natural childbirth advocates labeled it an intervention and with typical natural childbirth “logic” concluded that it must be unnecessary.

In an interview, Rebecca Dekker, of Evidence Based Birth, acknowledges that these injuries and deaths were both entirely preventable and caused by irresponsible claims. Dekker unwittingly gives a primer on the classic logic fails that lead to deadly advice irresponsibly offered by natural childbirth providers and irresponsibly followed by parents.

Logic fail #1: I haven’t seen it so it must not be a problem.

I knew that Vitamin K deficiency bleeding (VKDB) was rare, but I didn’t realize—until I started reading the research—how effective the shot is at basically eliminating this life-threatening problem.

Like most natural childbirth advocates, Dekker had no clue that a particular complication is rare because of interventions, not rare in nature.

Logic fail #2: I pride myself on being “educated,” although in reality I am ignorant.

…[T]here is this misconception that “Vitamin K doesn’t have any evidence supporting its use,” and I found that belief is totally untrue. There is a lot of evidence out there. People have just forgotten about it or not realized it was there.

Logic fail #3: If I am practicing natural parenting, my baby won’t need interventions.

That the two main risk factors for late Vitamin K deficiency bleeding (the most dangerous kind of VKDB that usually involves brain bleeding) are exclusive breastfeeding and not giving the Vitamin K shot.

Parents who have been declining the shot are the ones who are probably exclusively breastfeeding. So their infants are at highest risk for VKDB.

Logic fail #4: Inteventions by definition are always unnecessary.

There are so many misconceptions and myths. I’ve heard them all. The scary thing is, I’ve heard these misconceptions from doulas and childbirth educators—the very people that parents are often getting their information from. I’ve heard: “You don’t need Vitamin K if you aren’t going to circumcise.” “Getting the shot isn’t necessary.” “Getting the shot causes childhood cancer.” “Getting the shot is unnatural and it’s full of toxins that will harm your baby.” “You don’t need the shot as long as you have delayed cord clamping.” “You don’t need the shot if you had a gentle birth.”

Logic fail #5: Ignore doctors and do your own “research.”

… It is truly alarming the things that parents are reading. “Vitamin K leads to a 1 in 500 chance of leukemia.” “Vitamin K is full of toxins.” Most of the articles on the front page of results are written by people who have no healthcare or research background and did not do any reference checking to see if what they were saying was accurate. It’s appalling to me that some bloggers are putting such bad information out there.

If parents don’t trust the evidence, it may be because they have read so many of these bad articles that it’s hard to overcome the bias against Vitamin K. All I can say is, given the number of bad articles on the internet about Vitamin K, I can totally understand the confusion people have.

Logic fail #6: Believing natural childbirth advocates are knowledgeable, unbiased sources of information.

I mean, even I was confused before I started diving into the research! I truly went into this experience with no pre-existing biases. I just wanted to figure out the truth. If even I—the founder of Evidence Based Birth—didn’t know all the facts about Vitamin K, then I think that’s a pretty good sign that most other people don’t know the facts, either!

Dekker flatters herself. She started with a preexisting bias: reflexive distrust of doctors, scientists and government health agencies; she assumed they could not be trusted to determine that vitamin K is the best way to prevent bleeding from vitamin K deficiency.

Logic fail #7: My doula told me, so it must be true.

I don’t think we are doing a very good job with the parents who decline the shot, either. If you read the part of my article where I wrote about the epidemic in Nashville, all of the parents refused the shot, but none of the parents gave informed refusal. All of them had been given inaccurate information about the shot, so they couldn’t make a truly informed decision. Can you imagine what it must be like for the people who gave them the inaccurate information? That would be so terrible to know that your misinformation may have led to the parents making the choice that they did.

No shit, Sherlock!

Sadly, Dekker does not acknowledge that it is the logic fails so beloved of natural childbirth advocates that led to these preventable injuries and deaths. The reflexive distrust of physicians and scientists, the basic ignorance of science and the bias against interventions all combined to convince parents that refusing the vitamin K shot was “educated” when it was in fact deadly.

Which brings us to the biggest take home lesson of all: If natural childbirth advocates (including some midwives, doulas and childbirth educators) could be so wrong about something so simple — that vitamin K injections safely and reliably prevent vitamin K deficiency bleeding — should their advice ever be trusted?

Of course not.

I’ve spent the past 12 years writing about the dangers of radical midwifery and lactivism. Surprising, I recently acquired powerful new allies: midwives and lactivists themselves. Their mind boggling tone-deafness in responding to media criticism reinforces — in a truly nauseating way — the central point of all my writing:  natural childbirth advocates and lactivists really don’t care that their ideologies harm babies and mothers.

In the UK, midwives were recently forced to shutter their Campaign for Normal Birth in the wake of scores of preventable deaths of babies and mothers, multiple investigations placing responsibility of midwifery ideology, and nearly £2 billion in insurance payouts in the past year alone.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]It’s hard to imagine that anyone could be as tone deaf as Godfrey-Isaacs and Martinez-Sullivan in addressing preventable infant deaths, but I for one am grateful. They are doing my work for me![/pullquote]

If UK midwifery were devoted to improving outcomes for babies and mothers, we should have seen a public apology, a promise to learn from their mistakes, outreach to the families of those harmed by their ideology, and dramatic changes in policy. Instead we’ve gotten claims that dead babies are “fake news,” insistence that midwives will go on promoting the very policies that killed mothers and babies, and, above all, self absorption and self pity.

UK midwives are channeling Donald Trump: responding to facts that show them in a negative light by ignoring those facts, labeling them “fake news,” berating the media, and insisting they are being persecuted.

Consider this response, Birth (and midwives) in the media, from Laura Godfrey-Isaacs, “midwife, artist and feminist academic & activist”.

Godfrey-Isaacs starts off thus:

We will all experience a ´media-informed´ birth wrote Fleming et al in 2014, with information that is ´fragmented, weakly linked and poorly referenced´ – how pertinent this seems of the journalism displayed in major UK newspapers in August 2017, and how it highlights the responsibility journalists have to portray birth in a balanced way, as most women will not witness birth before they are in labour.

In 2016, I undertook an extensive literature search examining birth in the media since the 1980s. I identified the same themes. They are very much in evidence as you trawl through the articles. These themes have been seen to reinforce certain dominant ideologies and narratives of birth, as well as around motherhood and gender.

In a piece that is ostensibly a response to the reports that scores of babies have been injured or died on the altar of midwifery ideology, Ms. Godfrey-Isaacs can’t be bothered to mention preventable deaths of babies and mothers. Indeed, in a piece of over 1400 words, Godfrey-Isaacs doesn’t mention dead babies beyond chastising the media for reporting them.

I invite you to read Godfrey-Isaacs piece for yourself, but suggest that you take an anti-emetic beforehand. It’s hard not to vomit when you realize that ideological cant and extreme self-absorption betray a horrifying reality; midwives apparently think they — not dead babies and dead mothers — are the victims.

Thank you, Ms. Godfrey-Isaacs, for demonstrating vividly that normal birth ideology isn’t about what’s good for babies, but what’s good for midwives. Thank you for further demonstrating that it doesn’t matter how many people die as a result, midwives will continue to promote THEIR OWN best interests.

Lactivists have recently been confronted with a similar problem — an ideology that purports to be about what’s best for babies is killing babies. The problem is so widespread that the American Academy of Pediatrics has repeatedly called attention to the fact that breastfeeding promotion efforts ignore scientific evidence and lets babies die — from hypoglycemia, dehydration and starvation — on the altar of lactivism.

The Fed Is Best Foundation was formed by Christi del Castillo-Hegyi, MD and Jody Segrave Daly, RN, IBCLC, specifically to prevent injuries and deaths from aggressive breastfeeding promotion. Their message has resonated both with mothers (400,000 following their Facebook page) and the media, which has highlighted stories of preventable tragedies cause by the insistence that breastfeeding is always best even when it is killing babies.

The success of the foundation has led to an outpouring of vitriol. That hasn’t been very effective so lactivists organizations are trying a different tack, Moving Forward to Constructive Dialogue, by Lucy Martinez-Sullivan of 1000 Days, as if the appropriate response to preventable infant deaths is to discuss them instead of prevent them.

Dr. del Castillo-Hegyi had called 1000 Days to account for publicly chastising an organization that provides formula to babies whose mothers are DEAD. Just as in Mosul, where babies are dying due to lack of formula, lactivists are attempting to PREVENT them from getting life saving formula.

As Gayle Tzemach Lemmon, senior fellow at the Council of Foreign Relations pointed out:

Promoting breastfeeding is a laudable goal, but in some cases, international policy ends up determining women’s on-the-ground reality, even in wartime settings, rather than the other way around. In the process, policies run the risk of treating nursing mothers as children themselves, whose needs are best known by global policy makers sitting thousands of miles away, not doctors and humanitarians nearby doing their best to help.

How does Martinez-Sullivan respond to similar criticism of 1000 Days? With ideological cant:

…[T]he aggressive promotion of infant formula in sub-Saharan Africa and other impoverished parts of the world in the 1970’s led to a rise in infant deaths and horrific cases of malnutrition. This became an international scandal when the UK charity War on Want published their ground-breaking report “The Baby Killer” in 1974 which detailed how “more and more Third World mothers are turning to artificial foods during the first few months of their babies’ lives. In the squalor and poverty of the new cities of Africa, Asia and Latin America the decision is often fatal.”

What does the fact that fifty years ago formula companies convinced mothers who were successfully breastfeeding to switch to formula have to do with babies starving today for lack of breastmilk? Absolutely nothing except to burnish the ideological cred entails of Martinez-Smith and her organization. No matter, ideological purity is apparently more important than whether babies lives or die.

Martinez-Sullivan insists:

While opposing the aggressive and unethical promotion of breastmilk substitutes, 1,000 Days supports the safe and appropriate use of infant formula when necessary in accordance with the World Health Organization’s infant feeding recommendation.

Here’s a thought, Ms. Martinez-Sullivan, when you find yourselves letting babies die in order to promote what’s “best” for them, you might consider that you aren’t promoting what is best for them.

In my view, the entire episode is yet another example of lactivists trying to discredit the Fed Is Best Foundation for having the temerity to point out that lactivist campaigns are killing babies.

I understand if you do not wish to meet with me or 1,000 Days because of what I wrote in response to the aforementioned post. But please do not let that be the reason you decline the invitation to meet with the 43 other organizations that represent parents, physicians, health professionals and volunteers working tirelessly to help families give kids the strongest start to life and that signed the letter sent to you seeking a constructive dialogue with the Fed Is Best Foundation… 1,000 Days does however stand together with these groups in genuinely wanting to explore if there is common ground with the Fed Is Best Foundation when it comes to providing families with accurate and unbiased information on infant feeding.

But why should the Fed Is Best Foundation want to meet with 43 other organizations that have publicly opposed their effort to save babies lives? What is there to discuss when these organizations think that process is more important than outcome? Unless and until lactivist organizations acknowledge the preventable deaths that have occurred as the result of their commitment to ideology and, more importantly, take aggressive steps to prevent further deaths, there’s really nothing to say …

Except thanks Ms. Martinez-Sullivan for demonstrating that lactivism isn’t about what’s good for babies, it’s about what’s good for lactivists. Thank you for further demonstrating that it doesn’t matter how many babies die as a result, lactivists will continue to promote THEIR OWN best interests.

It’s hard to imagine that anyone could be as tone deaf as Godfrey-Isaacs and Martinez-Sullivan in addressing preventable infant deaths, but I for one am grateful. They are doing my work for me!

Childbirth and breastfeeding have been hijacked by WEIRD women.

No, I don’t mean that natural childbirth advocates and lactivists are weird, they’re WEIRD: Western, educated, and from industrialized, rich, and democratic countries. It’s a term from psychology highlighting the fact that the bulk of psychology research is done on Western, educated people from industrialized, rich, and democratic countries and therefore, should not be extrapolated to everyone else.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]WEIRD women view themselves as setting the standards for childbirth and breastfeeding to which other women should aspire.[/pullquote]

There’s nothing wrong with being WEIRD; I’m WEIRD myself. There is something wrong with imagining that being WEIRD makes you a role model for others or entitles you to speak for everyone else. Sadly, that’s just what has happened in the realm of childbirth and breastfeeding:

WEIRD women believe unmedicated vaginal birth and breastfeeding are best. They insist that the scientific evidence supports their beliefs, but in fact those beliefs are often logical fallacies or based on scientific research that is riddled with confounders. For example, claiming that unmedicated vaginal birth is safest is like claiming that those who don’t take blood pressure medications are healthiest. The correlation is real, but they’ve confused cause on effect.

Sure, those who don’t need blood pressure medications are often healthier than those who do, but banning blood pressure medications will not make people with high blood pressure any healthier; indeed it will make them sicker. And waiting until someone is in the midst of a heart attack or stroke to treat their high blood pressure will not decrease heart attacks of strokes; it will just increase serious injuries and deaths.

Sure, women who don’t need interventions in childbirth often wind up with fewer complications than women who do need them, but banning interventions in childbirth will not make people who need them any healthier; indeed it will make them sicker. Waiting until someone is in the midst of an obstetric crisis to use interventions will not improve outcomes; it will just increase serious injuries and deaths. That’s exactly what happened as a result of the UK Campaign for Normal Birth; it was inevitable.

Sure, women who can breastfeed exclusively often have children who are healthier, but that’s because women who can breastfeed exclusively have adequate supply, someone to support them while they step outside the workforce to breastfeed (or a job that allows them to pump), and are typically WEIRD, having more money, greater education and better access to healthcare. Demonizing formula use, as embodied by the Baby Friendly Hospital Initiative doesn’t make babies healthier; it makes many of them sicker. And waiting until a baby is hypoglycemic, dehydrated and or jaundiced to supplement with formula does not improve outcomes; it increases injuries and deaths.

WEIRD women insist that anyone who might want to use technology in childbirth (epidurals, fetal monitoring, C-sections) or infant feeding (formula) is either uneducated or brain washed. They imagine themselves as the ideal to which other women should strive. Therefore, any woman who is not striving toward that ideal hasn’t been properly instructed or is being duped by culture of industry.

There is a great deal of academic work in midwifery that attempts to place blame for the fact that most women don’t want unmedicated vaginal birth without interventions. Grantly Dick-Read, the father of natural childbirth, insisted that it is culture that causes women to believe that they want pain relief in childbirth. Contemporary midwives and natural childbirth advocates blame medicine for promoting technology, the media for (accurately) presenting childbirth as both painful and dangerous, and male physicians who wish to commit “obstetric violence.”

There is a great deal of academic work in lactivism that attempts to place blame for the fact that many women can’t or don’t wish to breastfeed. The villain of choice in these scenarios is the formula industry, an industry that engaged in villainous conduct in the developing world in the 1970s. But the unethical conduct of formula companies in the past had nothing to do with the safety of formula. Promoting formula in the developing world can lead to infant illness and death because the water used to make it was often contaminated. Formula companies behaved in an immoral fashion, but there is nothing immoral about formula.

WEIRD women practice medical colonialism by claiming to emulate indigenous women and by lobbying international health organizations like the WHO and UNICEF to promote WEIRD beliefs in developing countries. Sadly, WEIRD women are often motivated by a sense of class and race superiority. On the one hand, natural childbirth advocates and lactivists have created with an exoticized view the poor indigenous Other (generally black or brown) and claim to be emulating them. On the other hand, they are pleased to distinguish themselves from the poor industrialized Other within their own countries (both black and white) whom they conceptualize as ignorant and lazy.

Medical colonialism isn’t merely morally repugnant, it actually kills babies. Consider the plea from Doctors Without Borders begging for formula for infants in Mosul as reported by CNN, Don’t make babies rely on breastfeeding in war zones:

The mothers who need [formula] are those facing down life-and-death situations each day, often while caring for multiple children in the shadow of war. That giving infant formula to them is so controversial speaks to a policy tripwire few outside the humanitarian realm even know exists: global “breastfeeding first” policies.

Promoting breastfeeding is a laudable goal, but in some cases, international policy ends up determining women’s on-the-ground reality, even in wartime settings, rather than the other way around. In the process, policies run the risk of treating nursing mothers as children themselves, whose needs are best known by global policy makers sitting thousands of miles away, not doctors and humanitarians nearby doing their best to help.

WEIRD women practice medical paternalism, imagining that unmedicated vaginal birth and exclusive breastfeeding must be promoted as standards to which all women should be forced to achieve. Contemporary midwifery and lactivism are all too often based on the notion that midwives and lactivists know better than women themselves. In a bitter irony, midwifery and lactivism have exchanged the patriarchy for the matriarchy.

That doesn’t mean that contemporary female arbiters don’t believe completely in their view of childbirth; they do. But believing in the value of paternalism does not justify paternalism.

In countries like the UK where midwives are gate keepers of maternity care, it is the midwife who determines whether a patient needs pain relief and whether she gets it, not the patient. It is the midwife who determines whether a woman’s performance in labor is successful, not the patient. They have perfected delaying tactics (“You don’t really need it.””You’re doing great.” “You’re almost there.”), shaming tactics, and don’t hesitate to resort to simple obstruction by refusing to call for an anesthesiologist when the patient requests it.

Such paternalism isn’t merely unacceptable, it can be deadly as the UK experience with the Campaign for Normal Birth has shown. Scores of babies and mothers have died because midwives, in their belief that they knew best, refused to employ interventions to prevent or treat complications and refused to consult with the medical specialists who could have saved lives.

WEIRD women have moralized their ideology so that they can label those who have C-sections or formula feed by choice as selfish, lazy, ignorant and duped by culture or corporations.

This type of thinking has reached its apogee in lactivist memes such as this one:

If you don’t breastfeed you’re a selfish cunt.

Although the meme is crude, the sentiment at it’s heart is all too common. WEIRD women want to believe they are superior mothers. They wish to believe they are models that other women should emulate. And they need to believe that they set the standard to which other women not merely should aspire, but should be forced to aspire.

But WEIRD women aren’t a standard, not even for other WEIRD women; they’re just a particular cultural group whose views are not superior than the views of those who believe differently.

There’s nothing wrong with being WEIRD, of course, but there’s something very wrong with the conviction that being WEIRD means your views should be promoted by medical systems, governments and international health organizations. WEIRD women have hijacked childbirth and breastfeeding and we need to take it back from them.

Ideas have consequences.

Bad ideas about childbirth have deadly consequences.

That’s the take home message from the shuttering of the UK Campaign for Normal Birth. Midwives promoted process (normal birth) over outcome (healthy babies and mothers) and, inevitably, babies and mothers died.

It wasn’t always this way. There was a time when midwives were guardians of safety.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Midwives never intended for anyone to die, but deaths became acceptable collateral damage.[/pullquote]

Midwifery is often referrred to as the “second oldest profession.” Ever since our ancestors acquired the ability to walk upright, human childbirth has been fraught with extreme risk to both mother and baby. The first midwives were those who recognized that assistance in childbirth can minimize those risks.

They understood that something as simple as massaging a woman’s uterus after childbirth could prevent life threatening hemorrhage and that different fetal positions like breech posed specific problems that could be overcome with specific maneuvers. They acquired knowledge of the pharmacologic properties of certain plants and gave extracts to women with the intention of starting labor or stopping bleeding.

Outcome, whether mothers and babies live or die, was the MOST important goal in midwifery. It isn’t the only goal, of course; safe care can and should be accompanied by compassionate, comfortable care. But it was the sine qua non.

Despite profound changes in the human condition, midwifery changed very little … until the advent of midwifery theory. That’s when midwifery became radicalized and, as a result, babies and mothers died preventable deaths that midwives could have prevented but didn’t. Don’t get me wrong: midwives never intended for anyone to die, but deaths became acceptable collateral damage in a relentless campaign to promote process over outcome and midwifery autonomy over everything.

Don’t believe me? Consider this paradigmatic academic paper Including the nonrational is sensible midwifery, by Jenny A. Parratt, and Kathleen M. Fahy. Yes, you read that right; it is an exhortation for midwives to apply the nonrational to the care of patients.

The authors attack rationality itself:

We expose the limitations of pure rationality in the context of childbirth and use the concept of safety to exemplify the limitations that pure rationality imposes. The paper draws on philosophical and spiritual theory to present an analysis of ideas about mind, body, soul and spirit… This revised conceptualisation provides a theoretical basis that allows for and promotes more possibilities and thus more holistic ways of knowing in midwifery.

Both premise and conclusion are stunning: Many principles of midwifery are not supported by science. Rather than modify midwifery to reflect scientific knowledge, scientific evidence should be abandoned in service to midwifery autonomy.

For the treatment of postpartum hemorrhage, the authors suggest:

…[W]hen a woman and midwife have agreed to use expectant management of third stage, but bleeding begins unexpectedly, the expert midwife will respond with either or both rational and nonrational ways of thinking… [T]he midwife may focus on supporting love between the woman and her baby; she may call the woman back to her body; and/or she may change to active management of third stage… Imposing a pre-agreed standard care protocol is irrational because protocols do not allow for optimal clinical decision-making which requires that we consider all relevant variables prior to making a decision. In our view all relevant variables include nonrational matters of soul and spirit.

In other words, scientific evidence mandates technological intervention to treat postpartum hemorrhage, which isn’t compatible with the privileging of process over outcome. Rather than modify midwifery practice to reflect scientific knowledge, scientific evidence should be abandoned in service to midwifery autonomy.

There is a direct line between radical midwifery theory and the deadly Campaign for Normal Birth. In a Royal College of Midwives “analysis” published about the same time, the RCM insisted:

Care based on robust evidence probably has the highest profile it has ever had within midwifery. However, if policies, protocols, guidelines and pathways of care are too rigid and are unable to be applied flexibly, then there is a risk that midwives are unable to feel empowered to practice the art of midwifery. They need to use the intuition that experience and knowledge brings, to sense when a problem may or may not be occurring.

The RCM uses an example, too. A woman whose baby was breech was encouraged by the midwife to have a vaginal birth. The lesson midwives were to take from this:

Most midwives base their antenatal care on national guidelines … and local policies. ‘Trusting your intuition’ promotes these tools to be used flexibly …The intuition that Angharad would benefit from an extra visit at home enabled her to have the space and time to make informed choices that were right for her. Angharad made a choice that did not follow the current recommendations, i.e. the ‘safest way to have a baby in the breech presentation is by elective caesarean section’.

In other words, scientific evidence indicates that technological intervention (C-section) may be safer for breech babies, but that isn’t compatible with the privileging of process over outcome. Rather than modify midwifery practice to reflect scientific knowledge, RCM encouraged midwives to ignore scientific evidence in service to midwifery autonomy.

It’s not difficult to imagine why so many babies and mothers died as a result of such “reasoning.” In nearly every case, patients died because midwives ignored scientific evidence in favor of their intuition. This is a betrayal of the fundamental ancient goal of midwifery, putting patient health at its heart, and replacing it with a radical, contemporary imperative, putting midwife control at its heart.

Why did the UK National Health Service allow this deadly, self serving ideology to flourish? NHS made a Faustian bargain with midwives in exchange for the promise of saving money; midwives are less expensive than obstetricians. But it turns out that dead and injured babies are more expensive than both.

The radicalization of midwives has turned them from life savers to purveyors of and apologists for preventable deaths. That is unethical, immoral and completely unacceptable.

Scores of babies died preventable deaths, nearly £2bn was paid out in compensation in the past year alone, and multiple investigations have put the blame squarely on the midwives’ “Campaign for Normal Birth.”

How have midwives responded?

Australian midwife Hannah Dahlen made this repugnant claim:

For all those UK midwives feeling hammered this week by Fake News remember “thinking is difficult which is why most people judge” #ENOUGH!

Not to be outdone, the utterly reprehensible Sheena Byrom piled on with this:

I see more ‘fake-news’ coming through this am about women’s bodies and birth …

Byrom included an image blaring, “yellow journalism.”

I’ve often remarked on the fact that no sooner do I write a post then its targets rush to prove my point for me. Such is the case with my recent post What the UK midwifery leadership has in common with Donald Trump: they’re bullies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]I’d ask Dahlen and Byrom if they have any shame, but what’s the point? Anyone who dismisses dead babies as “fake-news” is beyond reasoned argument.[/pullquote]

I wrote that UK Midwives, forced to shutter their Campaign for Normal Birth, were copying our execrable president in the following ways:

• Although they purport to care about the people they are supposed to serve, they care only about themselves.
• They smash things up, refuse to accept responsibility, then blame everyone else for their own failings.
• They exist in a bubble, surrounded by sycophants, banning anyone who disagrees.
• They are bullies.

In the wake of multiple preventable infant and maternal deaths, multiple investigations ascribing them to midwives’ insistence on privileging the process of birth (“normal” birth) above the outcome (healthy babies and mothers), and skyrocketing liability claims and payouts approaching £2bn in the past year, UK midwives have demonstrated no interest in those preventable deaths, refuse to accept responsilbity, hide away on Twitter where they endlessly praise themselves, and continue to bully anyone who disagrees.

Now they are copying Trump in his insistence that any news that doesn’t make him look good is “fake news.” It’s an ugly look for him and its an even uglier look for midwives who are ethically responsible for the health and safety of the babies who died.

Dahlen and Byrom are poster children for the moral depravity and self-dealing at the heart of contemporary midwifery. I know they read what I write so I have a message for them and their colleagues:

Dead babies aren’t fake news! Desolate parents aren’t fake news. £2bn paid in compensation is not fake news. It is all tragically real and I don’t have enough epithets to fully convey my moral outrage at midwives who wish to bury dead babies twice, first by letting them die on the altar of “normal” birth and then by trying to erase the fact that they ever existed, are still loved and will forever be mourned.

It’s difficult to imagine how midwives could adopt such a tone-deaf tactic … until you consider what the Campaign for Normal Birth was really about. It was never about what was good for babies and mothers, and alays about what was good for midwives: higher employment, greater professional autonomy and the increased freedom to promote their ideology. If you observe these midwives on social media, you will see them engage in an endless round of mutual congratulations over their “success” in promoting normal birth. The dead babies are an irritating impediment to this continued “success,” so they must be dismissed as “fake.”

Social media has allowed midwives to so insulate themselves from reality that they don’t seem to have noticed that no one is supporting them besides themselves. The public has met the shuttering of the Campaign for Normal Birth with relief, writing comments and Letters to the Editor about women who felt ignored and abused in midwives’ care. The families of the babies and mothers who died preventable deaths have been eloquent in their grief. How dare Dahlen and Byrom dismiss their babies’ deaths as fake news?

Anyone with two functioning neurons knows exactly what Donald Trump means when he bleats, “Fake news!” He doesn’t mean that it is literally untrue, just that he intends to ignore it and wants his supporters to ignore it, too.

The same thing applies to midwives. They don’t mean that the dead babies are literally fake — those babies are real and really dead — just that they intend to ignore dead babies and want their supporter to ignore them, too.

It also explains why midwives have not (to my knowledge) undertaken root cause analysis of these deaths. It doesn’t matter to them why these babies and mothers died. It only matters that they are allowed to maintain autonomy and commitment to ideology.

I’d ask Dahlen and Byrom if they have any shame, but what’s the point? It’s painfully obvious that they don’t give a damn about the babies and mothers who die at the hands of midwives and care only about themselves.

Anyone who dismisses dead babies as “fake-news” is beyond reasoned argument.

Dear Ms. Gates,

I hope I can take a moment of your time to talk about an issue that it is dear to both our hearts, albeit for different reasons.

You’re a mother of three children; I’m a mother of four. You breastfed your children; I breastfed mine. You promote breastfeeding worldwide to improve the health of babies; I’ve come to the conclusion that the aggressive, world wide promotion of breastfeeding is harming babies.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The aggressive, world wide promotion of breastfeeding is HARMING babies.[/pullquote]

You and your husband invest in promoting breastfeeding because you believe that the scientific evidence shows it saves lives. I’d like to draw your attention to the fact that the scientific evidence is weak, conflicting and riddled with confounders; that there’s no evidence that breastfeeding rates have any impact on infant mortality; and, most importantly, that because of aggressive promotion, women are literally breastfeeding babies to death.

You have written:

Breastfeeding is the absolute gold standard in infant nutrition. Studies suggest it prevents everything from diarrhea to pneumonia to diabetes to obesity.

But the scientific evidence shows that breastfeeding DOESN’T prevent most of those things.

Many breastfeeding studies do not correct for confounders. Since, as you know, breastfeeding is correlated with maternal education and economic status, most of the benefits attributed to breastfeeding are actually benefits of being wealthier and having greater access to insurance and medical care.

No less an expert than Dr. Michael Kramer of the PROBIT studies that established that breastfeeding prevents colds and diarrheal illnesses has acknowledged that breastfeeding benefits have been grossly exaggerated. In an interview on Canadian radio he was emphatic that breastfeeding does NOT prevent obesity, does NOT prevent allergies, and does NOT prevent asthma.

When asked why lactivist organizations continue to insist on benefits that have been shown not to exist, he explains that these organizations rely upon preliminary data and simply refuse to accept anything that contradicts it. He is quite blunt that lactivist organizations won’t accept scientific evidence that doesn’t comport with what they believe and he worries that their insistence of exaggerating benefits will undermine women’s trust in healthcare providers.

I’m hoping that when apprised of this, you’ll go back to your experts and ask them for hard evidence that breastfeeding is really the miracle elixir they claim. They won’t have it.

Breastfeeding rates have no impact on infant mortality rates.*

I realize that’s not what you have been told, but what you’ve been told isn’t true. Studies that claim to show that breastfeeding saves lives (including the highly influential studies in the The Lancet) are based on mathematical models and extrapolations of small studies that assume that correlation is causation. But that’s not what happens in the real world. In other words, while breastfeeding saves lives in theory, it doesn’t do so in practice.

We know this from population data in both industrialized countries and the developing world. In the US, breastfeeding rates have varied widely in the past 100 years, starting at over 80%, dropping to a nadir of 24% in 1973 and rising again to rates to over 76%. At no time during those 100 years have breastfeeding rates had any impact on infant mortality rates, which dropped steadily throughout.

Both in the industrialized world and the developing world, countries with the highest breastfeeding rates tend to have the highest infant mortality rates and countries with the lowest breastfeeding rates have the lowest infant mortality rates.

During World Breastfeeding Week you posted the following on Twitter:

You noted that between 2009 and 2014 breastfeeding rates tripled to 57% in Vietnam, soared to more than 80% in Bangladesh and increased to more than 80% in Ethiopia. But what happened to infant mortality rates in response?

As far as I can determine, the change in breastfeeding rates had no impact in the trajectory of infant mortality rates. Perhaps you can ask your experts why, if breastfeeding purportedly saves lives, it hasn’t made any difference in those countries.

As a result of aggressive breastfeeding promotion, we are literally breastfeeding babies to death.

The Baby Friendly Hospital Initiative was implemented around the globe without any evidence that it increases breastfeeding rates. The Ten Steps of the initiative directly violate both scientific evidence and medical ethics. There is no evidence that locking up formula improves breastfeeding rates; there is no evidence that banning supplementation improves breastfeeding rates (and there is evidence that supplementation increases breastfeeding rates); there’s no evidence to justify banning pacifiers and considerable evidence that pacifiers reduce the risk of sudden infant death syndrome (SIDS); and it is deeply unethical to restrict what providers can say when counseling patients about infant feeding.

Worst of all, there’s a growing body of evidence that aggressive breastfeeding promotion is leading to brain injuries and deaths of infants from hypoglycemia, jaundice, dehydration, starvation and infants falling from or being smothered in their mothers’ hospital beds because well baby nurseries have been closed. It’s such a significant problem that 3 major papers have been published on the issue in the past year alone:

• The revised United States Preventive Services Task Force (USPSTF) guidelines
• Interventions Intended to Support Breastfeeding: Updated Assessment of Benefits and Harms
• Unintended Consequences of Current Breastfeeding Initiatives

In the developing world infants are literally starving to death because the WHO and UNICEF refuse to provide formula for them. As Gayle Tzemach Lemmon, senior fellow at the Council on Foreign Relations, wrote on CNN: Don’t make babies rely on breast milk in war zones. Babies in Iraq are starving to death even though they could easily be saved:

The surprising thing is that Lannaud and his colleagues at [Doctors Without Borders] didn’t place the blame for these underfed little ones just on war and the fact that the city was under siege. They also put the blame on other international organizations and policies that seek to do good.

“It isn’t a problem of access to food. The malnutrition we see here is primarily due to the scarcity of infant formula,” Lannaud wrote. “International organizations like UNICEF and the World Health Organization (WHO) promote breastfeeding … and provide infant formula, but only by prescription. We believe that distributing infant formula in a conflict situation like Iraq is the only way to avoid children having to be hospitalized for malnutrition.”

This is phenomenon known as white hat bias:

‘White hat bias’ (WHB) [is] bias leading to distortion of information in the service of what may be perceived to be righteous ends… WHB bias may be conjectured to be fuelled by feelings of righteous zeal, indignation toward certain aspects of industry, or other factors.

Babies are dying because the WHO and UNICEF are fired by righteous anger against formula manufacturers and their tactics of 50 years ago. But surely those charged with saving infant lives wouldn’t let them die just because they hate formula manufacturers? Actually they would.

In a remarkably tone deaf press release, Nurture Project International, “an international NGO providing technical lactation and nutrition support in Northern Iraq” insists:

Expertise, not milk powder, is the key to saving Mosul’s babies …

But babies cannot eat expertise; they need formula. A war zone is no place for ideologues who value process over outcome.

I’m writing to you, Ms. Gates, because you are deeply influential and profoundly committed to infant health. Breastfeeding, while a good thing, is not a magic, lifesaving elixir and those who claim otherwise have misled you.

I implore you to go back to your experts and ask them to address the fact that while there is no real world evidence to show that breastfeeding saves lives, there is considerable real world evidence that aggressive, unreasoning promotion of breastfeeding is killing babies.

Babies everywhere are depending on you.

 

*The major exception is the case of extremely premature infants where breastmilk lowers the risk of necrotizing enterocolitis, a deadly complication of prematurity.

Over the last few days British newspapers have been filled with articles about Royal College of Midwives shuttering their “Campaign for Normal Birth.”

One of the best appeared yesterday in the The Guardian.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]They smash things up, refuse to accept responsibility, then blame everyone else for their own failings.[/pullquote]

The announcement by the Royal College of Midwives (RCM) on Saturday that it will finally abandon its “normal birth” campaign is overdue but welcome. By promoting “normal” over medical births, the campaign has for too long dangerously implied that a non-medical birth is superior to one in which doctors are involved. Given that we have had firm evidence for more than two years that, in the very worst cases, normal birth ideology has contributed to the tragic and unnecessary deaths of women and babies, the only question is why it has taken the RCM so long to act.

As the piece notes ominously, the RCM leadership, while technically dismantling the campaign, appears to have no intention of stopping it.

Even as it ends the campaign, its chief executive has denied there may be a link between it and the sort of dangerous practice seen in Morecambe Bay. One of its honorary fellows has announced she will launch her own “normal birth” campaign as a response to the RCM moving away from this language.

They are right to worry. In my interactions with the midwifery leadership and their supporters on social media, I’ve seen no evidence that they have learned a single thing. They deny responsibility, refuse to mention let alone apologize for the countless preventable deaths at their hands, and engage in never ending congratulations of themselves and each other for their purported selflessness and commitment to women’s rights and desires.

They remind me of nothing so much as our execrable president Donald Trump. And although they aren’t leaders of the free world, they have the power of life and death over many people.

When I talk about the midwifery leadership, I want to be clear about who I mean. I’m talking about Cathy Warwick, the former head of the RCM, Sheena Byrom, often its public face, Lesley Page, the current head, premier midwifery apologist Milli Hill of the Positive Birth Movement, Soo Downe, Laura Godfrey-Isaacs and the fawning coterie with which they surround themselves.

How is the RCM leadership like Donald Trump?

Let me count they ways.

1. Although they purport to care about the people they are supposed to serve, they care only about themselves.

As I noted many times in the past, I am a cynical person. I’ve worked in the highest reaches of clinical medicine, and I’ve met a lot of people whose egos could barely fit into a conference room, but I’ve never seen such blatant self dealing and disregard for patients as I’ve observed in the UK midwifery leadership. Babies and mothers are dead. Multiple investigative panels have concluded they are the cause, yet they don’t have an ounce of shame.

Just like Donald Trump. Trump epitomizes self-dealing corruption. He apparently views the presidency as an opportunity to enrich himself. He demonstrates blatant unconcern for those he is supposed to protect and serve.

2. They smash things up, refuse to accept responsibility, then blame everyone else for their own failings.

Trump is legendary for his refusal to acknowledge his own failings, but the UK midwifery leadership is giving him a run for the money. They brazenly ignore the growing pile of tiny dead bodies (and large dead bodies of mothers, too). They literally ignore them. They don’t mention them, don’t acknowledge them, don’t accept responsibility for deaths at their hands. Despite official reports — which the RCM does not deny — that maternity negligence claims have soared and liability payments have rocketed to over £1 billion, they insist these reports are the products of their enemies, or worse. Trump claims that reports of his failings are “fake news.” UK midwives go farther, refusing to accept or acknowledge that they are news at all.

3. They exist in a bubble, surrounded by sycophants, banning anyone who disagrees.

Twitter is the Fox News of UK midwives. It allows UK midwives to recuse themselves from reality and reward themselves with a never ending round of self-congratulation. That rewarding feedback loop is infinitely more gratifying than facing the injuries and deaths that occur because of UK midwives overweening self-regard. Twitter allows them to customize their surroundings by blocking anyone who might intrude (laypeople and professionals) with distressing stories of babies and mothers who were injured or died because of midwives’ unethical promotion of “normal birth.”

Don’t believe me? Check out the Twitter feeds of Sheena Byrom and Cathy Warwick on any day. You will rarely find any mention of the preventable deaths that flood the mainstream media (except to excuse them). Instead you will be treated to a fantasy world where midwives proverbially kiss and congratulate each other over and over and over again.

4. They are bullies. Trump’s preferred method of dealing with those who disagree with him is to sue them. He is prepared to rack up enormous legal bills in the hope that his opponents will not have the financial wherewithal to keep up. One of the reasons he’s floundering so badly in the Presidency is that you can’t sue your political opponents.

UK midwives don’t have the financial resources that Trump has, but they use what they’ve got. Their treatment of loss father James Titcombe has been particularly egregious. They’ve harassed him and continue to harass him on social media, reported him to his employer and spent literally hundreds of thousands of pounds on lawyers to keep him from getting accurate records of the negligent midwifery care that killed his son.

James has been extraordinarily gracious in the face of abuse. In addition, he has cautioned me both publicly and privately to avoid attacks on specific UK midwives. He’s a far nicer person than I am. Moreover, I’m beyond the ability of UK midwives to intimidate, harass or report me. They literally cannot bully me, no matter how hard they try. And the fact that they try is emblematic of the moral rot at the heart of UK midwifery.

This morning James wrote on Twitter:

Best to avoid personal attacks (on both sides of the debate) – they don’t help.

I have to disagree with James. I suspect that publicly naming and shaming those who allow babies to die on the altar of normal birth, refuse to accept responsibility, and bully anyone who disagrees might be the only way to hold these women to account.

As the political philosopher Edmund Burke famously said:

The only thing necessary for the triumph of evil is for good men to do nothing.

That’s true about Trump and it’s true about UK midwives. Both cause suffering, both are bullies and both must be stopped.

Promoting normal birth is always and only about promoting midwives.

Many years ago, when I first heard the phrase “promoting normal birth” I was confused. Why would a healthcare professional be promoting any set of procedures or any particular approach to a health issue?

You won’t find any real medical professional who insists that he or she “promotes” one treatment over another. An ethical medical professional recommends whatever is safest for the patient, not whatever is most lucrative. Ethical medical professionals promote health and promote safety, not the opportunity to line one’s pockets.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The endless efforts of UK midwives to promote themselves have culminated in reflexive defensiveness and stone cold heartlessness in response to the cries of bereaved mothers and fathers.[/pullquote]

Normal birth has nothing to do with normal and nothing to do with birth. The definition of normal birth is simple and straightforward: If a midwife can do it, she calls it normal. If she lacks the skill to provide the needed care, she insists that the birth is not normal even if it results in a healthy mother and a healthy baby. “Normal birth” and “midwives” are interchangeable. “Normal birth” is nothing more than a marketing term.

Once you realize that, it is a lot easier to understand the Campaign:

The RCM Campaign for Normal Birth (Campaign for Midwives) declared that “promoting normal birth key to cost savings” (Promoting midwives a key to cost savings.) That’s especially ironic in light of what actually happened: the number of preventable injuries and deaths soared and liability payments skyrocketed. The NHS paid £1.2 billion last year alone!

You can look high and you can look low, but wherever you look, midwives or their advocates are behind every attempt to promote “normal birth” (i.e. market midwifery). Indeed, the leading textbook of the radical midwifery theorists is Promoting Normal Birth – Research, Reflections and Guidelines best understood as Promoting Midwives – Research, Reflections and Guidelines.

The editor Sylvie Donna has the grace to be abashed at the use of the word “promoting.” She starts the introduction with the following:

You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should normal birth be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions, especially cesareans — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women…

Even on its face, it’s a pretty inane explanation, but it is far worse when you substitute what is really meant:

You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should midwives be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions (most of which midwives cannot do), especially cesareans (which midwives definitely cannot do) — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women… not to mention the safest and the most highly desired by mothers.

Promoting normal birth is about one thing, and one thing only: promoting midwives. It has nothing to do with what is safest. The words safe or safety don’t even appear in the entire introduction to the midwifery textbook, which is fitting since safety is entirely irrelevant to the project of promoting midwives. As far as I can tell, using Google to search inside the book, the word safety doesn’t even appear until page 177 and then only to be used pejoratively (“An obsession with safety is characteristic of our age …”).

Insisting that women be cared for by midwives because midwives want employment and professional autonomy isn’t particularly persuasive. Insisting that women be cared for by midwives because only they can provide them with a “normal” birth (who wants an abnormal birth?) sounds a lot better. The key, of course, is to invest “normal” birth with a cachet beyond the word normal. That’s where all the stuff about birth warriors, empowerment and experience comes in.

Most women don’t fall for it. British women resent the fact that access to obstetricians is severely curtailed. They despise the fact that such practices have led to preventable injuries and deaths of babies and mothers. They are not alone. Dutch women go to other countries to give birth rather than settle for the midwife led care (and higher perinatal mortality rate) that is a feature of the Netherlands. The high mortality rate has led to a precipitous drop in homebirth, now down to only 13%. And the majority of American women, regardless of the availability of midwives, choose obstetricians. Indeed, there are not enough practicing obstetricians to accommodate all the patients who want them.

The fact that normal birth is a marketing term to promote midwives also explains the reflexive defensiveness of the RCM and their stone cold heartlessness in response to the cries of bereaved mothers and fathers.

As the Guardian notes:

The response of many in the midwifery profession has been characterised by defensiveness, rather than an open commitment to finding how far this problem goes and rooting out dangerous practice. The Nursing and Midwifery Council, responsible for regulating midwives, spent £240,000 on getting lawyers to redact information in response to a freedom of information request from Titcombe.

That is startlingly unethical behavior.

Even as it ends the campaign, its chief executive has denied there may be a link between it and the sort of dangerous practice seen in Morecambe Bay. One of its honorary fellows [Sheena Byrom] has announced she will launch her own “normal birth” campaign as a response to the RCM moving away from this language.

Regardless of who is injured, how many babies die, and how many mothers are left with empty arms, UK midwives will persist in promoting themselves. It’s hard to imagine anything more morally repugnant.

It’s tremendous vindication of everything I’ve been writing for years, but tragically it has come too late for countless babies, mothers and families.

The Royal College of Midwives has finally, FINALLY, been forced to end its Campaign for Normal Birth in abject failure. Oh, they successfully promoted “normal birth” alright. But they repeatedly sacrificed the lives of babies and mothers on the altar of unmedicated vaginal birth. British health authorities ultimately called a halt to the madness.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Morally bankrupt, blood drenched midwifery leaders, like RCM head Cathy Warwick and midwife Sheena Byrom, never cared about dead babies and I suspect they still don’t give a damn.[/pullquote]

As Clare Wilson, writing in The New Scientist, explains in Why Midwives are back-pedaling on natural childbirth:

In May, the UK’s Royal College of Midwives (RCM) quietly cancelled a long-standing campaign to promote natural births. Separately, doctors are beginning their own more proactive approach to ensuring interventions happen as soon as they are needed. And campaigners have formed a new pressure group called “Maternity Outcomes Matter” to ensure all healthcare staff prioritise safety over the process of childbirth.

What happened?

While it is sensible to avoid medical interference where possible, take this approach too far and childbirth becomes more dangerous, leading to brain-damaged babies and avoidable deaths.

Some of these occurred when women were denied caesarean sections even after begging for them.

It’s not as though these tragedies weren’t completely foreseeable. I first wrote about the Campaign’s death toll in October 2011 (Promoting normal birth is killing babies and mothers):

For years, the Royal College of Midwives in the UK has been on a relentless campaign to promote “normal birth.” We are now seeing the results, and they are nothing short of horrific.

Last month the focus was on Furness General Hospital in Cumbria where 6 babies and 2 mothers have died preventable deaths …

Lest anyone is tempted to conclude that this is a problem restricted to a single hospital, today’s newspaper reports demolish such wishful thinking…

Four women and seven newborns are believed to have died in the last 12 months on labour wards at the [Essex] trust’s hospitals.

But the RCM continued to promote their deadly ideology and babies continued to die.

In 2012 I reported on the financial consequences:

The 5.5 million babies born in England between 1 April 2000 to 31 March 2010, resulted in 5,087 maternity claims, involving payouts of £3.1bn, including legal fees…

The most frequent mistakes cited in claims involved management of labour including failure to recognise the baby was in distress from fetal heart monitoring equipment or delay in acting; caesarean section including mistakes and delays and cerebral palsy, where the baby is starved of oxygen at birth and sustains brain damage, often requiring life-long care…

The report said: “Unfortunately, many of the same errors are still being repeated.”

But the RCM continued to promote their deadly ideology and babies continued to die.

In 2015, the Kirkup report on the deaths more than a dozen babies and mothers at at Morecambe Bay was issued and it was a catalog of horrors.

Referring to the 5 deaths in 2008 alone, the report noted:

All showed evidence of the same problems of poor clinical competence, insufficient recognition of risk, inappropriate pursuit of normal childbirth and failures of team-working…

The midwives at Furness general were so cavalier they became known as “the musketeers”.

But the RCM continued to promote their deadly ideology and babies continued to die.

A different report published later in the year highlighted the fact that NHS errors leave 1,300 babies dead or maimed.

The NHS paid or set aside just under £1 billion [$1.5 billion] last year to settle 1,316 claims of negligence in maternity units, up from £488 million a decade ago, data from the NHS Litigation Authority show. The most costly claims involve babies brain-damaged during labour, who will require constant care for the rest of their lives.

One basic error accounts for a quarter of payouts, with campaigners saying it was a “scandal” that the health service was failing to learn from its mistakes. They blamed divisions between midwives and doctors, saying that the desire for “natural” births — without interventions — sometimes went too far…

But the RCM continued to promote their deadly ideology and babies continued to die.

And the financial costs continued to rise.

In May of this year The Guardian described a new report on liability:

The number of claims for brain damage and cerebral palsy has tripled in a decade, amid widespread monitoring failures…

… Since 2004/5, the value of claims against NHS maternity units for brain damage and cerebral palsy has risen from £354m to £990m, official figures show.

The cases – often linked with a failure to monitor babies’ heart rates, to detect risks of oxygen starvation – fuelled maternity negligence claims of more than £1.2bn in 2015/16 [$1.5 billion].

I asked at that time: how many babies have to die and how many billions of pounds have to be paid out before the morally repugnant, incompetently trained, self-dealing, deadly UK midwives are held to account?

That liability report appears to have been a tipping point. That was when the Campaign to Promote Normal Birth was quietly shuttered. The fact that the RCM has been silent suggests they hadn’t learned a damn thing and were pressured by higher authorities.

As Wilson notes in her New Scientist piece:

Thankfully, the bad RCM advice has now been taken down, although it’s a shame the midwives’ leaders have tried to do this quietly…

Back-pedalling on the quiet means news will spread more slowly to grassroots midwives and schools of midwifery. There is great variation in practice, and while there are many excellent midwives who prioritise safety, there are also those who may resist change.

If the RCM genuinely wants to reduce avoidable bereavements, it should shout about its change of heart from the rooftops. Most people think of medicine as a field where decisions are guided by evidence rather than ideology. That should be true for childbirth too.

I doubt the RCM has had a change of heart. Their morally bankrupt, blood drenched leaders, especially RCM head Cathy Warwick and midwife Sheila Byrom, have never cared about dead babies and dead mothers in the past and I suspect they couldn’t care less now, either.

The Campaign for Normal Birth was always at heart a campaign to benefit midwives, babies and mothers be damned. It was always about full employment, higher salaries and greater professional autonomy for midwives. If countless babies and mothers had to die to achieve that, Cathy Warwick, Sheena Byrom and the Royal College of Midwives were willing to let them pay the price.