I’ve been writing for years about the fact that UK midwives are running amok promoting “normal birth” and babies are dying. For years, the British media and the British population seemed uninterested, but now the death toll has become so high that even they cannot look away.
The Guardian reports in Exclusive: Baby deaths linked to lack of basic midwife training:
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]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?
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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].
Why? Among other reasons, it appears that UK midwives don’t know how to diagnose fetal distress.
Babies are dying and being put at risk of major brain injury because it is “commonplace” for British midwives to qualify without training in use of basic equipment, a senior coroner has warned.
The regulator for midwives has been told to reform the sylllabus for all trainees after a string of deaths of newborns following monitoring failures.
Hospital trusts have been advised to stop recruiting newly qualified midwives until they can prove they can perform foetal heart monitoring.
For example:
Baby Delilah Hubbard died two days after her birth at Leicester General Infirmary in March 2015. Although her mother Clara Bassford was classed as a “high risk” pregnancy, having had two previous babies prematurely, midwives failed to monitor her properly. After Ms Bassford warned that the baby was not moving, midwives tried to carry out checks. But they positioned the monitor wrongly – so that the child’s heart rate was not properly recorded. The NHS trust last year admitted that Delilah would have survived if staff had acted more quickly.
Baby Rupert Sanders died on Christmas Eve in 2012 after midwife Carol Marston switched off a heart monitor alarm 16 times during his birth. The midwife admitted to making “catastrophic” mistakes, failing to realise how severe the abnormalities were. Fellow midwife Anne Mather also failed to detect the gravity of the situation during the labour of first-time mother Lauren Sanders, at Stafford Hospital, the Nursing and Midwifery Council heard.
An investigation into maternity care at Shrewsbury and Telford NHS trust is examining the deaths of 15 babies and three women, including at least five cases involving foetal heart monitoring failures. The cases involve twins Ella and Lola Greene, stillborn in 2014, Graham Scott Holmes-Smith, stillborn in December 2015, the death of Kye Hall, at four days, in August 2016, and that of Ivy Morris, who died in May 2016, four months after her birth.
And that’s just the tip of the iceberg.
What, you might wonder, do UK midwives have to say about this?
Absolutely nothing.
As I recently explained, social media, particularly Twitter, allows UK midwives to recuse themselves from reality and reward themselves with a never ending round of dopamine-releasing 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.”
As far as I can determine, neither Cathy Warwick, head of the Royal College of Midwives, nor Sheena Byrom, a leader of UK midwives, nor any other midwifery leader has even bothered to mention the story thusfar. Instead their Twitter feeds are filled with self-congratulatory messages to each other on their promotion of “normal birth”.
What about their blogs?
Today’s RCM blog post is about the upcoming election and what the various political parties are promising to do for midwives and the NHS.
The post currently featured on Sheila Byrom’s blog is a guest post entitled — what else? — All this push for ‘normal birth’ – why I keep pushing:
As a consumer of the media, I see this – or some variation on this theme – so often. In a somewhat sinister twist, I occasionally see this one:
“Midwives endanger lives with their stubborn insistence on pushing for normal birth.”
I’m a third year student midwife, and a birth addict. In October last year, I attended the International Normal Labour and Birth Conference in Sydney, Australia. Seeing so many esteemed, brilliant and passionate people assemble to protect and promote normal birth was somewhat overwhelming, and possibly even more so was trying to keep up with it all on social media! Thousands upon thousands of tweets, Facebook posts and #normalbirth16 hashtags flooded the web, drawing many comments from people near and far…
Her response:
Because the move to protect normal birth is not, and has never been, about trying to conscript women into accepting less intervention, less Caesarian section, less pain relief in birth. The purpose of such advocacy is never about blaming women for their choices and experiences. The point of the exercise is NOT to make mothers feel like failures if their birth did not meet the ‘optimum’ recommendations. Birth is not, and should never be, a competitive sport.
Advocating for normal birth is NOT about holding women accountable.
Advocating for normal birth IS about holding birth workers accountable.
Surprise, normal birth is about midwives.
So don’t be fooled – advocating normal birth is not some crazy, midwife-led agenda to keep obstetricians out of work and see women suffer through difficult labour without pain relief (although that’s what some outspoken critics might have you believe). It’s true that many of the most articulate advocates for normal birth are midwives, but are midwives really that vicious?
But they ARE that vicious. At the same time the the NHS paid out £1.2bn in compensation for injuries and deaths, the Nursing and Midwifery Council (NMS) paid £240,000 to lawyers to keep the truth about baby Joshua Titcombe’s preventable death from his father James:
Now new documents reveal that the watchdog spent £240,000 on laywers – paid from subscriptions by nurses and midwives – on advice about how to respond to his attempts to uncover the truth.
The bereaved father sought information from the regulator, after the NMC refused to supply him with details of a review it had carried out, and correspondence to other regulators.
They also subjected James to a campaign of harrassment on social media.
For example:
Highlights include:
oh James-don’t let’s get on that roll again …
and:
getting out of bed in the morning has risks
Yes, James, how could you be so tiresome, always going on about the risks of childbirth and the babies who die as a result? Sheena is so over that.
Byrom ought to be ashamed of herself for the chilling way that she dismissed the father of a baby who died as a result of midwifery incompetence. But that would involve insight, compassion and a sense of responsibility, something in woefully short supply among UK midwives in general and Byrom in particular.
The latest revelations are hardly surprising given the appalling behavior of UK midwives in the past. All of which leads me to ask:
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?
Each one of those babies had a mom and a family that wanted them – each one, deserved better. It is heart wrenching to think of the toll that the whole normal birth push has taken. There are the deaths – but that is just the worst of it. Then there are the injuries, to both babies and moms. Top it off with a culture that reinforces it all – that demonizes certain decisions while stigmatizing the consequences of vaginal deliveries. Women deserve to go into the decision about birth plans informed of the advantages and disadvantages of each choice in their individual circumstance.
Shaun Lintern of the Health Service Journal has carried out a very good investigation into this (you’ll need to register to read it): https://www.hsj.co.uk/topics/policy-and-regulation/investigation-why-are-some-babies-dying-in-the-nhs/7018144.article
Sadly not surprising, and it’s about time a more reputable news source (beyond the Daily Fail) picked this up. I’ve just hit 36 weeks, and in the last couple weeks have noticed a serious uptick on my BabyCentre forum of people posting complaining that their midwives are writing bad information in their notes. Everything from one gal whose blood pressure spiked over 10 minutes and her MW wouldn’t write in the higher number, just kept re-measuring until it was lower again, MW’s writing in fundal heights without measuring, and writing baby is so-far engaged when they never felt mum’s belly. It really does make me rage.
Then add in I just found out a friend of mine, due next week, who had an utterly horrific first birth with her first has had her notes LOST (she doesn’t believe them, thinks is cover up, which given it was Milton Keynes during one of the spates of deaths Dr Amy has written about, I fully believe), I just can’t believe it’s taking so long for this to be picked up.
Can you privately hire a professional record keeper at your birth to ensure this doesn’t happen? If I or someone I cared about was in this situation I would want to look into this.
I hadn’t even thought of this… but we don’t have that kind of funding anyways. I’ve been approved for ELCS in ten days though, so am not too terribly worried, but if I go into labour beforehand I’ll definitely be bringing a notepad of my own.
This is excellent. Could not agree more. Maternal-fatal medicine has essentially become ultrasound. We need that subspecialty to be what it was originally meant to be.
“after midwife Carol Marston switched off a heart monitor alarm 16 times during his birth.”
How is this even possible? Where I trained, every strip was displayed on a monitor screen in the central station. It didn’t matter if the delivering provider was a midwife, family doc, resident or OB with 40+ years experience, the strips were up there for everyone to see. There was no way to hide a bad strip from other providers. There was no way to “switch off” an alarm. The whole ward knew if your patient was having a problem. And that’s the way I liked it.
I think it varies from trust to trust – it certainly wasn’t the case in Edinburgh when I gave birth last year, the traces were not hooked up to any central monitoring screen so any midwife could easily come along in response to an alarm, look at the trace, decide it was nothing to worry about and switch the alarm off without a doctor or anyone else at all being involved. They did it to me twice when my son’s heart rate set off an alarm by going above normal and that was not uncommon, just about everyone I shared a ward with had it happen to themat least once during their stay.
I was hooked up to a trace a number of times by different midwives and there was a fairly dramatic difference in how effective they were at even getting it in the right position. I felt MUCH better once I’d had an epidural and they hooked the baby up properly instead of having the crappy band that moved every time the baby did or whenever I had a powerful contraction.
They aren’t required to prove their handling of basic equipment?!… No wonder stillbirth rates in the UK are what they are.
Thanks a lot, midwives. That’s what I needed after a horrible, horrible day. Not required to handle basic equipment? My God.
I’m a student midwife in the UK. We are required to prove competence in handling basic equipment with numerous exams and demonstrations not to mention placements with sign off mentors. I’m afraid that this article is quite incorrect as the stillbitth rate has dropped and is a lot less than America’s. Though there is a lot of work left to do, I dont think that this article is particularly fair and quite wrong in its statistics. I can assure you that no midwife wants a mother to labour painfully if they can help it!
The last data (2015) available from the ONS shows that stillbirth rates in England are 4.3/1000 births, and 4.6/1000 births in Wales.
The UK measures stillbirths from 24 weeks.
The USA from 20 weeks.
The WHO from 28 weeks and the 2009 data showed the UK to have worse (3.5) rates of still birth than the USA (3.0) and most comparable income countries in Europe.
Using 2015 data the U.K. ranked 24th out of 49 high income countries for stillbirth, as per the Lancet.
What statistics were you using Ffion?
Are you sure you were comparing like for like?
We’re supposed to believe that you, as a STUDENT midwife, know more about this situation than the coronor?
The stillbirth rate has dropped since August 2016 when baby Kye died? How did you measure it? May I see your stats?
Actually, I have seen a midwife claim that a mother who died under her care at least had a beautiful spontaneous labour at home and her bereaved husband should remember that. Then, she tried to blame him for trusting her, the midwife, so I am quite doubtful re: your assurances that all midwives are so mindful of the mother’s comfort. Rose Kacary didn’t care about a mother’s DEATH.
I am ready to cut you some slack, tough. I don’t hold a starry-eyed student to the same strident expectations I have of a fully-fledged professional. But from what I’ve seen of your leadership, it’s rotten to the core and too busy providing work for midwives to place safety first.
“I can assure you that no midwife wants a mother to labour painfully if they can help it!” Sure – the problem is that rather than do anything about the actual pain they simply rename it “rushes” or “sensations” and try to persuade as many expectant mothers as possible that breathing slowly and deeply whilst bouncing around on a glorified spacehopper is all a REAL woman needs to get through labour.
So you offer epidurals at periodic intervals to women screaming in pain, then?
I’m afraid you are incorrect. I’m a paediatric pathologist, which means I do the autopsies on babies who are miscarried or stillborn. The UK stillbirth rate has not changed substantially in several years and its among the worst in Europe.
The last person I would want attending my labor is a “birth addict.”
When I hear the “Well, I read for pleasure and I get paid for it!” from an editor, I feel I know enough about them to try and keep my translated books as far as possible. They’re bound to miss a mistake or three. And I’m talking about books.
Really, birth addicts? A problem or three will definitely be missed here. Not with every patient. But for the one who draws the short stick, the consequences might be lifelong.
I’ve heard it said that the best paediatricians are those who don’t actually like kids that much. It means they approach a sick kid with ‘right, what’s wrong with you, then?’, rather than ‘ooh, poor baby, poor wee cherub, look at your poor chubby-wubby cheeks..’ I have absolutely no data for that though!
Like many professions, medicine requires detachment. There’s nothing wrong with finding babies adorable, but pediatrics requires practitioners to be able to evaluate evidence without being distracted by how cute they think babies are. (Pediatricians also have to be undistracted by how gross babies are – massive amounts of spit up can be quite inconsequential.)
Sort of like accountants who get excited about money are lousy accountants.
I am an emergency physician who finds cute babies and cute old people adorable, but I can also separate that feeling from the need to look objectively at what their health issues are. In general, medical training teaches you that.
As I’ve got older, I’ve also got better at engaging all sorts of people personally and learning what their needs are – which can vary from urgent resuscitation to reassurance and TLC.
I don’t think I would be a good doctor if I didn’t like people.
Interesting. I’m a pharmacist and I am dubious about medications, and I’m not the only pharmacist I’ve met who fits this description. I don’t think you necessarily can or should throw a drug at everything to make it better. They have their place but are not always the solution.
But I’m not sure what a pharmacist who loooves drugs would look like, aside from an addict… they don’t typically do well.
Exactly. I also don’t want my surgery performed by a surgery addict.
(In fact, isn’t that an argument of the NCB crowd, that OBs are just want to perform surgeries for the heck of it?)
Cathy Warwick is doing a webchat on Mumsnet tomorrow. You can leave questions for her now, if anyone is interested.
https://www.mumsnet.com/Talk/mumsnet_live_events/2933267-Webchat-with-Cathy-Warwick-RCM-Chief-Exec-on-Tuesday-23-May-at-12-45pm
12.45 UK time.
For the horrible guest-poster. An article comes out that pushing for normal birth is dangerous and your response is talking about how there were thousands of tweets with a normalbirth hashtag. *Are you out of your fucking mind?*
The response to a charge about a focus on normal birth being dangerous needs to be evidence about why normal birth isn’t dangerous. This is like going up to the podium of a debate on nuclear proliferation and saying, “Cheer if you like ice cream!” You can’t counter medical facts with facts about the popularity of a hashtag, you lunatic! You’re not making an argument! All you’re proving is that you don’t even understand what the argument is!
Seriously. Who would write #unnaturalbirth or #cesariansalltheway? And then there’re the ones who’ll write the same hashtag 37 times a day. (Although why would you do that?!?)
I’d like to see #cesareansalltheway trend. The mental image of thousands of NCBers spluttering tea and dropping monocles is hilarious!
I must say, the last person I would want anywhere near the birth of a child of mine would be somebody who describes themselves as a ‘birth addict’. That just does not seem to be a healthy attitude at all.
It’s bad enough when they claim that birth can be orgasmic. With these wackos, you start worrying, orgasmic for whom? It’s like it’s the birth attendant who’s having the orgasm.
Yup. For instance, I’m sure real addicts can’t be picky about where they source their stuff…they don’t care if it’s bad, they want what they want now.
Except a “birth junkie” midwife doesn’t hurt themselves in the slightest if they refuse to transfer a woman in an unsafe situation in their zeal to get their fix. It’s the woman and the baby who are hurt.
THERE YOU ARE!!! *ahem*.
Sorry. I was wondering where you had gone.
We just had an election in The Bahamas and I’m the chairman of one of the two political parties on my island. I’ve been busy. Also, we won. 🙂
Congratulations!
Also, I may be heading to the Bahamas this November. Any suggestions or can’t-miss ideas?
Well, it really depends on where you are going. If you are going to Nassau (the capital city) that’s one thing. If you are going somewhere else, I can help there, also.
It would be for a work trip (convention), with maybe a few days added on for vacation. The work part would have us at the Atlantis resort, which is in Nassau, but we’d stay somewhere else that wasn’t going to bankrupt us if we stayed extra time.
Look at the Comfort Suites on Paridise Island. It’s right next door to Atlantis (It’s actually closer to the Casino than some parts of Atlantis itself) and by staying there, you get all the rights to go everywhere in Atlantis at a much lower cost. See if you can manage a day trip to the Exuma Cays, you won’t be sorry.
Thank you 🙂
Just don’t swim with the dolphins at Atlantis
Congrats! (Since you don’t strike me as the type who in the US elected our dear mango.
Congratulations!
“Birth Addict” sounds like the new flanker for Dior’s Addict perfume.
Birthy smells and all that.
I’m guessing that she’s not so stoked about birth when the sunroof is involved. That tired old canard that “Cesarean isn’t birth.”
Midwives not knowing how to monitor the baby? Isn’t that like pretty much the most basic skill for midwives? That’s like a bus driver not knowing how to steer or an engineer not knowing how to do math. The mind boggles.
But if you’re an expert in “normal birth,” and every birth you attend is therefore “normal,” there is no need to monitor, as it will only hinder the natural progression of labor, and everything almost always goes fine, so why bother? Or so the logic goes, I guess.
Schroedinger’s Labor: the very act of monitoring it, changes it.
I don’t know if it’s changed, but at least when I was learning (and bear in mind I only DID the first year so only know what was supposed to happen in years 2 and 3) the midwifery degree was split…
Year 1: ‘Normal’ Birth, intro to all the physiology of normal birth, how to monitor baby and mum, what normal parameters were, community placements looking at ante and postnatal care of mum and baby etc…
Year 2: Abnormal, so common (and less common) illnesses of pregnancy, how to spot problems, how to manage problems, when to transfer care, how to manage pre-pregnancy illnesses in pregnant women etc…
Year 3: Back to ‘normal’ but with more independence, case loading, more responsibility etc…
Within all 3 years there was teaching on emergency procedures, and a constant ‘pressure’ on working within your scope of practice, and transferring care appropriately.
Monitoring a baby’s heart rate (whether by intermittent auscultation or EFM) was taught in 1st year and I would hope again in 2nd and 3rd years.
Saying that, the mentors for the course are made up of the midwives in the Trust, if there are issues there, there will be issues in the training 🙁
Also, I think the thing a lot of these midwives forget is that in the UK midwives look after high-risk women too, and that doesn’t make their labours ‘normal’ :/ An expert in normal has as much (if not more) responsibility to understand when normal ends and therefore where their expertise ends.
I feel like being an expert in ‘normal’ is entirely useless- an uncomplicated childbirth is so straightforward that taxi drivers with no training can and do deliver babies. The whole point of training is to be able to spot and respond to abnormalities and complications. Anyone can do it when things aren’t going wrong.
If you consider yourself an expert in normal, what exactly are you doing?
That’s what I mean, that their role is to spot when things are heading south and intervene themselves (if able) or transfer if they can’t fix it themselves.
“catching” babies, literally apparently.
I hate the “Let’s promote Normal Birth” If they mean We’re going to encourage you to not use any OB or hospital resources(pain meds, formula, C-section) so we can save $$$$$$$ and get rewarded for it then just say so
Exactly. My experience is in cattle births – but I could totally handle a “normal” cow birth before I knew how to open a gate. All I needed to do was stay out of the way.
After 5 years, I’m good at practicing within my scope. I can fix some very basic issues like a calf who might be suffocating in an amniotic sac or applying traction to a calf who is in the right position to get the back legs out a bit faster.
Anything more complicated and I am very good at getting a real professional to help the cow while I get the materials ready and move the other cows.
Again [this is getting boring, isn’t it?], in my time in the UK the parameters within which a midwife could function autonomously were extremely clear. The instant a patient crossed the line, an MD had to be in charge of the case, even though the midwife continued to be in attendance. So, while we cared for high-risk women, it was NEVER without medical supervision. It worked very well: a doctor knew, when he was called, that there was a valid reason, and the midwife had expert backup.
It does vary from unit to unit though. I was involved in a case (as the pathologist) where the mother delivered on a midwife led unit which was adjacent to a medically led unit. The way it operated was that the obstetricians could only come and look at a labouring woman with the permission of the midwife. The outcome was obviously that the midwife failed to recognise that the mother and baby were in difficulties for 5 hours, which ultimately led to the death of the baby. It was only after a shift change that the incoming midwife realised there was a serious problem and got hold of the doctor. If a patient crossed the line, medical backup was only available if the midwife recognised that.
Exactly this – thank you! The problem is that (as with CPMs in the US) UK midwives are increasingly stretching the definition of normal to include more and more dangerous situations. This is a particular problem with electronic foetal heart traces as the problems traces show can present pretty subtly sometimes on a trace and are therefore easy to miss/overlook if you’ve a mind to.
They really are! I was horrified to learn that a friend of mine who had her first baby at 43 was close to being classified as ‘normal’. She was happy about this because she’d been sold the BS about how lovely it is in an MLU – it was lucky she mentioned this to me so I could set her straight on where she was going wrong, but she was still too brainwashed to ask for an elective CS sadly and ended up on the ward but having a grim time trying to deliver ‘naturally’.
Same with my poor sister who is a size 6 and has the hips of a young boy – not quite sure how or why she was persuaded she wanted to ‘have a go’ at delivering a 10lb baby the old-fashioned way, but of course this happened, and the attempt no doubt cost the NHS a lot more than it needed to when she ended up having a crash section and my nephew had to be kept in the NICU for a week being treated to an infection sustained during the protracted ‘normal birth’ attempt.
Again, I will never give birth here in the UK. I want me and my family to live.
Imagine what would have happened if your friend had tried to give birth “naturally” in a MLU! Brrrgh!
I’ll never know what this obsession with being classified as “normal” is. My vision is “normally” short. My feet were “normally” broken. I actually had a midwife equivalent when I broke the first one (someone who wanted to keep me smiling more than he wanted to make sure I’d have no lasting damage or was simply unaware that the treatment was a must, no matter how much the patient dislikes the idea. He never told me that I needed it. The result was years of pain. The guy was substituting for the orthopedist while being some kind of surgeon.) Sure, go for normal if you can but it isn’t any kind of moral badge.
A friend of my mom’s had her first baby at 45. She was obese, with high BP and whatnot. She was treated as a high risk pregnancy. Ended up as a boring delivery. Never heard her complain that the doctors intefered too much because see? she did it at the end.
In my time, all British midwives were also registered nurses. There were no direct entry courses. I think it is important to note that.
I’m with you, Antigonos.
I can’t see how you could learn about abnormal physiology withour first working with sick people. Sepsis, shock and other acute complications are relatively rare in the childbirth population – you need experience in surgical wards, ED, ICU etc to become very skilled at detecting the early signs.
Or Birth Club. ” The first rule of Birth Club is ‘You don’t talk about Birth Club'”.
That certainly was not the situation when I was in the UK [nearly 40 years ago! How time flies!]
Minor nit: the link goes to the Telegraph, not the Guardian. Two different major UK newspapers.
Learn how to monitor the damn baby. Then monitor the damn baby.