False reassurance, the medical error killing new mothers


When people think about medical errors they imagine mistakes like prescribing the wrong medication, performing the wrong surgery, or leaving a sponge inside a patient. Sadly, there are many technical errors like this, but often the worst medical errors — and the most insidious — are the simplest. Indeed, it’s hard to imagine anything that kills more patients than false reassurance.

As I’ve followed and written about the ProPublica/NPR series on maternal mortality I’ve been struck by many pregnant and postpartum women have died or nearly died from false reassurance. Yesterday I wrote about how Serena Williams nearly died from a pulmonary embolus when the nurse falsely reassured her that her difficulty breathing was due to confusion from medication. ProPublica/NPR highlighted the case of Shalon Irving, who died of post partum pre-eclampsia after receiving multiple reassurances from a midwife that her weight gain, swelling and other symptoms weren’t anything to worry about. The series began with the story of the death of Lauren Bloomstein, a women in the throes of full blown HELLP syndrome (a variant of pre-eclampsia) who complained repeatedly about severe abdominal pain and was falsely reassured.

[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]We are falsely reassuring new mothers to death.[/pullquote]

“Listen to your patient, [s]he is telling you the diagnosis.”

Those are the words of William Osler (1849-1919) often called the Father of Modern Medicine for his contributions to the development of medical education. I first heard them from the chief of surgery at the beginning of my internship. It is almost always true, the patient is almost always telling you the diagnosis, but listening is harder than you might think. That’s because most patients are simultaneously offering a lot of extraneous information, and some patients are not complete or completely honest in the information they offer.

Listening is even more difficult on contemporary labor & delivery and postpartum floors as the societal emphasis has shifted from preventing deadly complications to crafting a birth “experience.” Listening is especially difficult for nurses in obstetrics who are are inundated with propaganda that unmedicated vaginal birth is superior, C-sections are a failure and that the most important postpartum nursing task is not saving lives but promoting breastfeeding.

OB and postpartum nurses, and to a lesser extent obstetricians themselves, have become experts in gaslighting pregnant and postpartum women.

Don’t worry; your baby isn’t moving less. He just has less room to move now.

Don’t worry; your headache isn’t serious. It’s just nerves.

Abdominal pain after birth? Don’t worry; that’s normal.

Or in the case of Serena Williams, this mindboggling exchange:

Short of breath off your daily anticoagulant that you take for a history of a near fatal pulmonary embolus? No, you’re just confused by your pain medication.

It’s as if everyone has developed collective amnesia of the fact that pregnancy, in every time, place and culture (including our own) has ALWAYS been one the leading causes of death of young women.

Everyone involved in the care of women giving birth should have a high index of suspicion for life threatening complications and instead they’ve been fooled into developing a low index of suspicion. As ProPublica noted:

Earlier this year, an analysis by the CDC Foundation of maternal mortality data from four states identified more than 20 “critical factors” that contributed to pregnancy-related deaths. Among the ones involving providers: lack of standardized policies, inadequate clinical skills, failure to consult specialists and poor coordination of care. The average maternal death had 3.7 critical factors.

Maternal deaths and serious complications often involve a myriad of these factors, but the most important is the one that isn’t mentioned: the low index of suspicion. You can’t diagnose a complication if you’ve been taught that complications are rare and doing nothing is the best response. When providers falsely believe that pregnancy is inherently safe when in reality it is inherently dangerous, nurses and even some doctors will insist that everything is fine even while a woman is dying before their eyes. Complacency is deadly.

This complacency is driven by ideology, not by science. Gallons of ink have been spilled on advancing the obsessions of privileged, mostly white women — the C-section rate, the induction rate, epidurals and promoting breastfeeding — while ignoring the deadly problems that are literally killing new mothers: cardiac disease in pregnancy, pre-existing chronic conditions, hemorrhage and blood clots. What’s worse is that when women present with these deadly complications they don’t get lifesaving medical care, they get gaslighted.

The single most important factor in diagnosing life threatening complications is listening to patients. Instead we are falsely reassuring them — to death.

101 Responses to “False reassurance, the medical error killing new mothers”

  1. baby-paramedic
    February 26, 2018 at 5:31 am #

    I sometimes rub my colleagues the wrong way because I have this whacky tendency to treat my female patients as humans, as opposed to fat and/or crazy aberrations.
    It is incredible how many female patients actually have something medically wrong… and are dismissed.

    • kilda
      February 26, 2018 at 9:49 am #

      that’s like my magic secret for getting along so well with the nurses at every hospital I’ve worked at – I treat them like humans. Other doctors have seriously asked me what my trick is.

  2. Lurkerette
    January 17, 2018 at 12:27 pm #

    MIsogyny writ large, when the consequences can be especially deadly. I’m lucky to have had very good practitioners, but I had to insist that I was in labor when I walked into the hospital at 11PM with my second. I guess I didn’t look like I was in enough pain? But lo, the nurse humored me (I’m sure she thought I’d go home) and I was 7cm. I can’t be that unusual.

    • Tigger_the_Wing
      January 18, 2018 at 6:15 am #

      You’re not unusual at all. The more I read the experiences of people on this site, the lower my opinion of midwives in general; and the less inclined I become to think that my negative experiences were bad luck or misinterpretation on my part.

    • Bugsy
      January 20, 2018 at 12:31 pm #

      I was sent home in my first labour (38 weeks, 5 days) for exactly that reason despite the fact that I was having contractions 5 min apart and period-like bleeding. Little guy arrived 8 hours later, after I insisted on returning to the hospital and being admitted. They didn’t think I was in labour with #2, either…but lo and behold, that one arrived 2.5 hours after I was admitted.

  3. PeggySue
    January 16, 2018 at 3:52 pm #

    So a bit off topic but I have been amusing myself in the evenings watching the odd episode of the British series One Born Every Minute on my phone. While the midwives seem much better about providing pain relief than some British midwives have been described, they do seem a little, I don’t know, young. In one hospital, one gets the impression of a group of giggly schoolgirls who can’t wait to have their own partners and babies. The model of care is different to the US, of course, no issue there. But here is a question: one episode featured a couple coming in for induction with a baby who had been diagnosed at a 20 week ultrasound with a right-sided hiatal hernia. She was induced, baby was born and lived for six days. I wondered why the baby had to undergo the stress of delivery–is a hiatal hernia one of those problems for which mode of delivery really makes no difference? Would doctors in the US have recommended C-section delivery or would vaginal delivery been equally safe for the child?

    • Haelmoon
      January 17, 2018 at 2:23 am #

      Probably a right sided diaphragmatic hernia. If right sided, the liver ends up in the chest and the prognosis is very poor (no rooms for the lung to development). Depending on the age of the induction, c-section would not be an option (mid second trimester inductions, a type of pregnancy termination. The alternative is a destructive D&E, not a c-section). There is no advantage to the baby to be born by c-section if the plan is palliative and not going to operate. Then the risk benefit favours labour over a c-section unless there is a maternal indication for c-section. Labour isn’t bad, it just has risks. If the baby is going to die anyways, why increase mom’s risk wither a c-section.

      • PeggySue
        January 17, 2018 at 12:48 pm #

        Thanks, this clarifies, this was a term birth of a very wanted baby, aggressive treatment was the goal and hope, but he simply did not have enough lung.on day 6 a comfort model was started, and he died in his parents’ arms.

  4. Kim
    January 16, 2018 at 8:31 am #

    The Guardian has an interesting piece on why women in labour are often turned away from hospitals and told they’re not “really” in labour. Some eye-watering comments below the line, too. https://www.theguardian.com/lifeandstyle/2018/jan/15/i-knew-i-was-in-labour-why-are-women-being-turned-away-from-hospital-during-childbirth

    • attitude devant
      January 16, 2018 at 3:10 pm #

      Woah. Am I getting this straight: they don’t even monitor the babies and sometimes they don’t check cervices?

      • Mattie
        January 17, 2018 at 4:40 am #

        Yep, it’s true, and it absolutely should not happen.

      • Lilly de Lure
        January 17, 2018 at 7:24 am #

        Yep – they’ll only monitor the baby if they decide they have a prior reason to believe there may be something wrong with the baby. I wish the very best of luck to any pregnant mother trying to convince them of that in practice (reporting reduced movements and bleeding does not cut it in my experience).

  5. attitude devant
    January 15, 2018 at 11:57 pm #

    Holy moly! Totally happy surprise! Samantha Bee’s January 10 episode addresses maternal mortality in the US and ties it to lack of access to quality care in rural areas. I’d embed a link but I’m clueless in that stuff

  6. attitude devant
    January 15, 2018 at 12:49 pm #

    Only the wee-ist bit off topic:

    On this MLK day, if you want to make a difference, consider collaborating with or donating to Black Mamas Matter (www.blackmamasmatter.org) a fairly young organization advocating for improved maternity care for WOC in the US.

    Thanks for giving them your attention!

    • yentavegan
      January 15, 2018 at 3:15 pm #

      Forgive my privilege…but is this a front for lay midwives?

      • Heidi
        January 15, 2018 at 3:41 pm #

        I clicked around on some of their PDFs and can’t see anywhere that they are advocating lay midwives.

        • yentavegan
          January 15, 2018 at 7:10 pm #

          There is a quote about supporting traditional birthing practices that kind of got my hair on edge…maybe I am too primed for seeing monsters under the bed

      • attitude devant
        January 15, 2018 at 3:43 pm #

        I’m mortally certain they are not.

  7. BeatriceC
    January 13, 2018 at 4:17 pm #

    Totally and completely off topic: Guess what today is??? If you don’t count a short relapse in the summer, today is the first anniversary of finally succeeding in quitting smoking. I’ve never quit this long if I wasn’t pregnant or nursing.

    • Tigger_the_Wing
      January 13, 2018 at 6:36 pm #

      Awesome! Well done! That is a great milestone, I’m impressed. I’ve never smoked myself, but I’ve known several smokers in my life and it has been a struggle for each of them to give it up. My husband admitted only yesterday that he still thinks of himself as a smoker who just won’t have a smoke today – and he gave up forty years ago.

    • Empress of the Iguana People
      January 14, 2018 at 8:55 pm #


    • Russell Jones
      January 15, 2018 at 1:44 pm #

      Outstanding, BeatriceC! Quitting is a brutally difficult thing (I quit 9 years ago after a heart attack, quintuple bypass surgery and pacemaker implantation, and quitting was hard as hell even after all that bullshit.) Respect.

    • Roadstergal
      January 15, 2018 at 1:51 pm #

      Wow, congratulations! What a great accomplishment! Do something nice for yourself? 😀

    • KeeperOfTheBooks
      January 15, 2018 at 11:23 pm #

      Good for you!!!! I remember when my dad quite cold-turkey from 5 packs a day…it wasn’t pretty, but it WAS enough to keep me from every trying to smoke. Much applause! Go buy yourself something very nice to celebrate!

      • BeatriceC
        January 16, 2018 at 3:04 pm #

        MrC bought the the family annual passes to a theme park I love. I bought them last year, but couldn’t really afford them this year. (We have his, hers, and ours finances…stuff like this comes out of individual funds.)

        • KeeperOfTheBooks
          January 16, 2018 at 3:44 pm #

          Yay MrC!
          (And we handle money somewhat similarly here.)

    • Sarah
      January 17, 2018 at 12:38 pm #

      You don’t count it. Well done. Think of all the money you’re saving!

    • Christy
      January 17, 2018 at 2:43 pm #


  8. Kris
    January 13, 2018 at 1:26 am #

    Help educate me a little. If you’re dying postpartum, isn’t that eclampsia? Pre-eclampsia is a concern because it progresses to full-blown eclampsia, which is often fatal, right? What do I have wrong here?

    • Pcogale
      January 13, 2018 at 5:48 am #

      Eclampsia is when you start fitting. Pre-eclampsia is the bit before you start fitting. However you can have some pretty life threatening things happening to your body with pre-eclampsia (which is the same as eclampsia, just without the fitting).

      • Daleth
        January 14, 2018 at 2:03 pm #

        And “fitting” is British for “having seizures.” Just a little clarification for the Yanks here.

        • Roadstergal
          January 15, 2018 at 1:57 pm #

          Thanks, I needed that! I was thinking it was something… about… clothes??

          • Casual Verbosity
            January 17, 2018 at 5:41 pm #

            Yes once you start walking around with a tape measure and some tailor’s chalk, then you know you’re in trouble.

  9. CSN0116
    January 12, 2018 at 5:17 pm #

    OT: I just found myself quoted on the page “Apologists say What?!” Ummm what is it? It only has like 30 members and they seem to only discuss Dr. Amy’s posts and our replies to them. Not that I much care, but is it like Brooke and a few cronies? It seems to be in direct and sole response to this page. I don’t see much else discussed…

    • momofone
      January 12, 2018 at 7:31 pm #

      I bet Anna Perch is there; she threw “apologist” around constantly.

    • BeatriceC
      January 12, 2018 at 7:50 pm #

      Brooke, Fishy Face (whoever that was), and one other person, I think, I recall throwing around the term “apologist”. Morons.

    • Heidi
      January 12, 2018 at 7:52 pm #


    • Sheven
      January 13, 2018 at 1:25 pm #

      An “apologist” is someone who defends a controversial viewpoint. Their strategy, therefore, is right out of the propagandist’s playbook–accuse your opponents of whatever you’re doing.

  10. Dr Kitty
    January 12, 2018 at 4:58 pm #

    If you believe in sending good thoughts and prayers, please send them for my friends, M&H, desperately trying to keep their baby son inside for as long as possible at 23+3.

    • BeatriceC
      January 12, 2018 at 7:49 pm #

      Been there, done that. They have my best wishes (I am not a thoughts and prayers kind of person.) This is a hell of a stressful place to be.

      • Dr Kitty
        January 14, 2018 at 6:24 pm #

        It is.
        They’ve made it to 48hrs so far, which is at least time to have steroids and antibiotics. They’re hoping to make it to another 48 to get to 24 weeks. Time will tell.

        • Tigger_the_Wing
          January 15, 2018 at 1:18 pm #

          Here’s hoping for the best of all possible outcomes.

          • Dr Kitty
            January 18, 2018 at 4:06 am #

            B.B. arrived safely yesterday at 24+1, and just over 600g.
            He’s holding his own so far. Time will tell.

          • Tigger_the_Wing
            January 18, 2018 at 5:51 am #

            Goodness, how tiny! Thank you for the update. I hope not only does he continue to hang on, but that he thrives and grows strong. It is amazing what can be done for such tiny preemies these days.

          • Lilly de Lure
            January 18, 2018 at 5:52 am #

            Thanks for the update – hoping for all the best for him!

          • Mishimoo
            January 18, 2018 at 8:28 am #

            Good luck to the tiny baby! Thinking of his parents (and you), hope things turn out amazingly well.

    • KeeperOfTheBooks
      January 12, 2018 at 9:52 pm #

      Thoughts and prayers heading their way.

    • The Vitaphone Queen
      January 14, 2018 at 9:42 pm #


  11. Emilie Bishop
    January 12, 2018 at 4:30 pm #

    “Listening is especially difficult for nurses in obstetrics who are are inundated with propaganda that unmedicated vaginal birth is superior, C-sections are a failure and that the most important postpartum nursing task is not saving lives but promoting breastfeeding.”

    This right here. And for that last item, I would add the baby’s life is also less important than breastfeeding promotion. If this weren’t true, my IGT would have been disclosed to me by the numerous LCs who noticed it and my baby would have been fed. Our calls to the hospital nurse line and breastfeeding center would have sounded alarm bells instead of reassuring us nearly to my son’s death that he just needed to keep nursing. These dismissive attitudes toward both mothers and their newborns are two sides of the same misogynistic coin. Both disgust me more than I can express.

    • KeeperOfTheBooks
      January 12, 2018 at 10:09 pm #

      Or mom’s life, for that matter.
      I’m nearly 30 weeks along, and found myself in a hospital–not the one at which I plan to deliver, long story there–with one hell of a kidney infection last week. Yay Rocephin, Ancef, and sundry other antibiotics! If I ever meet their respective creators, I shall keep them in a lifetime supply of homemade fudge. I digress.
      Please note that at no point in all this did I have so much as a single contraction, vaginal bleeding, concerning fetal monitor strip (and they did plenty of ’em), etc that might indicate I might deliver at this hospital.
      Nonetheless, I had at least two of my nurses ask about whether I was going to breastfeed, and at least one, possibly two (the admissions process is now a bit hazy) want to know *why* I’d had two C-sections, and not from a “any weird medical history we need to know about if you go into spontaneous labor?” perspective, either. (That, of course, I wouldn’t have minded at all.)
      I will give them that they backed the heck off when I gave them a polite-but-firm explanation on both issues, incorporating PPD/A into the breastfeeding one, but…seriously?! I’m peeing blood, and you’re worried about whether I’m planning on breastfeeding?

      • momofone
        January 12, 2018 at 11:45 pm #

        Well, clearly if you’re not going to breastfeed, there’s no need to waste the antibiotics on you.

        (sarcasm, of course)

        • The Bofa on the Sofa
          January 13, 2018 at 11:03 am #

          You’re going to breastfeed, so we’ll give you some less effective antibiotics.

          • Roadstergal
            January 15, 2018 at 1:59 pm #

            Kidney infections are great for the microbiome!

          • KeeperOfTheBooks
            January 15, 2018 at 11:25 pm #

            I mean, who needs functioning kidneys, as long as their breasts are functioning? *rolls eyes*
            Me, I’ll take my apparently “for decorative/Adult Fun purposes only” breasts plus kidneys that do as they’re supposed to for $500, Alex.

        • KeeperOfTheBooks
          January 13, 2018 at 8:55 pm #


        • Sarah
          January 15, 2018 at 3:35 pm #

          Yes, and also if you are going to breastfeed, we can’t give you antibiotics in case microbiome.

      • Mariana
        January 13, 2018 at 11:11 am #

        maybe they were concerned about mediation that would not be safe for breastfeeding moms?

        • KeeperOfTheBooks
          January 13, 2018 at 8:55 pm #

          It’s a possibility, I suppose, but it wasn’t the impression I got from the nonverbal cues.

      • January 13, 2018 at 2:37 pm #

        I remember being SO angry when I was admitted into the high-risk L&D unit for observation while they were awaiting my blood test results (e.g., the short period of time when I was diagnosed with severe pre-e but not HELLP yet) and the nurse was asking me all sorts of dumb delivery preferences interspaced with real medical questions. It was like:
        “Do you have a history of lung disease? ….. “Do you want skin-to-skin after birth?….. Any kidney issues? Bleeding issues? ….. Are you planning on breastfeeding?”

        I kept replying “I have no idea; I’m only 26 weeks pregnant.” That wasn’t an answer that could be coded using the pull-down menu so I alternated between “yes” and “no”.

  12. Emil Sinclair
    January 12, 2018 at 4:14 pm #

    My first son was 2 weeks early by spontaneous labour, so I expected No 2 to have a similar cooking-time. When I went to see my private OB’s colleague (mine was on holiday), he did an ultrasound and tut-tutted about how we should maybe consider induction, the baby’s just getting bigger and that’ll make it harder for me, do I really want that? Until I told him that I’m a doctor, at which point he said – look, as you approach your due date then go beyond, the risk of stillbirth from placental failure goes up and up, and your placenta’s starting to calcify.

    Why the heck wouldn’t he just be honest in the first place? Something is wrong if women are more worried about the pain of a ‘big’ baby than the risk of fetal demise. I chose to be induced.

    Son No 2, for his nearly 2 weeks of extra gestation, weighed a whopping 9 grams more than his brother.

    • January 13, 2018 at 5:08 am #

      There are a number of factors in play here. Patients do not always react positively to well meant warnings. They are seen as attempts to intimidate patients, to pressure them into “unnecessary interventions,”, to “cover themselves” in the event something goes wrong. It’s often hard for those of us “in the business” to understand how the lay public can be so medically ignorant or misinformed. Big baby? Isn’t that evidence he’s healthy?

      I often have to tell doctors in other specialties that while I’m a midwife, my last contact with other branches of medicine was in 1965, and they should not assume I’m better informed than the average patient — especially in a field like orthopedics. I want to be told everything.

      • Emil Sinclair
        January 13, 2018 at 5:29 am #

        You’re right. I have always felt that dealing directly with the truth is the best approach as anything less is essentially a waste of time. I understand that others don’t feel that way, though I have to admit that I don’t understand why they don’t feel that way.

        • Mariana
          January 13, 2018 at 11:25 am #

          What I don’t like is when doctors assume I won’t understand what the issue is and talk to me like I’m 5. Or tell me things in “installments”. Like when I found out in the operating room that I would have to spend the night in the hospital after the tonsil surgery. Why didn’t the doctor tell me that when I asked how long I’d be in the hospital for? Why wait until the minute before the surgery? I understand it would (and was) better for me to spend the night there getting fluids and being checked on, but if he knew that 1 min before the surgery, he knew it the week before… why make me wake up from surgery stressed that I now needed to arrange for childcare for the evening too?

          • Emil Sinclair
            January 13, 2018 at 4:34 pm #

            Agreed. It is difficult in any profession, I think, to communicate effectively with your patient/client/customer, but more jargon, more emotion, and bigger consequences make it even harder. When I was young, my own GP was consistently 1-2 hours late but I stuck with him – one of the reasons was that I never felt talked down to and I always left feeling like I knew what I needed to know.
            The situation you describe is quite inconsiderate. Last-minute arrangements for overnight childcare? Thanks, doc.

          • Casual Verbosity
            January 17, 2018 at 5:47 pm #

            That’s so bizarre. It’s standard practice for adult tonsillectomy cases to spend a night in hospital as they have a greater chance of bleeding. Information like when you can go home is just something that you tell people. I used to work as a specialist medical secretary in ENT, and the doctors would tell you that, we would then tell you that, and the hospital would tell you that: when you booked in, when they confirmed your arrival time the day before surgery, AND when you checked in for surgery… The only thing I can think of is that your doctor thought “Well someone’s bound to tell you at some point”, but that doesn’t excuse withholding that kind of information. And you don’t tell someone vital information just before you put them under, because there’s a decent chance they won’t remember it when they awake.

      • Pcogale
        January 13, 2018 at 5:54 am #

        And following on from that, if someone tells you that they are a doctor, you can’t assume that they know everything and you don’t have to explain stuff to them, say, if you are a nurse looking after them. Talking about midwifery stuff – they may be the best anaesthetist the hospital has, but they have no idea how to bath a baby, or change it’s nappy so often really appreciate the real basic stuff. But often what can change is the language that you use once you find out that they are a health professional – doesn’t mean that you don’t still need to go through the information.

    • EmilyC
      January 17, 2018 at 11:54 am #

      My wonderful OB drew me a graph to illustrate the risks of stillbirth after 39 weeks. I’m not a medical professional, just an inquisitive patient.

  13. MaineJen
    January 12, 2018 at 3:33 pm #

    You know what I’ll bet we *won’t* find on that list of 20 critical factors? “Using less technology to perform less monitoring, having as little knowledge of the situation as possible.”

    In none of these cases (Serena Williams’ especially) would LESS monitoring and testing have helped. The midwife-led model of care (or worse yet, home birth or birth center) would have meant certain death.

    • lawyer jane
      January 12, 2018 at 4:23 pm #

      I’m having a debate about the “midwifery model of care” and maternal mortality on a message board I frequent. Apparently they think that midwives just inherently listen better to mothers, so the answer is simply “more midwives,” full stop.

      • Amy Tuteur, MD
        January 12, 2018 at 5:25 pm #

        Midwives were in charge of childbirth for the past 50,000 and they didn’t make a dent in maternal mortality. Modern obstetrics dropped maternal mortality over 90% in less than 100 years.

      • Casual Verbosity
        January 12, 2018 at 5:27 pm #

        I imagine that the people who are arguing that midwives inherently listen better to mothers are people who already agree with the birth ideology that most midwives espouse. Thus, to them it seems as though they are being listened to because they’re on the same page as their midwives. But ask a group of women who wanted an epidural or any other intervention and you’d find that they weren’t listened to. You can hardly argue that midwives listen to mothers if they only listen to the ones who already agree with them.

        • Lilly de Lure
          January 17, 2018 at 7:19 am #

          You have just put your finger on precisely the problem with the UK maternity care system as it currently stands. During your pregnancy, if nothing goes wrong, they say they’ll listen to you and that you should trust your instincts, but when you are actually in their care you find they only listen to what they want to hear. If you’re a woman who is telling them that then they’ll be as responsive, sympathetic etc as you could wish but if you aren’t expect them to be dismissive, aggressively condescending and to generally bring out a model of care apparently inspired by the Aunts from the Handmaid’s Tale.

          • Casual Verbosity
            January 17, 2018 at 5:37 pm #

            It shouldn’t be so difficult to trust your care providers. I think the problem lies in the fact that midwives are the gatekeepers to the real experts. Thus, they get to decide if your concern is valid enough to pass it onto the obstetrician. They get to decide if your pain is bad enough to call the anaesthetist.

          • Lilly de Lure
            January 18, 2018 at 4:39 am #

            Exactly – the official line is always that the midwives will call the specialists in if there is anything to worry about but when they shut their eyes and ears to the signs that things are going pear-shaped its a terrifying experience (and the more you try to persuade them that no, there really is a problem here the more they label you as hypochondriac/ would be fine if only she trusted her body and the more determinedly they ignore the problem). When I experienced it it was a real shock to realise that in order to keep my baby safe I was going to have to work against the midwives, not with them every step of the way.

  14. Sheven
    January 12, 2018 at 3:22 pm #

    It must be so terrifying, feeling something very wrong with your body and having the very people are supposed to help you deny it.

  15. Ally
    January 12, 2018 at 12:37 pm #

    As an intensive care doctor I can only stand up and give you a long, slow clap.

    Sadly, the women we admit from the L&D and obstetrics floor come to us after suffering worrying symptoms for far too long while being gaslighted by midwives. They keep eveything under wraps until a serious medical emergency can no longer be denied, often because the patient collapses or loses consciousness.

    We have resuscitated women with coronary artery dissections after hours of being tutted at for nagging about their ‘acid reflux’ chest pain.
    We have intubated mothers with pulmonary edema from full-blown postpartum ecclampsia with the midwife still prattling in my ear about the patient’s ‘hysteria’ and ‘hyperventilation’
    We have called the massive transfusion protocol while flat-out running to the OR with a bleeding liver rupture mere hours after the HELLP mom had received the advice to take a paracetamol and stop nagging about her RUQ pain (it had to be gas, of course!).
    And don’t get me started on the dazzling array of ridiculous explanations I have heard from midwives over the years for why blood gasses were unnecessary for what turned out to be postpartum pulmonary embolisms and peripartum cardiomyopathies. Those silly hysterical little ladies, always going on about their so-called shortness of breath…

    There is something seriously wrong with the way midwives are trained (indoctrinated?).

    • The Bofa on the Sofa
      January 12, 2018 at 12:54 pm #

      This is thinking about it from more of an ER doc point of view. Someone comes into the ER complaining of symptoms, step 1 is to rule out the most serious potential causes first. If you rule out the serious possibilities, then whatever left, whatever it is, is likely not serious.

      The midwives are going the other way. Assume it’s not serious until it’s basically too late. Because, you know, your body was made for giving birth and if post-partum problems were really an issue, we would have died out. Therefore, we can just dismiss their concerns.

      The problem is, they usually are right. But when they are wrong, the consequences are deadly.

      • Ally
        January 12, 2018 at 1:45 pm #

        If tea and sympathy is basically all midwives are willing or able to provide, what exactly is the reason for their continued existence as a profession?
        Our hospital cafetaria staff does tea and sympathy a lot cheaper, and as an added bonus they DO call for help when someone in their establishment cannot breathe.

        • January 12, 2018 at 1:59 pm #

          Man, you just summarized why I preferred giving birth at a hospital under OB care first followed by a second best option of in the back seat of a taxi or at the farm.

          For the second option, at least the people around me would KNOW they were in over their heads, do whatever the 911 operator told them to do, and would not impede first responders from helping.

          • Amazed
            January 12, 2018 at 2:39 pm #

            Let alone the fact that having once reached the hospital, you’d be treated as a potential serious case, checked, and NOT marched to the postpartum unit to nurses for reassurance because hey, women have been giving birth since the beginning of time!

        • The Bofa on the Sofa
          January 12, 2018 at 2:30 pm #

          If tea and sympathy is basically all midwives are willing or able to provide, what exactly is the reason for their continued existence as a profession?


          “Trust your body, trust your body
          T R – UST
          B O D Y”

          “I trust my body, yes I do
          I trust my body, how ’bout you?”

          “Lean to the left
          Lean to the right
          Trust your body
          Fight fight fight”

        • Russell Jones
          January 12, 2018 at 2:46 pm #

          Tea, sympathy, and a promise not to interfere! Gotta hand it to midwives. They possess P.T. Barnum levels of bravado and huckstering skills.

          Midwife: “I swear by God and sonny Jesus, I ain’t gonna do jack!”

          Rube: “SWEET! *grabs checkbook* How much?”

          • laywer jane
            January 12, 2018 at 4:26 pm #

            Speaking of tea, can we import the post-labor tea and toast tradition to the US? That’s a USEFUL intervention we could all use more of. All I got was a horrific cold turkey sandwich. I even missed the candy stripers who were bringing around coffee.

          • January 12, 2018 at 8:31 pm #

            I missed the dinner hour, but some lovely nurses warmed up a couple of personal pizzas for me in the Natural Birthing Suite kitchen.

          • KeeperOfTheBooks
            January 12, 2018 at 9:56 pm #

            And cake! Someone on here posted about a L&D ward in the UK that would bring around tea, toast, and cake. In the exceedingly unlikely event that I’m ever in charge of a L&D/postpartum ward, I am TOTALLY implementing that.

          • lsn
            January 13, 2018 at 5:44 pm #

            The maternity ward (including the high risk room I was in for two weeks) had cake at afternoon tea time. Also – and I am very grateful for this – if you were in for longer periods you could order off an a la carte menu rather than the 9 day rotating menu. Given some of the women in the high risk room with me were there for months it was just nice to have more of a choice. (Apart from the poor woman who was fructose-intolerant and had GD – I think she had about three options total. On the one hand she wanted to get as far as possible gestationally speaking, on the other she was counting the days until she could eat more foods.)

          • KeeperOfTheBooks
            January 13, 2018 at 8:56 pm #

            Cake at tea time=very sound thinking, IMNSHO.

          • Empress of the Iguana People
            January 12, 2018 at 10:11 pm #

            My best friend fetched me _good_ tea when I’d had my first. It was MARVELOUS.

          • FormerPhysicist
            January 13, 2018 at 5:27 pm #

            My brother brought me chicken broth. I’d been craving it, and answered when he asked what I wanted.

          • Mariana
            January 13, 2018 at 11:31 am #

            I has tea and biscuits here in Brazil. Lovely and very civilized, if you ask me. Best tea and biscuits ever (they were really mediocre at best… but I was hungry), and I wasn’t even exhausted from pushing! (Csection)

        • guest
          January 12, 2018 at 5:08 pm #

          People love tea and sympathy.

          I had wonderful prenatal care from a nurse practitioner/CNM who insisted on constant check ups and monitoring. She took no chances.

          But when 41 weeks came and went I had to have an emergency induction, then C-section, I felt so angry, and frustrated. I was not prepared for my emotional response.

          I hated the monitors, the epidural, the IVs, my movement being restricted. It brought up the hurt of every bad experience I had ever had with a doctor in my past – and there had been a few. I hated my own body for betraying me and never starting labor naturally. It was the last bit of control and autonomy being stripped away from me after ten months of a truly miserable pregnancy.

          My rational mind knew that it was the best and safest option, but in that moment, all I wanted was somebody to tell me that I was still strong, and capable, and if I just endured the pain bravely, then everything would be fine. But nobody said that – the nurse midwife was bluntly honest. I hated her brusque bedside manner, even while I grudgingly admired her for it.

          So while I would do it all again to bring my daughter into the world safe and healthy, I can understand how the warm fuzzy homebirth attended by lay midwife cheerleaders looks very attractive. It gives you back all the illusion of control and safety.

          • Emilie Bishop
            January 12, 2018 at 10:14 pm #

            I can totally see how you arrive at those feelings. I think everyone needs someone in their life to reassure them no matter what. This was why I had my husband and one of my best friends both with me when I had my son–my husband is too honest, my friend can put on the happy face if she senses I need it. I just don’t think that person needs to be a medical professional. They have another role to play.

          • KeeperOfTheBooks
            January 12, 2018 at 10:31 pm #

            Right there with ya. I’d have the CSs I had with my kids all over again to get them here safely. Period. Nonetheless, I do wish I’d had someone to say warm fuzzy stuff to me in the process, and I totally see the appeal of the “your body was made to do this, you’re amazing!” birth in a giant tub by candlelight even while knowing that would be 110% the wrong decision.

          • Steph858
            January 13, 2018 at 12:25 pm #

            I’d HATE that. I hate it when I catch a bad cold. Mostly because I feel like crap, but partly because I get precious little sympathy. “It’s just a cold; take some paracetamol and get on with it like the rest of us!” You know the stereotype of ‘man flu’, as summed up in this video? That’s me whenever I catch a nasty rhinovirus. If I was in labour and some supercilious midwife tried telling me, “It’s just giving birth. Women have been doing it since time immemorial so you’ll be fine; stop moaning and get on with it!” I would NOT be impressed, even if she turned out to be right in the end.


          • KeeperOfTheBooks
            January 13, 2018 at 8:59 pm #

            Right. Exactly.

    • Dr Kitty
      January 12, 2018 at 5:10 pm #

      My concern with midwives is that they often seem to be concerned about the wrong things.

      The lady diagnosed with pneumonia at 39W, who has improved with a standard course of oral antibiotics and had an interval CXR planned for 4 weeks postpartum was told by her midwife at 3D postpartum that it was dreadful that she was “abandoned” and needed to get more antibiotics and an immediate CXR from me! Thankfully patient was very sensible and understood the rationale for the management plan.

      Meanwhile that lady with complete dehiscence of her 3rd degree tear at 2 weeks post natal was told that “it’ll come right eventually” and “scar tissue doesn’t hurt, so it won’t cause you any problems with intercourse” and just to stay in bed and try not to move.

    • mabelcruet
      January 13, 2018 at 3:32 pm #

      I think its only going to get worse. In the UK, all our midwives have to be properly qualified-we don’t have the lay midwife/certified type midwives that the USA does. In the past, midwives used to do nursing first, and then train as midwives, but nowadays there is direct entry to the midwifery degree. Obviously its a proper university degree but they don’t get the extensive exposure and experience to the spectrum of medical and surgical issues that the older nurse-qualified midwives have had. And with mothers getting older, and mothers with complex medical histories getting pregnant (that in the past would have been discouraged from pregnancy) a solid background in adult medicine is going to be important. I think we might end up going down a sub-specialized route, I know its happening in some large regional and supra-regional areas with midwives who specialise in women with cardiac disease, for example.

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