Ideas have consequences.
Bad ideas have deadly consequences.
Today’s report on the deaths more than a dozen babies and mothers at a UK hospital is a catalog of horrors.
According to The Guardian:
Frontline staff were responsible for “inappropriate and unsafe care” and the response to potentially fatal incidents by the trust hierarchy was “grossly deficient, with repeated failure to investigate properly and learn lessons”.
Kirkup [the author of the report] said this “lethal mix” of factors had led to 20 instances of significant or major failures of care at Furness general hospital, associated with three maternal deaths and the deaths of 16 babies at or shortly after birth.
“Different clinical care in these cases would have been expected to prevent the outcome in one maternal death and the deaths of 11 babies.
In 2008 alone there were 5 deaths:
A baby was damaged due to a shortage of oxygen during labour, while another died from an unrecognised infection.
“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,” Kirkup said. (my emphasis)
And most damning of all:
The midwives at Furness general were so cavalier they became known as “the musketeers”.
Those midwives are directly responsible for the deaths and should be held responsible to the full extent of the law. But the individual midwives are just the proximate cause. The real cause is radicalization of midwifery that values process above outcome, and midwife autonomy above all else.
Outcome, whether mothers and babies live or die, is the MOST important goal in obstetrics. It’s not the only goal, of course; safe care can and should be accompanied by compassionate, comfortable care. But is the sine qua non of all maternity care.
Midwives have forgotten that. Instead they have elevated process, specifically process that is good for them, above the health and even the lives of mothers and babies.
The goal of many midwives has become unmedicated vaginal birth, and professional autonomy.
The deadly results are not restricted to Morecambe Bay. The relentless promotion of “normal birth” has led to bad outcomes and soaring liability costs, now accounting for 20% of total obstetric spending.
I’ve written about these issues relentlessly and repeatedly over the years:
Promoting normal birth is killing babies and mothers
Midwife: UK deaths result of failing to meet the needs of … midwives?
New document on British maternity services is fundamentally unethical
In the UK, babies continue to die on the altar of vaginal birth
Government report: UK midwives put the lives of mothers and babies at risk
#FightFear: the hateful truth at the heart of UK midwifery
When UK midwives put the lives of mothers and babies at risk, the solution is not more homebirths
Who radicalized midwifery?
Biological essentialists.
They are fond of catch phrases like “trust birth,” “pregnancy is not a disease,” and #FightFear They insist that obstetrics has “pathologized” childbirth and they can display a shocking and callous fatalism by dismissing deaths with the dictum that “some babies are not meant to live.” Such views lead inevitable to the “poor clinical competence, insufficient recognition of risk, inappropriate pursuit of normal childbirth” highlighted in the report.
Feminist anti-rationalists
They dismiss science as a male form of “authoritative knowledge” on the understanding that there are “other ways of knowing” like “intuition.” Many are post modernists who believe that reality is radically subjective, that rationality is unnecessary and that “including the non-rational is sensible midwifery.”
Midwifery theorists
Consider Normal Childbirth: Evidence and Debate by Professor Soo Downe who dismisses the importance of scientific evidence in guiding clinical care:
The implication of the new subatomic physics was that certainty was replaced by probability, or the notion of tendencies rather than absolutes: ‘we can never predict an atomic event with certainty; we can only predict the likelihood of its happening’… This directly contradicts the mechanistic model we explored above, and it implies that a subject such as normal birth needs to be looked at as a whole rather than its parts…”
When we turn to the implications of this paradigm shift for our understanding of health, it becomes clear that the benefit or harm of an intervention for an individual can only be established with reasonable certainty by identifying and taking into account all the relevant “noise”. This includes environment, carer, attitudes, skills and beliefs, and the expectation of the woman and her family. Similarly, the appraisal of research and evidence needs to consider the concept of attitudes and roles of researchers and how these may have framed or influenced the process of generating evidence…
Not only is this NOT a justification for ignoring scientific evidence; it is utter nonsense that betrays a fundamental ignorance of physics.
The philosophy of “normal 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. In other words, “normal birth” is nothing more than a marketing term designed to promote full employment for midwives.
Midwifery leaders
Cathy Warwick, leader of the Royal College of Midwives, has not yet met a major problem that can’t be fixed by promoting increased midwife autonomy through homebirth and free standing midwife led units. Too bad for babies and mothers that Cathy Warwick believes the central problem in contemporary maternity care is meeting the needs of midwives, mothers and babies be damned.
The deaths at Morecambe Bay, and the subsequent coverup, are the inevitable consequences of a maternity system whose gatekeepers are biological essentialists, feminist anti-rationalists, believers in nonsensical theories, promoters of process over outcome, who appear to think that their primary responsibility is to themselves and not their patients.
The UK National Health System made a Faustian bargain with midwives to install them as gatekeepers in exchange for the promise of saving money; midwives are less expensive than obstetricians. It turns out that dead and injured babies cost a lot of money, though, not to mention the fact that allowing preventable perinatal and maternal deaths is fundamentally unethical.
The NHS needs to reorganize midwifery care to place obstetricians in control of patient care and midwives as their assistants. The radicalization of midwives, which provides the theoretical justification for placing their needs ahead of patient needs, means they can no longer be trusted to act independently.
The result is babies and mothers who didn’t have to die, shattered families, grieving parents and massive liability payments.
Horror, indeed.
Addendum
A direct quote from the report:
[M]idwifery care in the unit became strongly influenced by a small number of dominant individuals whose over-zealous pursuit of the natural childbirth approach led at times to inappropriate and unsafe care. One interviewee told us that “there were a group of midwives who thought that normal childbirth was the… be all and end all… at any cost… yeah, it does sound awful, but I think it’s true – you have a normal delivery at any cost”.2 Another interviewee “… was aware that there were certain midwives that would push past boundaries”.3 A third told us that there were “… a couple of senior people who believed that in all sincerity they were processing the agenda as dictated at the time… to uphold normality… there’ve been one or two influential figures who’ve perpetrated that… sort of approach and… there’s nobody challenging…”.4 Whilst natural childbirth is a beneficial and worthwhile objective in women at low risk of obstetric complications, we heard that midwives took over the risk assessment process without in many cases discussing intended care with obstetricians, and we found repeated instances of women inappropriately classified as being at low risk and managed incorrectly. We also heard distressing accounts of middle-grade obstetricians being strongly discouraged from intervening (or even assessing patients) when it was clear that problems had developed in labour that required obstetric care. We heard that some midwives would “keep other people away, ‘well, we don’t need to tell the doctors, we don’t need to tell our colleagues, we don’t need to tell anybody else that this woman is in the unit, because she’s normal’”.5 Over time, we believe that these incorrect and damaging practices spread to other midwives in the unit, probably quite widely. Obstetricians working in the unit were well-placed to observe these lapses from proper standards, and it is clear that they did, but seemingly lacked the determination to challenge these practices. This in turn represents a failure to maintain professional standards on their part.
