Despite my misgivings about midwife-led care, I would not have predicted this.
The Dutch experience with midwife-led care kills babies (and possibly mothers). The Netherlands has one of the worst perinatal mortality rates in Western Europe, and, remarkably, Dutch midwives caring for low risk women (home or hospital) have a HIGHER perinatal mortality rate than Dutch obstetricians caring for high risk patients.
Dutch midwives have acknowledged this hideous reality [link no longer active]:
In 2011 Dutch midwifery is under a microscope. Maternity care in general in The Netherlands has come under scrutiny by governments, media, the public and care providers themselves after two consecutive European Perinatal Statistical Reports ranked The Netherlands among those with the highest rates of perinatal and neonatal mortality compared to other members of the European Union (and Norway)…
… We have learned that infants born to women of low risk whose labour started in primary care with midwives had higher rates of perinatal death associated with delivery compared to those beginning labour in secondary care…
Yesterday’s publication of the Morecambe Bay report on a Cumbrian midwife-led hospital unit shows that midwife-led care has been a deadly failure in the United Kingdom as well. The report identifies 16 perinatal deaths and 3 maternal deaths that had taken place in the unit as potentially preventable, and concluded that the deaths of 11 babies and 1 mother almost certainly could have been prevented and the other deaths might have been averted.
My objection to midwife-led care came from my belief that care should be led by the most knowledgeable, most skilled members of the team. In this case that would be obstetricians and pediatricians. But the National Health Service (NHS) made a proverbial deal with the devil in order to save money. Midwives appear to be less expensive because their salaries are lower. Dutch authorities made the same deal for the same reasons.
I would have predicted a slight decline in the quality of care. Even I’m shocked that midwives have placed their needs and desires ahead of patient care, with the inevitable deadly consequences.
Midwife-led care kills babies and mothers because in the early 21st Century, midwife-led is ideology-led care.
The ideology is the philosophy of natural childbirth and the belief that unmedicated vaginal birth is healthier, safer and better than childbirth with interventions.
That ideology is utterly, spectacularly, fatally wrong. Interventions don’t kill babies and mothers; LACK of interventions is what kills them.
Childbirth is inherently dangerous. Obstetrics is preventive medicine, and the liberal use of childbirth interventions saves lives. Neither Dutch nor British midwives believe that, but both have unwittingly proven it yet again. The Dutch and British experience with midwife-led care merely confirms the fundamental truth of these historical facts.
Why do Dutch and British midwives place ideology over the health and lives of the patients they are ethically mandated to protect? Because the ideology of natural childbirth dovetails neatly with the self-interest of midwives. “Normal birth” is the holy grail of contemporary midwifery. Normal birth is distinguished from non-normal birth by a bright line; if it is under the purview of a midwife, she calls it normal and pronounces it “good”; if only an obstetrician can do it, she derides it an unnatural, dangerous and traumatic.
Midwives have an economic incentive to keep births for themselves. Normal birth provides the ideological justification for failure to acknowledge high risk situations, failure to acknowledge when low risk changes to high risk, and failure to acknowledge that greater expertise (of obstetricians and pediatricians) is needed. Babies and mothers die because it is more important to the midwife to keep the patient for herself than to provide the care that the mother and her baby need.
I would argue, though, that at some level, both British and Dutch midwives understand that they are providing substandard care. This recognition reinforces the midwives’ antipathy to calling for assistance when it is needed. By the time they urgently need to call for help they know that they have discounted risk factors, mischaracterized high risk patients as low risk, and ignored glaring warning signs. Paradoxically, the bigger the disaster they create, the less likely they are to call for help, because a laundry list of their errors will be revealed.
Many midwives want to practice in a way that violates safety standards, hence the relentless calls for autonomy. Within The Netherlands homebirth is promoted aggressively; in the UK, midwives are relentless in their promotion of homebirth as well as midwife-led units such as that in Morecambe Bay. They want to avoid any oversight.
Consider President of the Royal College of Midwives (RCM) Cathy Warwick’s tone deaf response to the horrors that occurred in Morecambe Bay.
The Morecambe Bay report stated:
…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’” …
In her response, Warwick IGNORES the central role of midwives in the deaths of babies and mothers. Warwick does not use the word “midwife” even once!
What does she claim that the report showed?
The report recommends that there should be a national review of the provision of maternity care and paediatrics in challenging circumstances, including areas that are rural, difficult to recruit to, or isolated…
The report states that the educational opportunities afforded by smaller units, particularly in delivering a broad range of care with a high personal level of responsibility, have been insufficiently recognised and exploited…
Finally, the report expresses concern about the ad hoc nature and variable quality of the numerous external reviews of services that were carried out at the University Hospitals of Morecambe Bay NHS Foundation Trust…
Warwick’s response is an affront to those who lost loved ones at the hands of RCM midwives and it is an insult to our intelligence. Not only does it fail to acknowledge the problem, it IS the problem. Warwick puts the interests of midwives ahead of patients’ health and lives.
The very first step in improving midwifery care in the UK would be to fire Cathy Warwick and reorganize the RCM; she has led the way in demonstrating utter contempt for the health and lives of British babies and mothers. It is under her watch that the reprehensible RCM “Campaign for Normal Birth” was created and promoted.
Midwife-led care kills babies and mothers. It has been in a failure in The Netherlands and it has been a failure in The UK. It’s time to call an end to this deadly practice before even more babies and mothers die on the altar of “normal birth.”
