Imagine if the Royal College of Midwives (RCM) treated breast health the way they treat childbirth.
Imagine a Campaign For Normal Breasts.
It would be premised on the assumption that most women (8 out of 9) will go through life without developing breast cancer. It would be premised on the notion that a breast biopsy that does not end with a diagnosis of cancer is simultaneously a failure, a waste of money and an indictment of the technology that discovered the lump in the first place. It would rest on an ideological commitment to “trust breasts” and rely on the provision of care by those who are NOT experts in the diagnosis, treatment and cure of breast cancer. A breast cancer specialist would only be consulted in the event that the patient was near death from cancer.
What would happen?
Inevitably, women would die of breast cancer who didn’t have to die.
Why?
Because we would not diagnose breast cancer until the tumor was large or until it had caused other symptoms by metastasizing. That’s what happens when you deprive patients of the opportunity of early diagnosis and early treatment. That’s what happens when you refuse to use preventive care.
Yet the RCM has done precisely that in its Campaign For Normal Birth. The Campaign For Normal Birth = A Campaign Against Preventive Care.
The RCM Campaign for Normal Birth is a campaign against obstetric interventions and C-sections, but obstetric interventions and C-sections are the pillars of preventive care in childbirth.
Ceseareans are like breast biopsies; most are unnecessary in retrospect. When a woman finds a lump in her breast, the odds that is breast cancer are quite low. When a mammogram detects an abnormality the odds that it is breast cancer are quite low. Therefore, applying the reasoning that RCM applies to cesareans would mean that the rate of breast biopsies should be cut dramatically. In most cases, watchful waiting is all that is necessary to demonstrate that the lump or abnormality was not breast cancer.
Applying the reasoning that the RCM applies to obstetric interventions, women should never have mammograms because most of what they diagnose turns out to be benign. Women probably shouldn’t examine their breasts and if they find a lump, they should watch it until other, more serious, symptoms develop.
Think about how much money we could save. All those mammograms and biopsies cost a fortune; just waiting to see what happens costs nothing.
Think about women’s experiences. If we did far fewer breast biopsies, women would not have permanent scars on their breasts. There would be no need for pain medication, dressing changes, etc. if you just watch and wait to see what happens.
Think of the midwife’s experience. She could maintain control of the patient until the last possible moment. She wouldn’t have to call a breast cancer doctor until it was clear that the patient was dying.
Of course if you think that a policy of watchful waiting is inappropriate for breast lumps and mammogram abnormalities, even considering that most biopsies are unnecessary, why would you think a policy of watchful waiting is appropriate for C-sections simply because many of them are unnecessary in retrospect?
Preventive care is not defective, unnecessary or a waste of money just because we find out later that it wasn’t needed. There is nothing better about “normal breasts” as compared to those that have been scanned or those that have been biopsied. It would be wrong and deadly to campaign for normal breasts by eschewing preventive care.
In medicine, the reasons for a procedure are known as “indications.” So, for example, the indications for a breast biopsy would be a lump in the breast or an abnormality on a mammogram. There is no expectation when undertaking a breast biopsy that a woman would die without it; indeed there is every expectation that a woman doesn’t even have breast cancer. We expect that most breast biopsies will turn out to be unnecessary in retrospect.
There are a variety of indications for obstetric interventions. There is no expectation when emplying interventions that the baby would die without them; indeed there is every expectation that the baby would have survived an unmonitored vaginal delivery just fine. But claiming that a healthy baby means obstetric interventions were unnecessary is like claiming that a benign breast lump means a breast biopsy was unnecessary.
The RCM Campaign For Normal Birth = an RCM Campaign Against Preventive Childbirth Care.
Dead babies, such as those who died at the hands of midwives ideologically committed to “normal birth” in the Morecambe Bay horror, are the INEVITABLE result of any campaign for normal birth.
The RCM should immediately suspend the Campaign For Normal Birth as unethical and deadly. I predict, however, that they will do no such thing. They will emulate the midwives of Morecambe Bay in protecting their turf while babies and mothers continue to die.
