Promoting normal birth is always and only about promoting midwives.
Many years ago, when I first heard the phrase “promoting normal birth” I was confused. Why would a healthcare professional be promoting any set of procedures or any particular approach to a health issue?
You won’t find any real medical professional who insists that he or she “promotes” one treatment over another. An ethical medical professional recommends whatever is safest for the patient, not whatever is most lucrative. Ethical medical professionals promote health and promote safety, not the opportunity to line one’s pockets.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]The endless efforts of UK midwives to promote themselves have culminated in reflexive defensiveness and stone cold heartlessness in response to the cries of bereaved mothers and fathers.[/pullquote]
Normal birth has nothing to do with normal and nothing to do with 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. “Normal birth” is nothing more than a marketing term.
Once you realize that, it is a lot easier to understand the Campaign:
The RCM Campaign for Normal Birth (Campaign for Midwives) declared that “promoting normal birth key to cost savings” (Promoting midwives a key to cost savings.) That’s especially ironic in light of what actually happened: the number of preventable injuries and deaths soared and liability payments skyrocketed. The NHS paid £1.2 billion last year alone!
You can look high and you can look low, but wherever you look, midwives or their advocates are behind every attempt to promote “normal birth” (i.e. market midwifery). Indeed, the leading textbook of the radical midwifery theorists is Promoting Normal Birth – Research, Reflections and Guidelines best understood as Promoting Midwives – Research, Reflections and Guidelines.
The editor Sylvie Donna has the grace to be abashed at the use of the word “promoting.” She starts the introduction with the following:
You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should normal birth be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions, especially cesareans — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women…
Even on its face, it’s a pretty inane explanation, but it is far worse when you substitute what is really meant:
You may have wondered, on first seeing this book, why the title includes the word ‘promoting.’ Why should midwives be promoted particularly? The answer is simple. Other forms of birth — those involving plenty of interventions (most of which midwives cannot do), especially cesareans (which midwives definitely cannot do) — get plenty of promotion, simply because they may appear to be the easiest option for caregivers or the least frightening ones for pregnant women… not to mention the safest and the most highly desired by mothers.
Promoting normal birth is about one thing, and one thing only: promoting midwives. It has nothing to do with what is safest. The words safe or safety don’t even appear in the entire introduction to the midwifery textbook, which is fitting since safety is entirely irrelevant to the project of promoting midwives. As far as I can tell, using Google to search inside the book, the word safety doesn’t even appear until page 177 and then only to be used pejoratively (“An obsession with safety is characteristic of our age …”).
Insisting that women be cared for by midwives because midwives want employment and professional autonomy isn’t particularly persuasive. Insisting that women be cared for by midwives because only they can provide them with a “normal” birth (who wants an abnormal birth?) sounds a lot better. The key, of course, is to invest “normal” birth with a cachet beyond the word normal. That’s where all the stuff about birth warriors, empowerment and experience comes in.
Most women don’t fall for it. British women resent the fact that access to obstetricians is severely curtailed. They despise the fact that such practices have led to preventable injuries and deaths of babies and mothers. They are not alone. Dutch women go to other countries to give birth rather than settle for the midwife led care (and higher perinatal mortality rate) that is a feature of the Netherlands. The high mortality rate has led to a precipitous drop in homebirth, now down to only 13%. And the majority of American women, regardless of the availability of midwives, choose obstetricians. Indeed, there are not enough practicing obstetricians to accommodate all the patients who want them.
The fact that normal birth is a marketing term to promote midwives also explains the reflexive defensiveness of the RCM and their stone cold heartlessness in response to the cries of bereaved mothers and fathers.
As the Guardian notes:
The response of many in the midwifery profession has been characterised by defensiveness, rather than an open commitment to finding how far this problem goes and rooting out dangerous practice. The Nursing and Midwifery Council, responsible for regulating midwives, spent £240,000 on getting lawyers to redact information in response to a freedom of information request from Titcombe.
That is startlingly unethical behavior.
Even as it ends the campaign, its chief executive has denied there may be a link between it and the sort of dangerous practice seen in Morecambe Bay. One of its honorary fellows [Sheena Byrom] has announced she will launch her own “normal birth” campaign as a response to the RCM moving away from this language.
Regardless of who is injured, how many babies die, and how many mothers are left with empty arms, UK midwives will persist in promoting themselves. It’s hard to imagine anything more morally repugnant.
