The recently released Ockenden Report could not have been clearer. UK midwives bear responsibility for literally hundreds of newborn and maternal deaths and injuries. The report faulted a culture of “normal birth” at all costs and a refusal to both investigate and learn from mistakes.
In case you doubted the Report, we now have the apologia from the UK midwifery leadership and it is every bit as damning as the original report. Hundreds of babies and mothers are dead, thousands of families’ lives have been destroyed and UK midwives are overcome by … SELF-PITY.
Responding to the Ockenden Review: Safe care for all needs evidence-based system change – and strengthened midwifery is an ugly, self-serving screed.
How does this paper address the preventable deaths and injuries? With misdirection, grievance and self-pity.
Misdirection:
Failures of care at this scale and duration stem from failure of the maternity and wider health system and a lack of political will to support a high quality national health service. Multiple structural reforms of the National Health Service (NHS) and a decade of severe NHS budget cuts have led to chronic underfunding of the maternity workforce, resulting in shortages of midwives, sonographers, and doctors, cutbacks in professional development and training, limited time to care, burnout, low morale, and unprecedented retention problems.
Those claims are true, but they are not responsible for nor do they justify the abysmal treatment of women and babies at the hands of UK midwives. The authors are brazen in their attempt to blame everyone but themselves and their ideology.
Claims of persecution:
Reports of service failures have dominated the headlines and overshadowed the many positive developments in place across the country. Some professional, political, and media responses to this and previous reports are feeding a narrative that blames midwives and the physiology of birth itself despite clear failings by multi-professional teams and organisations. The search for someone or something to blame has led to the notion of a widespread ‘ideology of normal birth at any cost’ as the scapegoat for complex system-wide failings, despite a lack of evidence for this in the reports themselves.
The central defect of contemporary UK midwifery is the radical ideology of “normal birth.” The authors of the piece are so blinkered by their devotion to that ideology that it literally never occurs to them that their cherished belief — “normal birth” is both better and safer — has repeatedly been shown to be both false and deadly.
Self-pity:
It is essential to recognise that midwives are the only professional group who are by a woman’s side from her first contact with the health services until after she and her baby are settled together, or during and after care for perinatal loss. Skilled midwifery care can prevent problems, support early identification of and referral for complications, and promote multiple positive outcomes including physical and mental health and well-being. Midwives are especially important for women who have additional care needs, whether physical, psychological, social, or cultural.
Did the authors read the Ockenden Report before criticizing it? They seem to have missed the part where midwifery care CAUSED the problems and that reform of midwifery care is a sine qua non for preventing similar injuries and deaths in the future.
The authors’ response is a classic effort at self-justification.
According to the book ‘Mistakes Were Made (but not by me)’:
As fallible human beings, all of us share the impulse to justify ourselves and avoid taking responsibility for actions that turn out to be harmful, immoral, or stupid… most of us find it difficult if not impossible to say “I was wrong; I made a terrible mistake.” The higher the stakes—emotional, financial, moral—the greater the difficulty.
It goes further than that. Most people, when directly confronted by evidence that they are wrong, do not change their point of view or plan of action but justify it even more tenaciously…
When directly confronted by the evidence that the radical “normal birth” ideology of UK midwifery has harmed babies, the authors do not change their point of view or plan of action, but justify their allegiance to normal birth even more tenaciously.
Indeed, they conclude:
We already have good quality evidence, strong national policy, transformational UK-wide midwifery education standards, positive change programmes, recommendations for increased resources, and skilled and committed multidisciplinary professionals. There are informed and engaged advocates for women and families, and examples of excellence to draw on.
Hundreds of babies and mothers are dead, thousands of families’ lives have been destroyed at the hands of UK midwives, but shockingly these authors use the preventable tragedies as yet another opportunity to celebrate themselves.
