You know those times when you're beyond exhausted?
You thought you'd stop a few hours ago but then another job appears, and another, and now you're still standing but not sure you can feel your legs anymore?
This is how I and many other people in the midwifery world feel about the press coverage on 'the cult of normal birth' right now. It's like whack-a-mole, misinformation keeps popping up.
There are many midwives and Mums writing about all this and they're doing an amazing job. They're trying to get the facts out.
I wanted to add to the pile because when something like this happens we should all speak our minds. As women. And advocates for women. Again.
(The good that comes out of all this is, I suppose, that we realise how many excellent advocates there are, it's great to see).
The basic message in the press and other media channels is that the 'cult of normal birth' has 'gone too far'.
This has stemmed from the Royal College of Midwives changing their 'Campaign for Normal Birth' into 'The Better Births Initiative'. The idea behind this was simply to ensure antenatal and postnatal care was involved in the initiative.
The press seems to have taken this, erroneously, to mean that the Royal College of Midwives is not advocating for normal birth anymore.
The main source the press is using is the Kirkup Report. This report found that in Morecambe Bay Hospitals, among many other factors leading to failures in care, there were a small group of midwives 'pursuing normal birth at all costs'.
However, this was one of 5 areas of failure in that trust and the press are not reporting on any other.
No-one wants to talk about the chronic warning signs, the underfunding, understaffing, pressure and major organisational failures that trust suffered...
At one point during the Morecambe Bay investigation, the Care Quality Commission was actually internally accused of a cover up. The government was successfully sued for libel over the case in 2013.
But we've forgotten this. Here we are talking about how midwives are 'dangerously obsessed' and Jeremy Hunt is tweeting about how ending normal birth promotion will help halve infant loss.
It's enough to make you weep.
This is a really complicated situation and everyone is trying to do the best they can. Midwives hold a weighty role and one of their biggest responsibilities is deciding what's abnormal and what's normal and when to get the medical team involved. Can we be surprised that in a trust failing in so many ways, this particular issue came up?
If it was as simple as 'let's be on the safe side', midwifery would be pretty simple. But we also have iatrogenic harm, which is the harm caused by medical intervention, a caesarean rate rising well beyond what the WHO suggests is safe and women's choices to think about.
My suggestion is that midwives are overworked, vulnerable and not paid anywhere near enough (remember the pay gap means compared to men, women work 57 days of the year for free).
They're an easy target for blame.
Midwives are tired and I don't think many of them care about the reputation of the profession for its own sake. Criticism is never nice, but the important thing is that midwives being vilified is very bad for women and families.
If you paint the advocates for women as dangerous and unbalanced, women's choices become limited.
This fight against what the media are saying is not about the midwives, it's about the women.
There is a petition on all this here: https://you.38degrees.org.uk/petitions/evidence-not-prejudice-deliver-better-births
(Further reading: the Midwife Diaries Morecambe Bay Report Summary; CEO Royal College of Midwives Cathy Warwick’s Words Matter and so does evidence based thoughtful care; Soo Downe's Normal Birth – evidence and facts; and Nikki Williams’ RCM campaign for normal birth and the media misrepresentation)
This is not the fun filled post I had planned for when I got back from holiday but I'm seething. If you are too, please consider sharing this post. And leave me a comment letting me know your thoughts!
Much love for everyone involved in this situation,
Ellie xxx
P.S. Cheerful news: I've had some conversations with midwives, students and others in the birth world who want to get small business ideas off the ground. The insight and inspiration they have is amazing and they're changing the rules for care as they can achieve things on their own terms. I really think we need to help ourselves until the government can help us again. If you'd like a one to one 15 minute chat with me about your midwifery business idea, email me on ellie@midwifediaries.com. I only have a few spots left this week but I'd be thrilled to hear what your plans are.
I think you make a lot of great points here Ellie – the title of the post concerns me a little though. It makes me wonder if people will give even less credence to the midwifery profession. We, as midwives should be seen as equal to the women we care for. We work in ‘partnership’ with them after all. It is all about the wellbeing of the midwife as well as the woman (and I think your article addresses this point well). Excellence in maternity care is reliant on a healthy workforce.
On the topic in question…the sad thing is that as a midwife, I do want to replace the word ‘normal’ with the word ‘physiological’….but I don’t want to be bullied and shamed into doing so.
Well done on the fabulous work you do 🙂
Hi Sally, I take your point, I know what you mean. I’m trying to draw attention to the importance of the profession for women as opposed to the professionals involved but I can see what you’re saying, the midwives being equal to women is important for all.
Thanks and I know, the shaming aspects of this coverage are so concerning.
Ellie,
I found this article informative and thought provoking. As a student Midwife I feel it is important to make sure I am doing right by my client, ensuring women centred care. Bad and unreliable press coverage of our profession is not helping the situation at all. We all need to stand together and support one another, after all we are a team, no matter where in the world we come from and practice.
Hi Claire. It’s heartening to hear your desire to pull together as a team 🙂 Thanks for your comment.
I’m going to say something that I know will not be popular, but please understand that I am writing from the perspective of an aspiring student midwife who deeply cares about the profession and future of midwifery, so please don’t flame me.
I have been really disappointed in the response of midwifery leaders/professional organisations and bloggers to the current discourse for one reason; they do not acknowledge the large number of preventable deaths and the almost 2 billion pounds paid out by the NHS in insurance claims for botched births last year alone. This goes way beyond Morecome Bay- these are not the fault of a few ‘bad apples’. We really need to listen to the experiences of women- and especially women who have experienced poor care from midwives! And not just those who have lost babies, but those who have been denied pain relief or have sustained severe obstetric injuries as a result of being denied a cesarean. The internet is full of these stories, and we cannot pretend it doesn’t exist! One only has to look at the harassment of James Titicombe by midwives and midwifery bodies to see the denial and defensiveness present in midwifery.
Rather than a reaction of ‘no no, never, not us!’ we need to listen to the experiences of those women who feel that the push for natural birth has harmed them in some way. If we do not do this, how are we being ‘with women’?
Thanks for your comment, I appreciate you taking the time to tell me and others your thoughts. No flaming here, ever, I’m just glad the dialogue is open 🙂
My suggestion is that you will always have women who feel pushed into normal birth choices which is terribly wrong, of course and not midwifery. Midwifery means ‘with women’ and being pushed into anything is not part of the architecture of the care model. You will also get women who feel pushed into medical management. The evidence suggests this ‘medicalisation’ happens more often than the pushing of normal birth.
The National Maternity Review was a government report from last year which looked into maternity care independently. It found ‘If we match services to meet women’s choices more clearly, it will result in an increase in the proportion of births at home, in a freestanding midwifery unit or in an alongside midwifery unit. ‘ (page 97)
This would suggest that overall, it’s the medical management of birth that is being pushed harder than normal birth? As women’s choices would = more normal birth style care?
National Maternity Review: https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf
It’s really tempting to read many stories online or listen to women and come to conclusions. But without large scale, systematic analysis of how women in the UK are feeling overall this wouldn’t be the type of evidence that’s classed as most reliable?
I think in terms of poor outcomes we need to look at high level evidence to make changes. The UK has the longest running ‘Confidential Enquiry Into Maternal Death’ in the world and all poor outcomes are looked at seriously. The evidence suggests that poor outcomes are far more to do with poverty, poor resources and specific areas of clinical improvements (like being more sepsis aware) than they are to do with normal birth being promoted.
Please do keep chatting, the debate is so important and no-one deserves to be heard more than you!
Call me cynical – but- this feels like a deliberate attack on the profession, in an attempt to down Band midwives to Obstetric Nurses (US style practice).
Therefore there will need to be less of us, we’ll be paid less and it all fits in nicely with this Governments vision for our future health care service.
We are crying ‘we need 3000 more Midwives’ and only a couple of weeks ago the headlines were about Maternity Units being forced to close (many Midwifery Lead) – their response is ‘No! No we don’t, Midwives are dangerous and cause neonatal deaths with their insistence on Normal Births at any cost!’
To me, this is Political. With a capital P. And for them ‘it’s not about the women, it’s about the money’
Short sighted, narrow minded, ignorant, arrogance – they are the dangerous ones!
Such a great piece Ellie. Thank you.
Thanks Mary!
Jeremy Hunt came to Morecambe Bay on Wednesday and held a closed audience seminar with a group of staff. I was there. The focus was patient safety. He was asked about his tweet by our inpatient maternity matron and his reply was that the ‘rcm had identified safety issues within the campaign which is why they removed the world normal. I welcome that acknowledgement as we move towards a safer system.’ When it was pointed out to him that this wasn’t the case and the campaign for better births had been “born” three years ago he said the same thing ‘due to perceived safety issues in the normal birth campaign’. I didn’t get to ask for his evidence for this or ask the questions I wanted or point out that physiological birth and continuity of care is actually the thing to reduce harm, stillbirth and maternal death (and therefore cost!) as per Finland and Sweden. No doubt if I had I’d have gotten the same political whitewash answer. My matron must have been flustered because she wasn’t her usual forthright self and I felt it was a missed opportunity. Even asking him what the other 4 issues in the Kirkup Report would have flummoxed him.
The midwives I work with in Morecambe Bay are some of the best this country has to offer and no-one I have ever worked with put normal birth above safety. If however you call for medical assistance and they refuse to come you are then very stuck and that is when incidents happen. The medical staff have been very absent in their vilification in the press and yet we know it happens. Consultants who suture without anaesthetic, who perform unnecessary episiotomy or interventions, who advocate c section because THEY want to get on with things. As a midwife we can protect women and advocate for them but if the team behind you don’t support it, it becomes an uphill battle which we haven’t the energy to fight.
Thanks for your input here. I’d love to understand what his take on all this is. I can’t seem to grasp where he’s coming from.
Thanks Ellie for writing this great piece. It is important we all communicate, illuminate and speak out for evidence, midwifery and most of all women.
Thanks Anna!
Enjoyed your blog. I found it balanced and a good description on the status quo. I am an experienced midwife…. nearly 30 years , I have worked in several places in the UK and abroad.
I was a community midwife for many years with a large caseload and saw my role to inform and empower women to be in control of what was happening to them… even when things started to veer off the so called normal pathway.
My experience taught me that you and your mum to be could do everything and anything to encourage a straightforward pregnancy and normal birth but that sometimes it doesn’t always go the way you plan. I have always disliked strict birth plans, it is setting women up to fail when things don’t go 100% to plan. There is no crystal ball, mums to be, and their supporters can only do their best….. I used to adopt a menu approach, where I went through possibilities with women and described why and what could happen and what interventions could be needed to keep mum and baby safe. Again my experience has taught me that some women feel terrible and failed when forceps or a C sections comes into play. The birth experience becomes more important than a well mum and baby it would seem for some folks. That’s why the RCM needed to think differently me thinks, even if we had a 99% normal birth rate we would still have 1% of women who are just as important….. I used to say to mums how can you be disappointed when you have made the most amazing baby, you just needed a little help. We need to keep women safe and make them feel great about the new life they have created…
I am a little depressed about my wonderful profession though, when did midwives become the enemy to women? When I trained it was unthinkable that women sought out doulas…. we were the good guys….. Now some are preferring to free birth or pay money for a doula.
By the way, I have worked with amazing obstetricians who are completely woman focused and also some midwives who like to think they are better than everyone else because ‘they can get a normal delivery when seemly none else can’. It is about themselves and not about the women, but on the whole my midwifery colleagues are amazing. I have a horrible feeling that we in the UK may go down the obstetric nurse route….. sad but perhaps women also want it that way.