I’m sitting here on an inflatable air mattress in an empty house in Maryland where I’ve slept for the past few weeks, bored, thinking wistfully about my two years apprenticing with independent midwives in England. That positive experience was immediately juxtaposed with the shocking “welcome back to America” I received by attending an Evidence Based Birth seminar addressing what to do for our clients and their providers when we observe our clients not receiving safe, evidence-based care, which according to statistics is the majority of the time in the majority of situations in USA hospitals. One of the things we talked about was the Ellis Prayer Method, in which the partner uses a long prayer to distract the care team from performing unnecessary, unconsented intervention (most usually immediate cord clamping.) Saying “I do not consent” does not work in the USA anymore, apparently.
This is what happens when we abandon the principles of Normal Birth, after tearing down the institution of midwifery.
Of course “normal” can be “unhealthy.” I’ve always thought that “Healthy Birth” was a better tag line for the Royal College of Midwives’ 12-year-long campaign because an emergency cesarean birth after a long induction is quite abnormal, but healthy- if it was all truly justified. “Healthy” implies a healthy baby and healthy mother- also mentally healthy- which is a natural result of striving for the most supported and normally-progressing birth possible. But the RCM, because of some feedback, is now wanting to call it “Physiological Birth.” To a birthing person, this might sound less emotionally loaded than “Normal” or “Natural” and thus easier to attain, more medical, and technically safer, but to me it sounds an incredible and even loftier goal than “Normal”!
A “Physiological Birth” is intervention-free. Powered by mother’s hormones and muscles alone. Not assisted by episiotomy or instruments.
In the resulting media misunderstanding of the Campaign for Normal Birth, the word “normal” is continuously being conflated with “natural” as if the two are interchangeable. Which they are certainly not.
But does James Titcombe, author of the Guardian article that set the media abuzz, realize that the Campaign for Normal Birth had already been rebranded as the Better Births Initiative and is now aiming for this Physiological Birth, and that nothing regarding the evidence basis of midwifery care will actually change?
Yes, it seems that the UK now has their very own Dr. Amy, Skeptical O.B. James Titcombe experienced the loss of his newborn son due to failures of communication, collaboration, and training in a particular NHS hospital system, Morecambe Bay, that led to the Kirkup Report. This report highlighted a realization that midwives are constantly being bullied, intimidated and suppressed, and are often unable to provide appropriate care because of personalities, overwork, and lack of a support network. Nothing that much to do with a “cult of natural birth at all costs.” But Titcombe, after writing a book about his tragedy and receiving an OBE after his work as a National Advisor on Patient Safety, Culture & Quality for the Care Quality Commission (NHS watchdog), has not stopped there. Encouraged by the media storm surrounding the RCM’s “rebranding” of their day-to-day, now he is coming for the entire institution of UK midwifery itself and the women who dare to be proud of their Normal Births, playing out currently on Twitter with words like “radicalised” and “cult.”
I cordially invite you to come to the United States to see what happens when intervention and anti-midwifery sentiment is the norm, Mr. Titcombe.
Come, watch our babies die at a rate (5.8/1000) higher to UK babies (3.7/1000).
Come, watch our mothers die at a rate over twice that of UK mothers.
Come, watch our women speak of birth trauma and birth rape due to a culture that does not allow for informed consent and refusal of intervention. Nothing to do with being forced to have a “natural birth,” because they very much did not have natural birth – birth trauma is experienced because of the way in which the care itself was provided, not the type of care. Poor information-giving, social support and counseling for new mothers does appear to be a serious problem, according to the words of the families responding to your Tweets with tales of their lingering birth trauma.
This is not only to do with the oldness, fatness or Blackness of our women, which is what the USA media likes to blame these statistics on. This has to do with our high rate of interventions in childbirth. The American College of Obstetricians and Gynecologists has ADMITTED this. We spend the greatest amount of money on maternity care in the world yet our maternal mortality rate is 26.4/100,000.
The majority of US births involve epidurals. The majority of US births involve synthetic oxytocin. 32% of US births are by cesarean section. 91% of US women birth with obstetricians in hospitals.
Only around 8 percent of women are attended by midwives in American hospitals. Only .9% of American women birth at home. Our maternity care system is driven by obstetricians, interventions, insurance regulations, fear, and profit.
But look at all of our women and babies who are dying.
Our neonatal early-onset GBS infection rate is .23/1000 where yours are .57/1000 ( about 1/2 of 1 percent greater). This is AFTER most American women are screened for GBS and then given loads of intrapartum antibiotics. That’s millions of dollars spent, the unknown sequelae of antibiotics, and new antibiotic-resistant GBS strains for 1/2 of 1 percent of reduced risk?
We don’t even get home visits from midwives. We are sent home a few hours after birth and not seen again for six weeks.
James Titcombe, this is what you are advocating for. This is what will happen when you attack midwifery principles and equate high-intervention medical care with safety and superiority.
In my two years of experience with the independent midwives and as a doula in NHS hospitals, I was so impressed at how easily the necessary medical interventions were obtained, as and when the need arose, and with consent and explanation. Yes, even most of the births I presided over with the “fringe” and “anti-interventionist” independent midwives required at least one serious medical intervention, which they received quickly with consent. I saw many births that needed lots of intervention that felt normal. They were healthy.
This was a result of one-on-one care.
How do you propose to provide the proven, worldwide-documented safety of one-on-one continuity of carer (caseloading) when you are upholding, provoking, and sanctioning the bullying and intimidation of midwives, at a time when they are leaving the profession in droves already?
I was so proud of your NHS maternity care system even though yes, it does need continual work, improvement, and introspection. If what I saw in the UK made me swell with pride and hope for you, what do you think my native (USA) maternity care system looks like? It looks like a battlefield in comparison. Women here can have the police and Child Protective Services called on them when they refuse certain perinatal interventions, some of which you do not even have in the UK. Is this your idea of improvement? Because I see the writing on your health service’s wall.
When you treat midwives with autonomy and respect, give them all of the tools they need, PAY THEM, and not overburden them by normalizing intervention and consultation on all women while reducing the workforce, they will provide wonderful care. What you propose turns birth into even more of a conveyor belt, which will do nothing but spit out damaged women and babies and absolutely destroy the NHS. I am very sorry your son died, but come and speak to some American families who received all of the interventions and attention available to them, and their babies still died. What is the excuse for that? Who can they blame? Come speak to some families whose mothers and/or babies died BECAUSE of unnecessary intervention. Come speak to some families who did not have access to maternity care or to midwives at all-because it’s not easy or feasible to be a midwife, or even an obstetrician, in many parts of this country- and their mothers or babies died. What will you say to them when this happens in your idea of an improved maternity care system?
What is your end goal when using words like “radicalised” “ideology” and “cult?” Do you think this language will improve the performance of midwifery, which has always been driven by understanding and protecting the science of physiological birth processes and will always be?
And why does one male voice get to rise up and speak for the voices of thousands of midwives and women, on either side of this “debate”? It’s interesting that many women are chiming in on Twitter saying “Finally, thank you for saying this.” Where were their voices before?
Perhaps a society that is not supporting and listening to women is the only problem here.