The announcement by the Royal College of Midwives (RCM) on Saturday that it will finally abandon its “normal birth” campaign is overdue but welcome. By promoting “normal” over medical births, the campaign has for too long dangerously implied that a non-medical birth is superior to one in which doctors are involved. Given that we have had firm evidence for more than two years that, in the very worst cases, normal birth ideology has contributed to the tragic and unnecessary deaths of women and babies, the only question is why it has taken the RCM so long to act.
The only thing that should matter when a woman is giving birth is what type of delivery is safest for her and her baby. For many women, a non-medical birth will be a good and safe option. But there are serious risks associated both with over-medicalising the process and leaving medical intervention too late. Women must be supported to make an informed choice about the type of birth they want, not put under pressure from their midwife to go for a “natural” birth because they personally believe it to be preferable. And a woman who opts for a non-medical birth must not be denied medical intervention should problems arise.
Yet that is what some women have experienced, with tragic consequences. The independent report on the provision of maternity care by the Morecambe Bay NHS trust found that some midwives at the trust pursued natural birth “at any cost”. They prevented obstetricians from intervening, and even assessing, women clearly in need of medical intervention. This contributed to the avoidable deaths of mothers and babies.
We don’t know how widespread a problem this is, because serious injuries and deaths in maternity units are rarely followed up with a proper investigation. Every year, 500 to 800 babies die or are left with serious brain injury because something goes wrong in labour. The Royal College of Obstetricians and Gynaecologists believes many are avoidable. Not all, or even most, may be due to medical intervention occurring to late. But we don’t know: its review of hundreds of cases has revealed serious failings in the local investigations carried out when death or injury occurs. The independent report into Morecambe Bay only happened as a result of tireless campaigning by James Titcombe, whose baby, Joshua, died in its care.
But Morecambe Bay is unlikely to be an isolated case. Earlier this year, the health secretary, Jeremy Hunt, ordered a similar investigation into Shrewsbury and Telford NHS trust after seven baby deaths were judged to have been avoidable. Parents have said they felt under pressure to have a natural birth. Senior midwives from the trust have boasted in the local press about their “department-wide ethic of natural childbirth”. We don’t know how many other trusts may be affected.
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. The RCM was defending its “natural birth” campaign as recently as April this year, only going as far as telling midwives to stop using language such as “obstetric violence” and the “natural glory of childbirth”, common in some parts of the profession. 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 has announced she will launch her own “normal birth” campaign as a response to the RCM moving away from this language.
Nobody is perfectly rational. All human beings rely on rules of thumb when making decisions and those rules are often based on dogma, not evidence. That’s why people who make life-and-death decisions have a responsibility to critically reflect on whether what they are doing is in the best interests of a patient or whether their own ideology is coming too much into play. In implicitly promoting a natural birth ideology that can mutate into dangerous practice that costs lives, the RCM’s “normal birth” campaign was irresponsible. Let’s hope that in scrapping it, the only type of birth it will be promoting in future is the one that is safest for each individual mother and her baby.
