Two weeks ago I reported on 15 deaths at two hospitals in the United Kingdon (Promoting normal birth is killing babies and mothers). The 15 tragedies were united by the fact that midwives were so busy promoting "normal" birth that they failed to recognize complications or refused to refer patients to specialists in the face of complications.
The mounting death toll of midwife attended preventable neonatal deaths and preventable maternal deaths demonstrates that efforts to promote normal birth kill babies and mothers. That's not surprising when you consider that promoting normal birth is fundamentally unethical.Last week I posted the story of Joshua Titcombe, whose needless, senseless, entirely preventable death occurred at the hands of midwives who refused to acknowledge that he was ill and never alerted a pediatrician.
An ethical medical professional recommends whatever is safest for the patient, not whatever is most beneficial for the provider.
Today I came across the response of a midwifery professor published in The Guardian. According to midwife Sarah Davies, we need a new model for maternity care, not blame for individuals, a piece which could more aptly be titled "mistakes were made ... but not by us."
It's a masterpiece of the genre employed by errant politicians and corporate malfeasors, the non-apology apology.
Ms. Davies acknowledges that mistakes were made, specifically mentioning:
... two maternal deaths at Queen's hospital in Romford that should never have happened, and the abusive and neglectful behaviour by midwives ...Concluding:
... individual midwives treated women with disrespect – one midwife was heard to say: "Hurry up, or I'll cut you." ...
But blaming individuals for failing to care is no solution when the whole system is wrong.Actually, blaming individuals for their unacceptable, unprofessional behavior is an excellent solution. We even have a special word for that solution. The word is "accountability." Health professionals who commit malpractice (for that is precisely what happened in these instances) should be held personally accountable for their failings.
According to Ms. Davies, though, the midwives are not responsible for those deaths, "the system" is responsible. In a remarkable bit of rhetorical jujitsu, Ms. Davies insists that the failure of the midwives to obtain help from other clinicians (obstetricians and neonatologists) is the result of a shortage of ... midwives!
... the circumstances described reflect the continuing neglect of pregnant women's core needs. The government has chosen not to recruit the 5,000 additional midwives the Royal College of Midwives has repeatedly stated are required.Those two sentence sum up what is wrong with the UK maternity system, though not in the way that Ms. Davies had in mind.
First, Ms. Davies deliberately conflates the needs of pregnant women with the needs of the midwives who care for them. The core need of pregnant women is for safe, professional, compassionate maternity care. The core need of UK midwives is apparently full employment for UK midwives.
Second, is there a shortage of midwives in the UK? Perhaps, but this is not an example of it. These were not overworked midwives who did not have the time to attend to their responsibilities. These were midwives who had more than enough time to "care" for patients who should have been cared for by specialists.
These tragedies occurred because midwives deliberately took on work that properly belonged to others in an apparent effort to protect their turf. The preventable deaths at both hospitals include cases in which obstetricians were told that their help was not needed and parents were told that the expertise of pediatricians was unnecessary.
Thirteen babies and mothers are dead at the hands of midwives, but Ms. Davies apparently thinks that this is the perfect opportunity to praise midwives:
All the research indicates that continuity of midwifery care gives the best physical and psychological outcomes for women and babies ...Apparently not, since thirteen babies and mothers are dead specifically because their midwives did not provide the best care.
Student midwives ... are dedicated, caring individuals who make many sacrifices as they learn how to help women have a safe, satisfying birth experience ...How nice, but what does that have to do with the disasters that occurred? Nothing.
Because of the lack of recruitment, many newly qualified midwives struggle to find posts.How sad, but what does that have to do with the disasters that occurred? Nothing.
For the long-term health of mothers, we desperately need a different model for maternity care – one that is community based; gives midwifery continuity; and where birth takes place at, or close to home for most healthy women.Really? Would community based care, homebirth and midwifery continuity have prevented any of the thirteen deaths? Of course not, but it would lead to greater employment opportunities for midwives and that's more important.
What led to the deaths of these babies and mothers? Midwives putting their needs ahead of the needs of patients. Ms. Davies is doing the exact same thing in this piece: putting the needs of midwives ahead of the needs of mothers.
The uk is naturally going to have a high mortality rate under midwife care than the US simply because maternity care is provided my mainly midwives in the uk as opposed to obs in the us. That does not mean maternity care in the uk is horrendous or that midwives are incompetent and determined to 'out' obs. As for the 'hurry up or I'll cut you' comment Ive heard americans who had exactly the same treatment from obs. Buy you won't post that. The very fact the UK is mainly midwife led makes is easy for you to rant against uk midwives as naturally they are responsible for more women than obs here, so any mistake or malpractice falls right into your anti-midwife hands, whereas you never discuss the mistakes and malpractice made by US obs, because that wouldn't suit your very biased agenda.
ReplyDeleteIn other posts you have ranted that mortality rates in low risk pregnancies can be due to lack of the monitoring provided in high risk pregnancies. This IS effected by the midwife shortages and lack of recruitment as women are not seeing midwives for monitoring as regularly. Also, maternity wards can be short-staffed and over-worked leading to tired miswives (and obs) who them make mistakes. You have assumed the midwives acted to push out obs, but in the UK there is no need for such action, we're already prodominently midwife led. You are avoiding the possibility that the midwives were simply poor midwives, that they were tired from over-work or that it was simply a mistake. All factors which also effect US obs - who you don't write about. You are making up the fact UK miswives need to push out other professionals, uk midwives are the primary source of care, they aren't under threat because while they are understaffed so are obs and other medical professionals, midwives are still an essential part of our system.
As for accountability, that is for the courts to decide. No professional would admit accountability to a newspaper for the same reasons most car insurance policy dictate that you never admit fault but leave it to be discussed by the legal pros. However, the shortage of midwives is an important matter.
You know, your opinions would see more reasonable and balanced if you put them in context against equivalent discussions on obs failings (which do exist), but you just come across as a biased ob with a grudge who'd rather twist unfortunate events to suit your agenda. That should be a warning sign to anyone who would listen to you to run away, fast.