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Eleven babies and one mother died needlessly at a hospital run by Morecambe Bay health trust in the UK in the past decade. This week’s , supposed to overhaul childbirth services in part to stop such deaths happening again, is an insult to their memories.
While an official report blamed failings at all levels for the, it highlighted a problem of gung-ho midwives who prioritised natural childbirth at any cost; they called themselves “musketeers”. When births went wrong, they failed to call for doctors who could have given routine interventions like instrumental deliveries or caesarean sections.
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And what has the Maternity Review called for? Less access to medical interventions, less involvement by doctors and more control ceded to midwives. US obstetrician and blogger Amy Tuteur calls it of those who died.
The review does not call for such measures explicitly, but it talks continually of the need to reduce interventions, when of course they can at times be lifesaving. Let’s not forget interventions also include epidural pain relief, a conscious choice for many women.
Global movement for natural childbirth
Predictably, the review extols the virtues of births at home or at midwife-led units separate from hospitals – – and envisages more such births in future. This reflects a long-standing and vocal lobby groups.
Their stated goal is to promote – as if any woman who needs an intervention is abnormal. Their mantra is to give women more choice – “but only if we choose from their menu”, says Pauline Hull, an author and campaigner for C-sections on demand in Calgary, Canada.
The evidence is building that this approach is dangerous. Morecambe Bay was just the most shocking illustration of what can happen. Thankfully deaths in childbirth are rare; much more common are bad deliveries that wreak irreparable damage on women’s bodies.
Anti-caesarean agenda
The natural childbirth movement’s central tenet is to reduce or at least cap the rise in C-sections, which now account for a quarter of all births in the West. Many see the rise as an inevitable result of societal trends such as obesity and women having children later in life, both of which make vaginal births more difficult. But in the UK, the influential and the National Childbirth Trust have pushed the anti-C-section agenda into many hospitals, packing their members onto guideline-writing bodies and shouting loudest in the media, with doctors apparently capitulating.
One way to avoid a caesarean is to persuade women to push for longer before resorting to surgery. But that’s not without risk: a longer labour raises the likelihood of dangerous haemorrhage after birth, as by then the woman’s womb is too weak to contract as it should. One hospital in Sydney, Australia, following a move to reduce the number of C-sections.
Doctors can also use forceps to pull the baby out – a practice that can damage the woman’s pelvic muscles and anal sphincter, leading to incontinence and prolapse of the womb. Until recently, the use of forceps had been on the way out in most countries, replaced by the gentler alternative of a vacuum device (which detaches if too much force is used).
Damage to women’s bodies
But the crusade against C-sections is seeing a resurgence of forceps use in the UK and Australia. “The more forceps you do the less C-sections you do, because you get babies out vaginally that otherwise would not be coming out,” says Hans Peter Dietz of the University of Sydney.
Dietz has pioneered the use of ultrasound scans after birth to assess the damage done to women’s internal muscles. His team has shown that 44 per cent of women have such damage after a vacuum delivery compared with 81 per cent after forceps.
It might take litigation to reverse this trend. In a recent landmark UK court case involving a vaginal birth that left a baby brain-damaged, the Supreme Court ruled that doctors must stop hiding the risks of vaginal delivery from mothers.
Wave of litigation
Dietz predicts a wave of litigation brought by women who have prolapses and incontinence that could have been avoided by a C-section, “once women learn what’s been done to them without telling them the risks”.
Before then, however, there might well be another Morecambe Bay scandal. The review itself admitted that nearly half of all maternity units require improvement – yet fails to recognise the problems with blind veneration of natural birth. Since the review’s lead author has been pushing this dogma for years, that comes as no surprise.
When the next Morecambe Bay happens, I hope all the authors can live with themselves. Their review is a whitewash.
