I'm slowly reading through the report.
from p13
1.4 Third, midwifery care in the unit became strongly influenced by a small number of dominant individuals whose over-zealous pursuit of the natural childbirth approach led at times to inappropriate and unsafe care. One interviewee told us that “there were a group of midwives who thought that normal childbirth was the… be all and end all… at any cost… yeah, it does sound awful, but I think it’s true – you have a normal delivery at any cost”.2 Another interviewee “… was aware that there were certain midwives that would push past boundaries”.3 A third told us that there were “… a couple of senior people who believed that in all sincerity they were processing the agenda as dictated at the time… to uphold normality… there’ve been one or two influential figures who’ve perpetrated that… sort of approach and… there’s nobody challenging…”.4 Whilst natural childbirth is a beneficial and worthwhile objective in women at low risk of obstetric complications, we heard that midwives took over the risk assessment process without in many cases discussing intended care with obstetricians, and we found repeated instances of women inappropriately classified as being at low risk and managed incorrectly. We also heard distressing accounts of middle-grade obstetricians being strongly discouraged from intervening (or even assessing patients) when it was clear that problems had developed in labour that required obstetric care. We heard that some midwives would “keep other people away, ‘well, we don’t need to tell the doctors, we don’t need to tell our colleagues, we don’t need to tell anybody else that this woman is in the unit, because she’s normal’”.5 Over time, we believe that these incorrect and damaging practices spread to other midwives in the unit, probably quite widely. Obstetricians working in the unit were well-placed to observe these lapses from proper standards, and it is clear that they did, but seemingly lacked the determination to challenge these practices. This in turn represents a failure to maintain professional standards on their part.
I think its one thing to criticise the midwives concerned, but their comments do not spring from nowhere.
There has been much campaigning to promote normal birth. There has been much pressure from politicians and NHS leaders to reduce CS rates.
Some of this is needed as there are women who are suffering because of over medicalization, but targets also having a hugely detrimental effect on women too.
Why is funding to maternity wards affected by CS rates? If your rate is too high, you loose money. That's absurd. Especially when you consider there is no optimal rate of CS. It infuriates me. Surely, if you have concerns about a high CS rate you should be investigating but not removing resources. Its a recipe for disaster.
WHO did suggest an optimal rate of 15% but rescinded this in 2009 saying whoever needs a CS should get one. However this figure keeps popping up and seems to be deeply ingrained into planning and thinking.
In August 2011 Dr Michael Dixon, Chairman of the NHS Alliance said the following: ‘We are going to need to balance all sorts of things in future, from cancer to heart disease. When it comes to treatments we may need to spend less on, that caesareans may be one.'
Article about fear of CS ban
What was very interesting about this was the timing. At the time the draft guidelines on CS had just been published for consultation before their final publication. It was highly politicial and very much in contrast to what NICE were proposing. NICE had even stated that cost alone should not be used as a reason to refuse ELCS as a) it was cost effective and b) there were down stream costs that weren't being considered.
In September 2011, Dr Michael Dixon then went on to a radio debate on local BBC radio quoting this WHO guidance of 15%. He was later forced to apologise for using the incorrect figure.
Article about his apology
This WHO thing won't go away either.
I spotted this article in the Guardian dated September last year. Again it appears, unchallenged. (FTR I don't think a CS rate of 90% is healthy either. The point is the WHO figure is being used to vilify and sensational and to influence the public).
So everything that happened at Morecambe Bay happened against a political background where influential and important individuals were using information that were both out of date and out of step with the NICE recommendations. A climate and pressure to avoid CS was being advocated from high up due to finances not just from an ideological belief that 'normal is better'.
Its interesting that there has been a big rise in women reporting birth trauma in the last ten years. It could be down to awareness. It could be down to poor experiences. It could be down to other things.
Whatever it is I really think we need to have a long hard think aboutthe 'right way to give birth' and why such a poor and unsophisticated understanding of health economics is harming women and babies.