Mothers and babies in danger - Midwifery must curb its radical ideologues
Stillbirths. Tiny tots who lose their mortal coil. Mothers who succumb to physiological trauma. A hundred years ago these were common outcomes of pregnancy, but now are thankfully rare. So when a spate of tragic deaths occurred at the maternity unit of Furness General Hospital in Morecambe, an enquiry was eventually held. Unlike previous NHS scandals, the Morecambe debacle was not simply a result of staff negligence and poor management. Babies died due to a dangerous dogmatism.
I am emphatically not criticising the whole corpus of midwifery. My sister is a highly experienced midwife at a prestigious London hospital, where she has dealt with the most complicated of births. In my family we have had marvellous midwives facilitating two home births, giving excellent care to my wife and newborns.
But something has gone wrong with this noble profession. Midwifery has become immersed in an ideological agenda. As in other vocations such as the police, this is not the fault of ordinary practitioners, but the leaders. The march through the institutions has succeeded by stealth, as those who spout the favoured political orthodoxy are promoted, and then impose themselves through policy. In midwifery, the theme is radical feminism; the enemy is the patriarchy.
In 2015, Walsh, Christianson and Stewart published an article titled ‘Why midwives should be feminists’ in a midwifery journal. The authors argue that ‘by raising a feminist consciousness, we believe the profession of midwifery will be more effective in challenging and overturning injustices in childbirth’. This may appear virtuous until you realise that perceived injustice includes delivery by a doctor (traditionally, a man). Hence, midwifery must strive for ‘birthing autonomy’ with ‘resistance to the ongoing medicalization of childbirth’. Apparently, ‘competition for control over the terrain of childbirth remains an enduring feature of the maternity care landscape’.
In midwifery, the theme is radical feminism; the enemy is the patriarchy.
Pregnancy is not an illness. Working in mental health, I’m as much a critic of medical hegemony as anyone. Obstetricians, like psychiatrists, tend to take over, and not always for the better. Epidural and excisions may be foisted on women unnecessarily, with adverse effects. Yet, undoubtedly, medical input is needed for some births. Inspired by postmodern messages of hierarchical power dynamics, radical midwives strive to banish doctors from maternity.
Some women insist on a Caesarean section. By doing so, they are choosing an obstetrician and anaesthetist over the midwife-led unit. Operative surgery is costly for the NHS, but a growing proportion of women want a relatively painless birth in a fully equipped theatre. Midwives are justifiably concerned about surgical deliveries when they are not clinically indicated. But also this stymies their professional project. The right way, they argue, is a natural birth in the care of a midwife.
Empowering women is fine, but no sensible midwife would prioritise choice over safety. Sometimes, though, it is midwives who are choosing unsafely. Writing in the The Guardian, Elaine Glaser described her experience of going to a maternity unit while having contractions, but despite bleeding was told to return home and not to worry. Soon after, she was rushed back to hospital for an emergency Caesarean section. The placenta had become detached from her womb lining, a common cause of maternal death. ‘The cult of natural childbirth has gone too far’ was the title of Glaser’s article, accusing midwives of betraying feminism by bullying women.
At Furness General Hospital, a band of like-thinking practitioners (known as the ‘Musketeers’) egged each other on, injudiciously pushing an ideology to the extent of endangering women and their babies. Dr Amy Tuteur wrote on the Skeptical OB website that, ‘the deaths at Morecambe Bay, and the subsequent cover-up, are the inevitable consequences of a maternity system whose gatekeepers are biological essentialists and feminist anti-rationalists’. As science is portrayed as a male construct, evidence-based practice is undermined.
Inspired by messages of hierarchical power dynamics, radical midwives strive to banish doctors from maternity.
The close-knit supervision system in midwifery demonstrated the folly of feminist ideology in freeing midwifery from institutional control. A clear conflict of interest was created, whereby the supervisor was responsible not only for a midwife’s professional development, but also to investigate the same midwife’s failing (which would draw attention to her own failings). At Morecambe, relationships were further enmeshed by the maternity risk manager being the professional union steward. The Cumbria coroner accused the midwives of colluding to mask malpractice.
The dogmatic movement is personified by Cathy Warwick, until recently chief executive of the Royal College of Midwives (RCM). Warwick certainly made a name for herself in leading an organisation representing 46,000 midwives. Without consultation, or a vote by the board, she announced policy to support decriminalising abortion. In collaboration with the British Pregnancy Advisory Service, the prolific abortion provider, Warwick pledged the RCM to the ‘We Trust Women’ campaign.
It soon transpired what was meant by decriminalisation, and many midwives were horrified. A fully-formed baby could be terminated right up to the due date, without sanction. Warwick justified this by defining the RCM as ‘being for women, and respecting their choices regarding their bodies’. The other human body was conveniently ignored. Indeed, Warwick envisaged midwife-led services that encompassed babies being born or extinguished depending on the woman’s preference.
Again, the problem is the patriarchy. Under current law, women need two medical certificates to abort beyond 24 weeks. Yet Warwick’s supposedly liberal stance would perpetuate the disadvantage of women in firmly patriarchal cultures. The sex imbalance in births in communities of particular Asian background, due to girls being aborted, could become a serious social problem. Unwittingly, Warwick was promoting misogyny.
Babies died due to a dangerous dogmatism.
Midwifery leaders laud routine questioning of pregnant women about whether their partners beat them – a government policy since 2004. Some women support this generic approach, but on Mumsnet many resent this implied perpetrator-victim dyad. And although their views don’t seem to count, loving husbands and fathers are likely to find this grossly insulting. For militant feminists, such probing is paramount: any man is a potential abuser.
Identity politics is all the rage nowadays, but inevitably conflict arises between groups in their claim for special status. Remarkably in a discipline that advocates for the cause of women, I now find midwifery students’ essays referring to ‘pregnant people’. Transgenderism has arrived in midwifery training, but it is not a comfortable fit. The hardly patriarchal BMA issued guidance on ‘inclusive language’, stating that we should not assume a pregnant person is a woman.
Conventional feminists are aghast at this denial of womanhood, but they will find themselves like social conservatives, rowing against the tide. In pathologising norms, cultural Marxism is never short of a target. For all their feminist credentials, radical midwives are beginning to accuse peers of transphobia.
There are lessons here for all professions and institutions. Zealots who get their hands on the tiller may cause reputational damage. Healthcare should never be a platform for subversive ideology. Leaders should be appointed not on political posturing but performance. Let the committed legion of midwives do their wonderful work unfettered by feminist propaganda. We should all be grateful to the caring craft that helped bring us into the world.
(Dr Niall McCrae is a lecturer in mental health, and a writer on social and political affairs. He regularly contributes to The Salisbury Review, The Conservative Woman and Bruges Group website, and has written two books: The Moon and Madness, and Echoes from the Corridors: The Story of Nursing in British Mental Hospitals).