For decades, women have been encouraged to give birth naturally â that means avoiding all medicines and interventions, including continuous monitoring of the babyâs heart rate and caesarean sections.
But now, several events suggest the pendulum is swinging back the other way. In May, the UKâs Royal College of Midwives (RCM) quietly cancelled a long-standing campaign to promote natural births. Separately, doctors are beginning their own more proactive approach to ensuring interventions happen as soon as they are needed. And campaigners have formed a new pressure group called âMaternity Outcomes Matterâ to ensure all healthcare staff prioritise safety over the process of childbirth.
Whatâs behind this sudden backlash? Isnât natural birth a good thing?
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While it is sensible to avoid medical interference where possible, take this approach too far and childbirth becomes more dangerous, leading to brain-damaged babies and avoidable deaths.
Some of these occurred when women were denied caesarean sections even after begging for them.
The natural childbirth movement within the UK health service is mainly driven by midwives, who oversee the care of all women at low risk of complications, and vastly outnumber obstetricians. That means midwives are often the ones who decide whether to call in doctors when a birth seems to be going wrong. If the midwife overseeing your care has a natural-birth agenda that is at odds with your own, you may be overruled.
Wait and see?
As part of its natural birth campaign, the RCM website until recently advised midwives that during births they should âwait and see â let natural physiology take its own timeâ, and if uncertain they should âtrust their intuitionâ.
Such policies are directly at odds with safety advice to consult guidelines on how frequently to check the babyâs heart rate, for instance, and to seek second opinions to make sure danger signs are not being missed.
Ignoring such guidelines can be dangerous. A recent inquiry found that three-quarters of the 1136 babies who died or were brain-damaged during birth in the UK in 2015 might have been saved with better care.
Thankfully, the bad RCM advice has now been taken down, although itâs a shame the midwivesâ leaders have tried to do this quietly. Their climbdown was only highlighted by safety campaigner James Titcombe, whose own baby died at a hospital run by Morecambe Bay health trust in 2008. Services there were judged by an inquiry to have been run by âmusketeerâ midwives who over-prioritised natural childbirth, leading to 12 avoidable deaths.
Back-pedalling on the quiet means news will spread more slowly to grassroots midwives and schools of midwifery. There is great variation in practice, and while there are many excellent midwives who prioritise safety, there are also those who may resist change.
If the RCM genuinely wants to reduce avoidable bereavements, it should shout about its change of heart from the rooftops. Most people think of medicine as a field where decisions are guided by evidence rather than ideology. That should be true for childbirth too.
