In 2005, the Royal College of Midwives (RCM) launched their campaign for ‘normal births’, an initiative to encourage expectant mothers to give birth without medical interventions such as epidurals, inductions, caesareans or the use of instruments.
As part of the campaign, the RCM’s website published guidance tips for midwives such as “wait and see”, “trust your intuition” and “justify intervention”; advice that was clearly intended to influence the behaviour of midwives, and the decisions made, at critical moments during childbirth.
Although the objective of delivering maternity care in a way that minimises the chances of unnecessary interventions is of course one to be encouraged, concerns about the campaign started to emerge following an inquiry into the deaths of 16 babies and three mothers at Furness General Hospital in Cumbria between 2004 and 2013. The inquiry found that a “lethal mix” of failings had led to the unnecessary deaths of 11 babies and one mother treated at the hospital’s maternity unit which is part of the Morecombe Bay NHS Foundation Trust.
The Morecombe Bay inquiry, chaired by Dr Bill Kirkup, said that the hospital’s maternity services were plagued by denial, collusion and incompetence and that the relationship between midwives and doctors on the unit became “seriously dysfunctional” with reports of midwives neglecting to alert doctors in time about patient complications. One of the babies in the inquiry, Joshua, sadly died nine days after being born. His left lung was more damaged from infection than the consultants looking after him had realised and the inquiry found that five minutes of a doctor’s time and a single dose of antibiotics at the right moment would have saved his life.
The inquiry also found that a small number of midwives appeared to have looked at the ‘normal births’ campaign and thought it meant pushing normal birth “beyond the point of safety” which “led at times to inappropriate and unsafe practice”. The inquiry held that these midwives, calling themselves “the musketeers”, contributed to unsafe deliveries due to their desire to see women have ‘normal births’ at any cost.
Speaking after the publication of his report in March 2015, Dr Kirkup said: “Our findings are stark and catalogue a series of failures at almost every level”. Seven midwives have been investigated as a result of the investigation, of which two have been struck off and another suspended.
Professor Cathy Warwick, chief executive of the RCM, has denied that the decade-long campaign compromised the safety of expectant mothers but has admitted that the guidance provided on their website could have been “misleading” and may have created the wrong impression.
Since the inquiry, several mothers have spoken out to say that they felt pressured towards achieving a ‘normal’ delivery without their concerns or wishes being listened to by their attending midwives. Professor Warwick has stated “what we don’t want to do is in any way contribute to any sense that a woman has failed because she hasn’t had a normal birth” but she admits that this is unfortunately how some women have felt since the campaign was launched in 2005.
The RCM has now confirmed that its dropped its ‘normal birth’ campaign and has permanently removed the advice from its website. The campaign has been replaced with a more evidence based ‘better births’ initiative and the midwifery trade union will instead start to use the term “physiological births” to describe those births without intervention to try to reduce the stigma for women who do not achieve a ‘normal’ delivery and to reduce the chances of preventable death by ensuring that ideology is never allowed to be put before a patient’s safety.
In recent years, the Government has become increasingly focused on maternity care and safer births and aims to reduce the rate of still births and brain injuries at birth by half by 2030.
For further information, please contact Sophie Moss, Solicitor in our Clinical Negligence Team
Call: 0191 232 8345