Is the UK childbirth policy dangerous?

February 29, 2016

Imagine being asked to have a haemorrhoid removed without a local anesthetic. Or undergo laparoscopic gallbladder surgery while fully awake. Now imagine pushing a bowling ball out of your body through a hole the size of a golf ball. That’s childbirth. Millions of women do it every day without benefit of pain control or medical intervention. But they shouldn’t be told they have to.

A post last week in New Scientist comes out strongly against the UK’s National Maternity Review report, asserting that the report’s recommendations are potentially ‘dangerous’ to women and babies, advocating a midwife-led model of natural childbirth with minimal intervention. It blames a midwife-dominated service, reluctant to call upon MD assistance, for the unjustifiable rate of maternal and child deaths and injuries. Last year, 151 women and newborns died on NHS maternity wards and another 351 suffered severe harm.

Now the service is advocating even more midwife autonomy and giving each patient a fixed budget for “personal midwives and home births.”

Natural childbirth, at home with a midwife, can be a positive and affirming experience. It’s the model of family-centered care and should be one option for having a baby. But it shouldn’t be the default national health policy. What the New Scientist points out is that the National Maternity Review is essentially waging a political campaign in support of midwives to get women to have their children ‘naturally.’

But the fact is women are delaying child-bearing and when they do so, vaginal deliveries become potentially more difficult.

UK statistics confirm that rates of conception have risen the most in women ages 35-39. Women over 40 are having babies at over 100 times the rate they were in 1990, thanks to the advances of reproductive technology. It’s simply more difficult physically to deliver a baby at what’s considered an ‘advanced maternal age’ especially if it’s a woman’s first delivery. C-sections, though certainly a major operation, are often lifesaving to both the mother and child.

But life or death shouldn’t be the primary benchmark. Injuries from childbirth are also rising. One hospital in Sydney, Australia, found that the need for blood transfusions after vaginal births roughly trebled following a move to reduce the number of C-sections. In an attempt to avoid a C-section, doctors often need to resort to vacuum or forceps delivery. Hans Peter Dietz of the University of Sydney ran a study using ultrasound scans after birth to assess damage done to women’s internal muscles. It showed 44 per cent of women have such damage after a vacuum delivery and 81 per cent are damaged after forceps.

The National Maternity Review report advocates full disclosure of the risks and benefits of natural childbirth vs C-section. But what appears to be missing is inclusion of the long-term consequences of natural childbirth.  A study published in 2013 out of Sweden reports women are more likely to experience urinary incontinence, prolapse and faecal incontinence 20 years after one vaginal delivery rather than one caesarean section.

Advances in medical technology mean we can have a gallbladder removed with little discomfort. Why should women be forced to endure unnecessary pain and avoid medical intervention until damage has been done when it comes to having babies? Women are older now when they have their first child and childbirth is more fraught with risks. This is one place where the care plan for an optimal outcome should be as individual as each mother and include both midwives and obstetricians working as a team, not at odds with each other.


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