Mothers are having fewer children later. This makes them more high risk, and most sensible ones will have whatever form of delivery gives the best chance of a normal child.
For an event so natural that none of us can avoid it, the business of childbirth has become an unfortunately ideological battleground. Since the 1960s advocates of “natural” birth have been pitted against defenders of medical intervention. The assumption, driven in part by advice from midwives, has been that a natural birth is somehow superior. In an interview with The Times today Cathy Warwick, chief executive of the Royal College of Midwives (RCM), acknowledges that her profession has got the emphasis wrong. There are great benefits to birth without interventions, but they should be pursued in a way that is sensitive to every woman’s situation, not as an article of faith.
For 12 years the RCM, midwives’ professional and representative body, has campaigned, as a matter of policy, for births where the mother enters and completes labour without medical intervention. Avoiding epidurals, forceps, artificially induced labour or a Caesarean section, the RCM argued, was better for mother and child. Yet that orthodoxy has been criticised, on two grounds. First, it can take a psychological toll on mothers. Those who ask for medical intervention because of their own anxieties or past experiences, are often left feeling as if they have failed. The RCM has sensibly decided to scale back the use of value-laden terms such as “normal birth” in favour of more neutral phrases like “physiological birth”.
The second, and more trenchant criticism of old habits is that they risk putting patients in danger. There is some evidence to support this charge. In 2015 an inquiry into a catalogue of unnecessary deaths in a Morecambe Bay hospital found that midwives’ pursuit of normal childbirth “at any cost” was, in part, behind the failures.
James Titcombe, who brought the scandal to national attention after the death of his son, has warned that the pressure for a delivery without medical intervention is rooted not in concern for patient safety, but in ideology. There have been concerns, too, about the role that midwives’ prejudices may have played in a string of deaths at Shrewsbury and Telford Trust.
None of this means that more intervention is always better, or even that it often is. There is value in a physiologically natural birth — the touch of a mother’s skin to her child’s in the moments after delivery helps to build a bond; a profusion of tubes, doctors and medical instruments does not. Caesarean sections come with well established risks. Mothers are vulnerable to the complications of any major surgery, and researchers have found some evidence that babies born this way are more likely to suffer from asthma and obesity in later life.
However, parents are well able to understand these risks and come to a considered view on what is best for them. The dangers are greatest, in any event, when interventions are emergency measures, taken after the failure of a “normal” birth. Better that midwives speak openly and neutrally about the benefits and risks of epidurals, inductions and Caesarean sections, well in advance, to avoid eleventh-hour panics.
Healthcare in Britain mostly compares favourably to that in other countries. Childbirth, however, is the exception. Britain has among the highest infant mortality rates in western Europe. That is all the more reason for midwives to eschew ideology and focus instead on what will work best for mothers and babies.