Doctors and midwives around the world are railing against comments made by a top U.K. midwife that doctors are "hopeless" at childbirth.
Statements such as these only hurt both professions and damage efforts for more collaborative care, many doctors and midwives agree in the online fallout to midwife Caroline Flint's assertions.
Flint, the former president of the Royal College of Midwives and an advocate for natural birth, was reported as saying that the U.K. should, "Get rid of half the obstetricians. That money could produce zillions of midwives. Doctors are hopeless . . . at childbirth," according to an article published in the Times on Sunday.
Flint also said that doctors interfere with breastfeeding, and criticized doctors for seeing most aspects of childbirth as "dangerous."
Irresponsible grandstanding! #obstetricians & #midwives are partners in childbirth. Mutual #respect for each other's skills would make #childbirth safer for all. So glad this is not the attitude in any of my workplaces! @MidwivesACM @ranzcog https://t.co/wpcEPvmmzm— Nisha Khot (@Nishaobgyn) March 18, 2018
"It is much more difficult for women to breastfeed in 2018 than it has ever been before and it seems to me [that is] because they lose so much blood at birth because their physiological processes are messed about — and that is to do with the fact that we are dominated by obstetric practice," Flint said, according to the Times.
"Midwives know women can give birth perfectly happily if they are encouraged and supported. Obstetricians ... see every part of birth as a really dangerous thing."
The Doctors' Association U.K. called Flint's comments "completely irresponsible," and the professional organization wasn't the only one to speak out on the topic. Doctors and midwives around the world took to Twitter, some of them in defence of their profession, but many saying that collaboration and mutual respect are key.
Completely irresponsible for Caroline Flint, the past President of @MidwivesRCM to be saying this in The Times.— The Doctors' Association UK (@TheDA_UK) March 18, 2018
"Doctors hopeless at childbirth"https://t.co/JXYyQwVwNL#morecambebay #patientsafety https://t.co/3IxTOdXGf7
Always encouraging to see a midwife use precise terminology, like "zillions" https://t.co/YL5gfbrQaS— Jennifer Gunter (@DrJenGunter) March 18, 2018
My personal experience in Ontario is that there's mutual respect between OBs and midwives. Which is, you know, a bit more productive! (Dunno if training and regulation are different - I imagine that could have an effect.)— Fiona McPhaden (@fmcphaden) March 18, 2018
I mean... have you heard OBs speak about midwives?? In 20th C US, docs paid for the ads calling them untrained, dirty, dangerous. To this day the prejudice exists and the language is only slightly less sexist, racist, inflammatory.— Cristen Pascucci (@CristenPascucci) March 19, 2018
Not sure it does much for harmony between obstetrics and midwifery.— David (@tweediatrics) March 18, 2018
This woman does not speak for me and other midwives - shocking views like this have no place in any profession.— Natasha (@NatashaMellon) March 18, 2018
In fact, the same day as the Times article was posted online, the Royal College of Midwives (RCM) and the Royal College of Obstetricians and Gynaecologists (RCOG) released a joint statement on their commitment to work together on maternity safety and positive birth outcomes.
"Multi-professional working plays a vital role in the provision of high quality care for mothers and their babies. The RCOG and RCM both recognize this to be a key component in the delivery of safe maternity care and emphasize the importance of respectful team working to build a supportive workplace culture," the statement said.
Midwives in Canada
About 10 per cent of births in Canada are led by a midwife, according to recent data from the Canadian Association of Midwives (CAM). The highest rates are in B.C. (21 per cent), Nunavut (15.4 per cent) and Ontario (15.2 per cent).
One of the central tenets of evidence-based midwife care is informed choice, according to the CAM website.
A recent study from the University of British Columbia's Birth Place Lab and the B.C. Women's Hospital and Health Centre found that women who had midwifery care during childbirth tended to report higher levels of both respect and autonomy compared to those with physician care.
Last month, the World Health Organization released a new set of guidelines to help women be placed at the centre of their own care and have a more positive birth experience. Among the recommendations were that respectful maternity care that "enables informed choice and continuous support during labour and childbirth" should be delivered.
It's a woman's choice (usually)
Midwives and OB-GYNs in Canada are both qualified to provide "safe and comprehensive" prenatal care during pregnancy, labour and birth, Dr. Sheila Wijayasinghe, a family doctor at St. Michael's Hospital and the medical director of primary care outreach at Women's College Hospital, both of which are in Toronto, wrote in the Globe and Mail in 2013. Midwives tend to spend more time with their patients, tend to be non-interventional, and will visit a woman in her home after she gives birth, Wijayasinghe wrote.
But if a pregnancy is considered high-risk, a OB-GYN will likely be necessary, Wijayasinghe added.
"If you are followed by a midwife or family doctor and a complication arises in the labour or delivery process, an obstetrician can be called upon for support," Wijayasinghe said.
This process, however, can be less-than-ideal for an OB-GYN who has to take over a high-risk case at the last minute, according Time magazine.
"When hospital-based obstetricians see midwives and their clients it's usually because something has gone wrong and the laboring mother is rushed in for care ... What's more, doctors in this position find themselves not just being forced to take on someone else's case, but someone else's problem. That's enough to sour them on the entire profession," Time reported, summarizing 2009 U.S. research by medical anthropologist (and midwife) Melissa Cheyney.
While collaboration between midwives and OB-GYNs is ideal, a number of barriers remain, according to a 2017 Quebec case study.
"Although having collaborative and multidisciplinary teamwork is a goal of maternity care systems, it is hard to achieve," the authors wrote.
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