Beverley Lawrence Beech is -Hon. Chair of AIMS - the Association for Improvements in the Maternity Services. This letter is reprinted here with her permission.
Dear Ms Alibhai-Brown,
I read your article "Give me a hospital birth any day" and I have the following comments:
The major cause of maternal death in the Third World is abortion, haemorrhage following abortion, and infection following birth and inappropriate care.
Whilst recognising that medical intervention has saved life you may be interested to know that in the UK when the doctors went to war and midwives were responsible for birth the infant mortality rates substantially decreased during the period 1939-45.
Analysis of infant death statistics by Marjorie Tew revealed that had the hospitalisation of all women for childbirth not taken place our infant mortality rates would be four points lower than it is. I suggest that you read Safer Childbirth - A Critical History of Maternity Care, published by Faber.
Every year thousands of babies die in the UK. The Confidential Enquiry into Stillbirths and Deaths in Infancy has revealed that of the preventable deaths 47% had sub-optimal care from obstetricians 30% hospital midwives 6% community midwives and 5% GPs. Furthermore, the most recent falls in infant mortality rates have occurred because those babies with abnormalities were aborted, so they appear in the abortion statistics and not in the infant mortality statistics. This gives the impression that there has been an improvement.
There is no evidence that hospitalisation for birth for all women has improved outcomes or brought about the falls in infant mortality; one could just as easily argue that the improvements have a direct correlation with the spread of colour television sets!
I am fascinated that you think that women who want natural birth should 'want to dance in the meadows with daisies in their hair, mugs of elderberry tea in their hands, and then squat somewhere nice to bring baby into the world'.
In the twenty five years that I have been helping women get the kind of care they want (and that includes helping women who want to book a caesarean section) I have never come across such a person. I wonder why you have the need to denigrate and trivialise the wishes of women who, in the main, are fighting to get a good birth for themselves and their babies. I expect you are unaware of the fact that the majority of women who fight (and I do mean fight) to get a home birth have had a previous hospital delivery and are determined never again to submit themselves or their babies to the barbaric (and often unnecessary) treatment they received.
The position of people like me, and others who campaign for women to be able to birth at home if they wish, is that childbirth is a normal physiological event for the majority of women and the role of the midwife is to facilitate that process and help the mother to give birth by her own efforts. It is fascinating how research reveals that the majority of women giving birth at home do not need pharmacological pain relief. They are not Amazons, nor masochists, but they are often very well informed of the risks of obstetrically managed births and the research, for example, which shows a 4.7 times increased risk of teenage drug addiction following the use of barbiturates and narcotics during birth. They are also aware of the Winterton Report which concluded that "There is no evidence to support the claim that the safest policy is for all women to give birth in hospital". It goes on to state that: "There is some evidence, although not conclusive, that morbidity is higher among mothers and babies cared for in an institutional setting".
Nobody is suggesting that women who have difficulties and complications should birth at home; those are the women that need obstetric care. The irony is that at a worst scenario estimate no more than 20% of women are in that category, yet 98% are required to submit to care which is geared to the difficulties.
It appears from the article that you find it difficult to believe that GPs could coerce women into a hospital birth. Our files bulge with reports of GPs doing just that. Indeed the situation was so bad that the Royal College of GPs and the Royal College of Midwives issued a joint advice statement reminding GPs that if they did not want to be involved in home births they should refer women to another GP or a midwife. A recent comment from a GP to a mother who wanted a home birth was "The only home births in this area in the last 30 years have been dead ones". This was manifestly untrue. Furthermore the British Medical Journal published four studies in November 1996 which showed that, for selected women, home birth was safe. Studies which supported what Marjorie Tew was saying in the early eighties.
I accept that GPs may be genuinely concerned. It would be helpful if they read the research, and even if they did not it does not give them the right to give women the third degree and such hysterical advice. I suspect that their approach has little to do with safety (otherwise they would be campaigning to close down the large, centralised, obstetric units) but more to do with power, control and fury that women are rejecting medical advice.
I have enclosed a journal which focuses on normal birth. You are quite right; a normal birth can turn very quickly into an abnormal one. Unfortunately, examination of the hundreds of case files we deal with each year frequently reveals that women with normal births were more often than than not given routine and inappropriate interventions (such as breaking the waters and putting up a drip) which led to a cascade of interventions resulting in the doctors "saving" the baby from the damage they had just caused. Many women who have had that experience often state that "had I been at home my baby could have died". Had she been at home the problem would not have arisen in the first place, because such interventions would not have been undertaken. A fact which escapes many women.
You wonder whether organisations like ours care about the fact that thousands of women now feel failures because they had to have intervention and therefore feel themselves to be imperfect mothers? Of course we care; that is why this organisation and members work (voluntarily and without any Government subsidies) without payment to help those women who are unhappy about their care, or who are trying to understand what happened to them and why, and to obtain care appropriate to them for the next birth.
You mentioned the young couple who did not want pain relief giving birth at Queen Charlottes. What a pity the young couple were not told that the chances of having a normal birth in Queen Charlottes is less than 10%. They were going into one of the most interventionist hospitals in Britain.
You finish with an appeal for the public to recognise that "not all women want normal births and don't malign those who make sure that all mothers are equally protected from harm". I will accept that the medical profession and those obstetric nurses who believe in managing birth from beginning to end are doing so because they believe that they are protecting women from harm. Unfortunately, research and our case files show that they are often causing harm and there is a pandemic of damage throughout the developed world. I suggest you also read Marsden Wagner's book 'Pursuing the Birth Machine', ACE Graphics. When you have done that you might then be in a position to write an article about childbirth that has some accuracy to it.
You mentioned that you had two complicated deliveries in hospital. I am sorry for that, but why does that lead you to denigrate and trivialise women who say 'that form of care is not appropriate for me and my baby'? I suggest that perhaps you are angry about that experience and instead of taking your anger out on those whom you perceived saved you and your babies, you are targeting women who have achieved something that you did not.
I have always enjoyed your articles but if the others are as inaccurate as the one on childbirth I will now treat them with a very large pinch of salt.
Beverley A Lawrence Beech
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