# Episode 177 - Defending birth and midwifery in the UK

An episode of [The Great Birth Rebellion](https://invisiblenetwork.ai/podcast/1639430316), 16 Nov 2025, 1 h 13 min.

Audio: https://episode.flightcast.com/id2fpdya8dop2ou65dqbmcvy.mp3

The UK used to be held up as an idyllic maternity care system worth replicating, but in the past 10 years, the caesarean section rate has increased to over 45% and poor maternal outcomes are rising as a result. Midwives are leaving in droves, birth services that once facilitate physiological birth are closing and the whole system is becoming hostile toward normal birth. There are people petitioning to put a stop to midwifery education from focusing on physiological birth which will fundamentally change midwifery in the UK relegating midwives to obstetric nursing roles. In this episode Mel speaks to Dr Sheena Byrom and Prof Soo Downe who explain the situation and offer practical solutions. The easiest way to help save physiological birth in the UK is to sign this open letter from @thepeoplesbirthtribunal People power = change… sign the letter to help enact change. Together we can save physiological birth in the UK. This episode has been generously sponsored by Poppy Child from @popthatmumma. Great birth rebellion listeners get 25% off the Birth box. Use the code “Melanie” at the check out to claim your discount. Get more from the Great Birth Rebellion Podcast • Join the podcast mailing list to access the resource folder from each episode at www.melaniethemidwife.com • Join the rebellion and show your support! Grab your Great Birth Rebellion merchandise now at www.thegreatbirthrebellion.com • Follow us on social media @thegreatbirthrebellion and @melaniethemidwife • If this podcast has improved your knowledge or pregnancy, birth or postpartum journey please consider thanking us financially by leaving a tip to support the ongoing work of this podcast. Disclaimer The information and resources provided on this podcast does not, and is not intended to, constitute or replace medical or midwifery advice. Instead, all information provided is intended for education, with it’s application intended for discussion between yourself and your care provider and/or workplace if you are a health professional. The Great Birth Rebellion podcast reserves the right to supplement, edit, change, delete any information at any time. Whilst we have tried to maintain accuracy and completeness of information, we do not warrant or guarantee the accuracy or currency of the information. The podcast accepts no liability for any loss, damage or unfavourable outcomes howsoever arising out of the use or reliance on the content. This podcast is not a replacement for midwifery or medical clinical care. All transcripts are generated by ai and may contain errors

## Transcript

[0:00] Welcome to the Great Birth Rebellion podcast.
[0:02] I'm your host Dr Melanie Jackson.
[0:05] I'm a clinical and research midwife with my PhD and each episode I cast a critical eye over current maternity care practice by grappling with research and historical knowledge to help you get the best out of your pregnancy, birth and postpartum journey.
[0:22] In the interest of keeping this podcast completely free to you, this episode is sponsored by my dear friend, Poppy Child from Pop That Mama.
[0:32] I'm so picky about who I allow to sponsor this podcast, but I really get behind the work that Poppy is doing.
[0:39] What I love about the birth box is that it's so practical.
[0:41] She's had so many amazing reviews in the birth box.
[0:45] You'll learn the tools that you need to manage the pain of labor and also stay steady and calm your nervous system.
[0:53] The mindset that you get from doing hypnobirthing and more specifically the one that Poppy has put in the birth box.
[1:00] It works when the big day of birth comes but also in the big days that will follow in your life as a parent.
[1:07] The birth box has been rated five stars across the board.
[1:10] And with my code, Melanie, you'll get 25% off at the cart.
[1:16] So if you're preparing for birth, go to the checkout.
[1:19] You'll be so glad you did.
[1:21] The link is in the show notes below.
[1:23] Use the code Melanie for your discount.
[1:25] That is the birth box by Pop That Mama.
[1:28] Welcome everybody to today's episode of the Great Birth Rebellion podcast.
[1:32] I'm your host, Dr. Melanie Jackson, and I'm joined today by Sheena Byram and Sue Down, and we're going to talk about the current situation in the UK.
[1:41] They've got all the information, they've been there from the beginning, and I want to talk about this because I feel as though there's some
[1:49] interesting attack upon midwifery and physiological birth that's going on over there because it's been heavy on in the media this week.
[1:57] So welcome to the podcast.
[1:58] Thank you.
[1:59] Thank you.
[2:00] I'd love to give each of you first an opportunity to introduce yourselves to our podcast listeners because neither of you have been on the podcast before.
[2:09] So Sue, we'll start with you.
[2:11] Can you let us know who you are?
[2:13] Okay, my name is Sue Down.
[2:15] I'm Professor of Modrifty Studies at the University of Lancashire.
[2:18] I'm the Associate Dean for Research and Knowledge Exchange at that same institution and I've been a midwife, qualified since, I'm a direct-hundred midwife and qualified since 1985.
[2:30] I'm turning 42 this year and I was born in 84.
[2:34] There you go.
[2:34] Sheena.
[2:36] Hi.
[2:37] Hi, Mel.
[2:37] Thanks for having me.
[2:39] My name's Sheena Byram.
[2:40] I'm a midwife and I've been a midwife since 1978.
[2:45] And I've worked in all areas of clinical and leadership work as a midwife.
[2:52] And I now am the co-owner with my daughter, Anna, of All4Maternity.
[2:57] And we publish the Practicing Midwife Journals and the world's only student midwife journal as well.
[3:04] It's great to be here.
[3:06] So the reason I wanted to get you onto the podcast is that in the papers and the media this week in the UK has been newspaper articles about how student midwives in the UK are being taught.
[3:24] I mean, I.
[3:25] It's ludicrous.
[3:26] This is why I've got you on the podcast.
[3:29] But maybe I'll leave it to you.
[3:30] Can you explain what happened in the media this week around midwifery?
[3:36] Whether we can start here or whether we have to begin at the beginning, I don't know.
[3:41] I mean, certainly what was in the paper was basically accusing some midwifery courses of promoting, well, they called it promoting physiological labour and birth.
[3:52] which is the term that's now being used rather than normal birth because for reasons we're going to explain we can't use the term normal birth.
[3:58] And the thing that was really being objected to was the notion of promotion.
[4:02] Promotion of one kind of birth over another, as in vaginal birth or physiological birth over cesarean section.
[4:09] So that's the kind of gist of it.
[4:11] Yeah, I think it's been interpreted differently by different universities, but certainly with Sue's right, that in the press it came out, you know, the article came out quite clearly saying that
[4:24] It's causing harm, is midwives pushing an ideology.
[4:29] This is the word that's used.
[4:31] A normal birth ideology is being pushed on women and it's causing harm.
[4:38] And so that's the general kind of story.
[4:42] And it's been going on for a long time.
[4:44] It's been going on for 10 years.
[4:47] So we can tell you how it kind of all unfolded.
[4:50] But certainly, the latest newspaper article was on Sunday morning.
[4:56] And since then, there's been a lot of upset from every party.
[5:04] You know, we've got to remember that there's families, mothers and babies, who have been harmed.
[5:10] And, you know, in some cases, mothers and babies have died.
[5:15] So we always have to start with the fact that we do acknowledge that there has been harm.
[5:21] And we're sorry about that.
[5:22] But what one of the
[5:24] The concerns for us is that a lot of this is being associated with normal birth, physiological birth, when we don't always believe that that's the case.
[5:36] And it's being blamed for almost everything right now.
[5:40] Yeah, yeah.
[5:41] Would you agree?
[5:42] Midwives and their ideology.
[5:45] Absolutely, that's right.
[5:46] Yeah, without any balance.
[5:48] Obviously, nobody would want any mother or baby harmed in any way.
[5:53] But we know that harm does happen, unfortunately.
[5:55] And often it's because of overstretched systems with not enough midwives, with people who were
[5:59] grown out, possibly not as compassionate as they could be as a consequence of that.
[6:03] And that can happen in hospital, out of hospital, under midwife care, under obstetric care, under any circumstances.
[6:09] And so I think Sheena's right.
[6:10] This is the issue.
[6:11] It's the constant emphasis on that particular aspect and on extrapolating from maybe one or two cases to the whole profession.
[6:20] So the crux of what's happened recently is
[6:23] is that they've reinvigorated the conversation around midwives and universities promoting physiological birth as an ideology.
[6:34] And the claim is that that is causing danger to women and babies.
[6:39] And it's almost like that's the only thing causing danger to women and babies.
[6:43] Yeah.
[6:44] Overarching narrative, really.
[6:45] Yeah.
[6:46] Just to mention as well that –
[6:48] The term that's bandied around is normal birth at any cost.
[6:52] And that term was coined by the reviewer of the maternity service, the first maternity review in 2015, which was Morecambe Bay and the Kirkup Report.
[7:07] And Dr. Kirkup used that phrase when he talked about what he felt that the midwives,
[7:18] were telling him that there seems to be this pursuit of normal birth at any cost.
[7:25] So that was the thing that was worrying, that the belief was or the evidence was that women were being, even if they needed intervention or they needed support or they needed some kind of, well, an intervention, that it wasn't happening and that midwives were holding back from doing that, from making sure they got the doctor, for example.
[7:46] But that term has carried on for 10 years, you know, and when things have happened, it's being brought back to that phrase.
[7:56] Would you agree, Sue?
[7:57] Yeah, and I think that phrase also arose from the reports of one specific midwife at this particular place.
[8:04] So he just used it, I think, as almost a throwaway line.
[8:07] Unfortunately, then, obviously, subsequently, a number of families who've lost babies have experienced that.
[8:14] In some cases, they've entered the process probably wanting a normal birth.
[8:18] And I use the word normal birth now because that was what we called it until very recently.
[8:21] And then for whatever reason, that has become possible.
[8:23] And I think some of them have felt that whichever, for whatever reason, the intervention wasn't given to them soon enough or wasn't offered them soon enough or they weren't given enough information to ask for it soon enough or whatever it happened to be.
[8:33] So although it originally started with one midwife just kind of as a throwaway line and a group of midwives being accused of doing this, it's now become almost a go-to explanation.
[8:44] Even if actually there were lots of other things going on around a particular case, that's become the only thing it gets focused on.
[8:49] So a bit of a convenient rhetoric to explain all of the ills and fails of the maternity care system.
[8:56] Yeah.
[8:56] There's this convenient push to pin it upon midwives in particular who are promoting physiological birth.
[9:03] Yes.
[9:04] And it might be that there were one or two cases where, you know, really this was going too far.
[9:07] Nobody's going to argue about that.
[9:09] Like in some cases, things go too far in terms of intervention in the hospital.
[9:13] There's always going to be scenarios where either because people are exhausted or because they don't understand the situation or whatever, they make a mistake.
[9:20] That happens all the time.
[9:21] Very occasionally, you get people who are intent on causing harm.
[9:26] Obviously, that does happen.
[9:27] But it's incredible.
[9:28] incredibly rare.
[9:29] And when people are making mistakes, when it comes, you know, from the point of view of making mistakes, usually it's because they're working for a shift or they're exhausted or, you know, they're trying to maintain some kind of ideal for the woman in a system which is actually not really designed for that.
[9:44] So it becomes difficult to do and they might just take it that bit too far because they really feel they're helping the woman.
[9:49] And in fact, in the end, the things go wrong.
[9:50] So, you know, we all know there are all these systemic problems that build on each other that can create mistakes and harm.
[9:58] But they're not unique to any particular professional space.
[10:01] They're across the board, really.
[10:02] Let's start from, what's the history?
[10:06] So we know what the current situation is now.
[10:09] Where did this all start?
[10:10] What's the history of this ongoing issue?
[10:12] I'll begin with that.
[10:13] The government, the previous Labour government, so before the Conservative government, the previous Labour government had a policy called Maternity Matters.
[10:21] And that was built on the Changing Childbirth Report, or the two were intertwined together.
[10:25] And in Maternity Matters, there was a strong case for saying
[10:29] midwives should support normal birth, using the word normal.
[10:31] It was very, very clear that that was the line of travel because of evidence that was brought out during the changing childbirth report.
[10:38] But it became apparent to me and others because one of the childbirth, the women's groups called AIMS, the Association for Improvement in Maternity Services,
[10:49] had started to report on the fact that a lot of women were contacting them with birth trauma because of interventions, specific interventions.
[10:56] So five specific interventions that they were reporting were traumatic for them.
[11:00] So artificial rupture of membranes, episiotomy, induction of labour, augmentation of labour and cesarean section.
[11:07] These are the things that women were continuously contacting this women's support group about.
[11:12] And so Aims wrote a paper about this.
[11:14] So they said, you know, this is a problem.
[11:15] We need to stop birth trauma.
[11:17] So I was at the time working in an area of the UK called the Trent region.
[11:22] And we decided to do some research to find out, well, actually, how many women were experiencing these interventions, just to see whether AIMS had a case or not, really, because we wanted to get the best for women and because women were telling us this was a problem.
[11:34] So we, with AIMS, did a survey and we found something like only about 20% of women having their first baby in the UK at the time had a birth without one of those interventions.
[11:44] which was shocking for Royal College of Midwives.
[11:48] They didn't really, hadn't really grasped that.
[11:50] So the RCM, the Royal College of Midwives, then set up this campaign to try and work with midwives to help them to support women
[11:59] who were not wanting those interventions, obviously when it was safe to do so.
[12:02] We all assumed that clearly that this was about when it was safe to do so.
[12:06] Nobody thought that anybody would question the fact that we would not talk to women about doing these things if there was a need.
[12:12] That was even need saying, really.
[12:15] So that was where the campaign for normal birth started from.
[12:18] How long ago was that?
[12:20] 2014 it finished, yeah.
[12:22] So it was a few years before then, Sue, wasn't it?
[12:26] At least five years it was going.
[12:28] And for those listening, the job really of a midwife is to support women through labour and birth.
[12:37] And our specific training and scope is typically in physiological birth and then referring on as physicians.
[12:47] If things become complex and involving other care providers in the woman's care in that event.
[12:54] I mean, at a core, if you're kind of sitting here going, I'm not sure what the issue is.
[12:58] At its core, midwifery is supposed to be about midwives nurturing women to have the type of birth they want.
[13:05] But specifically, our skill set is physiological birth, normal birth, if we're going to use that word.
[13:11] And then also the skill and knowledge to refer on to other practitioners when the woman's needs exceed our scope.
[13:19] Well, yes, because I was working during this time in a maternity unit as a consultant midwife.
[13:26] Yeah.
[13:27] And campaign, what happened was they produced some amazing little graphics, beautiful, beautifully drawn graphics of how midwives could support women in labor and during labor and birth.
[13:43] And they included things like upright positions and keeping mobile.
[13:48] And one of them was use your intuition.
[13:51] And another one was something about, was it, Sue, something about listen and watch and wait?
[13:58] Yeah.
[13:58] Watch and wait.
[13:59] One of them was, so there was 10 steps or 12 steps.
[14:03] So these beautiful graphics were sent out to all maternity units and we had them up on the wall.
[14:08] And we also had some little swatches that we could use.
[14:11] And around the world, people wanted these.
[14:14] So the RCM found, the Royal College of Midwives found that actually people were wanting these resources everywhere.
[14:22] And so I, Sue eventually was, she was the chair of the campaign for normal birth.
[14:27] And then you, you handed it to me.
[14:30] So I was there sort of at the end of it.
[14:34] And I remember we were receiving emails all the time to people asking us, would we send them to other countries?
[14:42] So it was seen as a real kind of a brilliant thing that the college were doing.
[14:47] And I remember the people who were involved and they were really passionate about it and supporting midwives.
[14:52] And because I was in practice, clinical practice at the time,
[14:56] I found these resources really useful.
[14:59] And we had them, as I say, we had them up on the wall so women could see them and they could do the positions.
[15:04] So you know what, you know, there's lots of this going on now, but it was quite rare though then a day.
[15:10] So that was fine.
[15:11] But then in 2015, when the
[15:14] the very first review was undertaken due to failings in a maternity service.
[15:20] And this terminology around normal birth at any cost was said by this particular midwife and picked up by the reviewer and used in the document.
[15:32] Then it became, that was the thing that they focused on.
[15:36] So even though within the review it was about the dysfunctional service,
[15:42] lack of partnership, collaboration between the staff, you know, toxic behaviors, bullying, lack of resources, lots of different things going on in that.
[15:53] And he, Dr. Kirkup described it as a toxic mix or something.
[15:59] You know, it was really, really a difficult thing happening.
[16:03] And there were tragedies.
[16:05] And one particular parent lost his son in the postnatal period
[16:10] And he was the one who instigated this report.
[16:14] And he's the one who's kind of picked up on this phrase and been, you know, personally taken it as this is the thing that needs to be got rid of, stamped out.
[16:24] They call it stamping it out.
[16:26] So during that time, I started to use Twitter.
[16:32] And when I took early retirement around that time to do a PhD and to look after my grandchildren, I started to use Twitter because it kept me in touch with everything.
[16:41] And I used that to kind of help me to stay in touch.
[16:44] And on Twitter at that time, there was a lot of debate going on.
[16:49] about this normal birth.
[16:50] And also at the same time, the same report had said that the supervision of midwives, which we've had, the supervision of midwives have been with us since the statute of midwifery.
[17:02] We've kind of had it since the time began.
[17:05] And so supervision for us in my service was brilliant because it meant that it wasn't just supporting midwives.
[17:13] It was also about supporting women that maybe wanted to have a birth that
[17:18] people were worried about, say, for example, what we would call now outside guidance.
[17:22] But at this time, we didn't have much guidance.
[17:25] And so it was, you know, if anybody wanted to have a water birth and no one knew how to do a water birth, you would go to the supervisor of midwives.
[17:32] This is 25 years ago.
[17:34] So supervision was really focused on the professional aspects of midwifery and protecting the public.
[17:40] So I particularly loved it.
[17:42] I was a supervisor and I loved the fact that we could help each other, etc.
[17:46] But in this particular maternity unit, supervision wasn't being used properly.
[17:51] And so this father was very distressed that he felt that supervision had hidden a lot of what had been going on.
[18:00] and he was against supervision so all this debate was going on on social media and I was naive at the time Mel I have to tell you I was really naive because I I was of the belief that well if I explain it maybe they'll understand and and maybe then everything will be okay and so I'd be trying to explain it you know sending them Hannah Dolan's papers and
[18:21] you know, all kinds of things and just being battered down all the time.
[18:25] So in the end, I kind of gave up.
[18:28] But unfortunately, my comments were used sometimes out of context.
[18:34] So screen grabs were taken.
[18:36] You know, one thing it was used, I said this and it wasn't anything to do with that particular topic.
[18:43] And so it was just a nightmare.
[18:45] So I had to really stop using social media in that way.
[18:48] I had to come away from that platform.
[18:51] because it started to be bullying, like really, really toxic bullying.
[18:58] You know, it's just, this is part of the story.
[19:00] So it's gone on for 10 years.
[19:03] A lot of the things that have happened have grown in parallel with their ex in particular being quite a difficult space.
[19:10] And I think that's catalyzed a lot of the things that's going on.
[19:13] Following that first individual situation, there are other families who feel aggrieved by what kind of care they've had from different hospitals.
[19:20] Yeah.
[19:21] And they've added into the mix, if you like.
[19:23] And, you know, again, you can understand people who are very upset when their baby's died.
[19:28] Lots of people, unfortunately, however, do lose baby, I'd say lots, relatively speaking, very few.
[19:32] But there are many who do.
[19:34] And many of those don't actually turn that into, don't feel they have to make the kinds of comments that,
[19:41] that we're beginning to get or we have had for some time now from some individuals.
[19:47] Many cases, people try and turn that into something positive.
[19:50] But that's unfortunately not really what's happening in this particular case.
[19:54] I think the other thing that's happened in parallel with all of this is that at the same time as this was happening around the campaign,
[20:00] there was a pushback against the notion of normal-abnormal.
[20:03] So women saying, well, you know, if I don't have a normal birth, I must be abnormal, which again is a kind of category error, really, because it's like saying, you know, that you do not have a birth that's normal doesn't make you personally abnormal necessarily, but that assumption was made.
[20:19] which was also problematic for people because they thought they were being put in that box and that they failed by not having a journal board.
[20:26] And then there was also the kind of growing impetus for the request of cesarean, maternal request of cesarean.
[20:33] So that was probably not really in the dialogue when we started the whole thing.
[20:38] By the time the campaign stopped, it was very much in the dialogue that women must have an opportunity to choose an elected cesarean section if they want one, given that they get all the appropriate information, da, da, da, da.
[20:48] And that has now morphed into, we should put no limit on serene section.
[20:52] So our serene flux rate in the UK is now 46%.
[20:56] overall.
[20:57] Wow.
[20:58] Yeah, ours is up in the 40.
[20:59] In some hospitals, it's apparently 60%, has been 60% for some months.
[21:04] Now, that has happened over the last 10 years.
[21:06] So, in fact, since the campaign stopped, now whether this is cause and effect, it's difficult to say, but you can see the graph.
[21:12] So, we've gone up from about 25% cesarean to about 45% cesarean over 10 years in the period of time since the campaign stopped.
[21:20] And at the same time, our maternal
[21:27] But ironically, the whole argument for being against normal birth stuff is because it's unsafe.
[21:33] And yet, as our cesarean selection rates have gone up, our births have got less safe.
[21:37] There's a slight decrease in stillbirth, but it hasn't gone down as much as the government wanted it to go down at all.
[21:42] Anywhere near as much.
[21:44] So the kind of solution is not only not resolving the problem, it's actually making the problem worse.
[21:51] But that doesn't change the dialogue.
[21:54] Interestingly.
[21:55] And I just want to clarify a few details of the story.
[21:58] So that original report, that was the Kirkham report, is that?
[22:02] Kirkham.
[22:03] Kirkham.
[22:03] Kirkham, yeah.
[22:04] There's been two reports.
[22:05] So he did the Morecambe Bay one.
[22:08] And then he also did the more recent one in East Kent, which actually is a very balanced, sensible, clear report.
[22:14] So in between, there were the Ockenden, the two Ockenden reviews.
[22:18] So these are named after the reviewers?
[22:21] Yes.
[22:22] Well, East Kent is named after East Kent.
[22:24] Interestingly, I think Bill Cookup deliberately didn't name the East Kent report after himself.
[22:30] It's the East Kent report.
[22:31] And in fact, the Morecambe Bay one is the Morecambe Bay report, although it's always referred to as the East Kent report.
[22:35] But the Donna Ockendon ones are named after her, yeah.
[22:38] Okay, so there's those reports.
[22:40] There's talk of this word around normality, normal birth is starting to erupt.
[22:48] And then something that was previously embedded into the UK maternity care system was this idea of midwifery supervision.
[22:57] And I'm just clarifying it because here in Australia, possibly most places in the world, we don't have any understanding of what supervision means.
[23:04] But it sounds like you're saying that in the event that the midwife or the woman wants something that the midwife doesn't feel is in their scope, they can call on the help of the supervising midwife.
[23:18] Just to be clear as well, supervision is gone now because that was one of the –
[23:25] failings of the first review that they felt that supervision was actually unhelpful and in cause and helping it, you know, part of the harm that was caused was the supervisors weren't, were kind of hiding things within
[23:39] within rather than reporting it outwards.
[23:42] So that was kind of part of the problem.
[23:45] So supervision in those days, which is, as I say, is now gone, has been there for all my time as a career.
[23:53] It's really where we had a training, education really at master's level, and you looked at professional aspects of supervision and separating
[24:05] keeping the standards of the Nursing and Midwifery Council, making sure that you balanced everything that you did was against those standards.
[24:16] And you helped other midwives to practice safely.
[24:20] So you had meetings with midwives and you'd have, say, 15 midwives who you were their supervisor.
[24:26] They came to you every year.
[24:27] You had a one-to-one with them.
[24:28] And if they had any professional issues, anything to do with their professional practice, they could come to you and say, so, for example, when I was asked to facilitate my first water birth,
[24:39] at home, and this is like 30 years ago, and I'd never even seen a water birth in a hospital, I went to my supervisor and said, can you help me to get the skills so that I can facilitate this birth?
[24:52] If I'd have said to the woman, no, I can't do that because I don't know how to do it, then she could have called at the hospital and spoken to the supervisor on call
[25:04] who would then have met with her and said, I will find you a midwife who will help you.
[25:10] Right.
[25:10] Right.
[25:10] So it was so that the woman was safe.
[25:14] But in some hospitals, it wasn't working properly.
[25:17] But that was down to this toxic behavior.
[25:20] And you know what maternity services can be like, that you can have bullying going on and conflicts of personalities.
[25:29] And there's all kinds of different scenarios there.
[25:33] I felt that it was a really good safeguarding.
[25:38] And, you know, the rest of the world used to say, we wish we had that.
[25:42] But it's gone now.
[25:43] It's gone.
[25:44] Historically, we would hold up the UK maternity care system as one that could be replicated and...
[25:52] that was very midwifery-led, evidence-based.
[25:57] The idea of supervision was considered superior to other ways of midwives working.
[26:04] It sounds like over the last 10 years, the UK is reverting to the bad habits of the rest of the world in terms of maternity care.
[26:15] The things that we're trying to get away from, you guys seem to be walking towards intentionally and
[26:22] I don't know if that's a harsh way of explaining it.
[26:25] So there were these reports which highlighted significant issues in the UK maternity care system.
[26:31] And it sounds like there's particular elements of those reports that have been picked up and run with and they're specific to the destruction of midwifery.
[26:43] It feels like that.
[26:44] It feels like that.
[26:45] Yeah, it does feel like that.
[26:46] Now, whether there's any intent there, I mean, you know, I'd be surprised if there was actual intent, but that is the consequence.
[26:53] Would you be surprised?
[26:54] Wait, would you be surprised if there was actual intent?
[26:56] I mean, historically, and this is me being potentially facetious, but historically, medical societies and people with an agenda had very much wanted midwives to go away.
[27:09] Yeah.
[27:10] Yeah, I take your point.
[27:11] But I don't, see, I don't think this is about the medical society.
[27:15] I mean, we have a lot of obstetricians who are very supportive of, in fact, we understand that the Royal College of Receptrics and Gynecology is about to present a statement in support of midwifery.
[27:25] So it's great.
[27:26] I do take your point, but I think it's more complex than that.
[27:30] It's an outworking of a whole range of postmodernist theories
[27:35] situation like you know a resistance to uncertainty like a love of tech like individualism like you know i want things right for me i don't really care what effect it has on anybody else possibly possibly some underlying commercialism this might be a way to move towards a towards a private health system possibly so i think those things are at play
[28:00] And there may be some individuals who just really hate midwives.
[28:02] That's quite possible.
[28:03] But, you know, I do think that these other things are probably more powerful.
[28:08] And unfortunately, because midwifery is the antithesis to all of that,
[28:12] It's kind of in the firing line, really.
[28:15] That's my analysis anyway.
[28:16] I agree with you, Sue, and I totally agree.
[28:19] And I think that it's such a shame that we can't just come together to sort this out.
[28:26] Right?
[28:26] So everybody wants the same thing.
[28:28] We all want...
[28:30] we all want mums, mothers, babies, families, partners, birthing people, you know, the whole society.
[28:37] We all want safety and we want women to feel that they're supported and that they've got their power to do what they feel is right for them.
[28:48] And, you know, we all want that.
[28:50] And I'm sure that
[28:51] The critics want that as well.
[28:53] I know they do.
[28:54] And it's such a waste of energy and time, and it's causing so much harm.
[29:00] And there's so much rhetoric and so much, I don't know, kind of conflating conversations when really if we could just sit down.
[29:11] But I know that there is a group of people who've tried to do that.
[29:15] Yeah.
[29:16] they've made an attempt to gather people together to stop the polarization because basically it is this dreadful polarization that you get caught up in because you're trying to, so for example, a lot of this plays out on social media, Mel, and you know that because you use it and I use it prolifically too.
[29:40] And what I see, you know, in one space, you've got one set of people who are
[29:46] you know, on X who are, you know, really sort of angry with what's got angry with normal birth, you know, the concept of normal birth at any cost, angry with midwives and seeing people as the enemy.
[30:00] And then you've got this whole set on Instagram who have got a completely different viewpoint.
[30:06] You know, they're saying that midwives are doing harm because they're intervening all the time.
[30:11] So one lot is saying that they're calling us medwives.
[30:15] And that we're just bothered about, you know, making sure that we, you know, we get the drips up and get the woman delivered and, you know, and real criticism of midwives for that.
[30:28] And then on X, we have a whole set of people who are saying that we're pushing normal birth.
[30:33] So midwives can't do right for doing wrong, seriously.
[30:37] And it's all happening on social media.
[30:39] Unfortunately, and I have to mention this, is that...
[30:44] Really what's happening is that our politicians and people in senior positions are also on X.
[30:52] And they're picking up on that.
[30:55] It's really worrying because not many midwives or even obstetricians or people want to use X now because of the toxic space that it can be.
[31:06] There's one conversation going on all the time.
[31:10] You know, it's the echo chamber that's kind of feeding in, but it's feeding into the places where people are deciding to make,
[31:21] to create articles from what they've seen on X to write actual articles on it.
[31:27] And then they're contacting the nursing midwifery council and then it's affecting policy.
[31:33] So it's actually influencing what's happening to our maternity service.
[31:38] All the while, we have another set of people who are on, you know, on another platform saying exactly the opposite.
[31:47] But yeah, that's kind of the history of it.
[31:49] That's in a nutshell.
[31:50] There's a lot more to it, actually, Mel.
[31:52] There's a lot of things that have happened, really unfortunate things, actually, that have happened because of this discussion.
[32:01] And really, it's been 10 years of tricky negotiating for us in the UK.
[32:08] And of course, Sue will tell you about the conference.
[32:12] So that's where it all started were these reports and then picking out of particular elements that people felt needed to be changed.
[32:20] And then, Sue, there was an upheaval about the word, the use of the word normal with reference to birth.
[32:27] So normal births.
[32:29] It's somewhat been, the terminology has been outlawed in the UK.
[32:33] What's happening?
[32:34] Yeah, really?
[32:36] Well, yeah, again, as I say, part of it was this kind of resistance to being abnormal, the opposite of normal.
[32:41] But then it all got tied up with this whole thing that Sheena's already been telling you about.
[32:44] So the conference went through a bad phase with this, and now it's getting better.
[32:47] So just actually maybe to explain, we run this conference.
[32:50] We run this conference every year, more or less, since the year 2000, alternately in the UK and overseas.
[32:57] So it's been in Australia, for example.
[32:59] And it's always been called the Normal Labour and Birth Research Conference.
[33:02] And it's always been a scientific research conference with a focus on what we called normal labour and birth because we felt there was a gap that people didn't understand enough about it.
[33:11] There's lots of research on preeclampsia and all the kind of complications of pregnancy, but not very much on this particular thing that we didn't think was well understood.
[33:18] So no problem with it.
[33:20] Everybody accepted it.
[33:20] It went very well.
[33:21] Da-da-da-da-da.
[33:22] And then probably three or four conferences ago in the UK, we started to get, because of all this, we started to get pushback from people saying it was dangerous to run this conference because it was influencing midwives to behave in ways that were promoting normal birth at any cost.
[33:39] We were like, no, it's actually a scientific conference.
[33:41] And then two times ago, when it was in the UK, there were threats from some of the people on X saying that they would come to the conference with pictures of their babies, dead babies, babies that died, and they would stand outside the conference with their placards and stop people going in and tell them how dangerous normal growth was.
[34:00] And we had to pay for security at the conference just in case the truck came off, which cost us thousands of pounds, and nobody turned up.
[34:07] And then two years following that, we had the same kind of pushback from X.
[34:12] And at that point, this whole thing was really boiling at the time.
[34:16] And the NHS England basically said that nobody from NHS England could go to the conference.
[34:21] And the chief nurse was saying the conference was a really bad thing.
[34:23] Nobody had seen the program, as far as I'm aware, of the conference when the numbers was happening.
[34:27] Yeah.
[34:28] And in fact, we were contacted by the BBC.
[34:29] Our university was contacted by the BBC to say, what's this terrible thing that you're doing?
[34:34] We sent them the programme.
[34:35] We received back talk because they could see from the programme it was a scientific conference.
[34:39] So that was difficult for everybody.
[34:41] This year, none of that, nothing.
[34:44] We held it this year.
[34:45] A very good MP came and taught.
[34:46] Mayor Ellis, who's one of the big committees of the parliament, hardly any pushback.
[34:53] We now call it the physiological labour and birth conference because obviously that's more acceptable.
[35:01] For our international events, our international steering group wants to still call it normal labour and birth research because it's not a problem anywhere else.
[35:08] So we do have two different names for it now, but certainly in the UK it has that other title.
[35:12] The other thing that happened about it was it was always held in a specific place in the Lake District.
[35:17] And one of the other reasons why people said they were going to come and protest was because it was held in the hotel next door to one of the hotels where one of the inquiries reported back to parents once.
[35:27] So, what he didn't want is to hold it in that particular place.
[35:29] And we have actually moved it from that place, mostly because we have got too big for that place.
[35:35] So, you know, a little bit because of that reason as well.
[35:38] That was a big thing, Mel.
[35:39] So, that was a huge thing for Sue.
[35:42] Sue had a lot of pressure with that.
[35:44] She was put under a lot of pressure.
[35:46] Yeah.
[35:47] Who is driving this campaign against the promotion of physiological birth?
[35:55] I mean, there's lots of, seems like there's lots of players.
[35:59] There's some consumers and parents.
[36:01] There sounds like there's media involved, particular journalists, I imagine, who've persisted in sharing the story.
[36:09] Okay.
[36:10] What are the role of the regulators and politicians?
[36:13] Because this sort of change doesn't just happen because there's some journalists and parents who are on a campaign.
[36:21] How has this happened in a relatively short time, in around 10 to 15 years, that the UK has gone from a shiny example of where we should all be to an attack on midwifery and physiological birth?
[36:36] Yeah.
[36:37] Well, it's, yeah, I think politicians got involved.
[36:40] I think there was a connect between the politicians wanting to do the right thing around childbearing families.
[36:47] And when somebody's lost a baby, Mel, and they are, you know, obviously deeply distressed and understandably deeply distressed and politicians are listening to that, they're going to be sympathetic to that, aren't they?
[37:04] So politicians got involved very early on.
[37:07] and made it very public that they were taking this on board.
[37:11] In fact, you know, that same politician has just rehashed what he said originally in another article on Sunday.
[37:21] So, you know, it's that kind of politicians got on board with it straight away.
[37:26] So that made a difference.
[37:27] And the regulator, the regulators, I'm not sure about our regulator, but certainly our regulator.
[37:35] College, the Royal College of Midwives, apologised for any deaths that were caused due to the campaign because the campaign was under their umbrella.
[37:47] It wasn't really anything to do with the campaign, but the families were making it out that it was, that that was part of it because they saw the materials on the wall, I guess.
[38:00] And
[38:00] kind of thought that that was why they were being pushed to do that.
[38:03] And yet the campaign was really just about sharing evidence-based knowledge, basically.
[38:09] So they, you know, they were very much...
[38:12] affected because you're bound to be, aren't you?
[38:14] When someone's lost a baby and believes that it's because of that, it's very hard not to feel responsible in some way.
[38:24] So I can kind of understand why people felt worried because I definitely would feel upset if I thought that I had
[38:32] contributed.
[38:32] But of course, we're not contributing to them knowingly, to anything knowingly, because as Sue and I both say that if anybody's interpreted our work, we can't guarantee how people will use
[38:49] the publication of journals, for example, or the publication of a book, you know, how people use it is that it's up to them.
[38:56] But, you know, there was an understandable feeling of remorse and sadness for babies that were lost, which is, you know, acceptable.
[39:10] But the thing is that it's just continued.
[39:12] That's the thing.
[39:14] There's not been any let up at all.
[39:16] It's still kind of going on, even though we've got these soaring induction rates.
[39:22] And so if there was a pursuit of normal birth at any cost, we wouldn't be seeing these induction rates.
[39:32] We've got a rising free birth rate.
[39:35] So women aren't feeling safe within our services.
[39:38] And when you think about,
[39:41] Great Britain having induction of cesarean section rates of almost 60% in some maternity units.
[39:48] And it's not driven by finances like it could be in a country that has, like America and Australia, that has private systems.
[39:57] This is all free.
[39:58] It's all free at the point of access.
[40:01] That is when you start to think, you know, I'm in contact with Sue is as well, international colleagues who can't believe that it's that, you know, because there's no money driving it at all.
[40:13] It's just fear.
[40:15] There's total fear.
[40:16] And part of it is fear of being in the media, fear of being outed, etc.
[40:20] And then coming back to the regulator question.
[40:24] So when this last came up, the regulator was actually very supportive, in fact.
[40:30] This time around, because it's education, last time it was practice, it was being attacked, or some of our publications, that kind of thing.
[40:37] This time it's education, which is obviously directly in the remit of the Nursing and Medical Free Council, and actually...
[40:44] Some members of this group have been quite keen to undermine military governance for a while.
[40:50] So, you know, the attacks on the governance system are not new, but this is much more direct than it has been before.
[40:57] And in fact, you know, as one of our professors group did point out today in a meeting I was at, the way you dissolve a profession, if you come back to your question about is it deliberate, which I still think not.
[41:07] But anyway, the way to dissolve a profession is to get rid of the professional's autonomy, their education and their governance.
[41:13] And so those are the areas that are actually, they are the areas that are under attack or under scrutiny, however you want to frame it.
[41:19] So the NMC, I think, have almost had their arms twisted a bit to come out with a way of trying to get universities to check that their curricula fit with the standards that they have.
[41:34] That's what they've asked the university to do, to check actually nursing and midwifery curricula, not just in drivel.
[41:39] So to check nursing and midwifery curricula against their NMC standards to make sure they fit.
[41:43] And at the end of that letter they sent out, there's a little line which says something like, and to make sure that normal birth or physiological birth is not prioritised or promoted over cesarean section and that language that is used is contemporary.
[41:59] Who knows what that means?
[42:00] Okay.
[42:02] So the complaint currently is that universities are teaching midwifery students about physiological birth and that that should not be prioritised over medical ways of birthing.
[42:16] It shouldn't, no.
[42:17] The phrasing is something like physiological birth should not be something about the promotion of physiological birth.
[42:23] By which it means pushing it above and beyond, if you like.
[42:27] Not equally with everything else.
[42:30] Okay, so my midwifery and research brain is pinging at the idea that evidence suggests in terms of safety and satisfaction –
[42:47] That physiological birth is, in fact, superior to medical ways of approaching birth.
[42:55] Unless the woman explicitly and specifically wants a medicalised birth.
[43:01] Or she needs it, for whatever reason.
[43:02] Or she needs it, absolutely.
[43:05] But there's no possible way that 40% to 60% of women need caesarean sections.
[43:13] Or want them.
[43:14] And so here we're deviating from, and you said it earlier, that with an increasing cesarean section rate, you've got an increasing rate of poor outcomes.
[43:26] So then when a nursing and midwifery regulation body or education regulation body is telling the universities to stop prioritizing a focus on physiological birth for midwifery students, for whom that's their entire job.
[43:44] My job is not, we're not obstetricians, we're midwives.
[43:51] And part of that role is the promotion of physiological birth.
[43:57] I mean, the International Confederation of Midwives is really clear about the role of a midwife.
[44:02] So all of the things that are happening here in the UK are in not only direct opposition to research evidence on the benefits of physiological births.
[44:15] and the avoidance of unnecessary medicalisation of childbirth.
[44:19] But it's in direct opposition to the whole, the global purview of midwives.
[44:24] I just am so confused as to how this is allowed to happen as I watch it from afar.
[44:32] Yeah, I mean, you and many other people, and I think that's, and you and many of us.
[44:36] And, you know, the other thing is that, you know, consistently about 80% of people, women, would prefer to have physiological labour and birth.
[44:45] And probably 15% would prefer to have a cesarean section.
[44:48] So it doesn't fit with what we would prefer.
[44:50] It doesn't fit with what is probably best practice.
[44:53] For all the reasons you said, the problem is, as researchers, we look at this on a population basis.
[45:00] We're in an environment where individualism is paramount.
[45:05] And so there's no concern about the population level.
[45:08] The concern is what each individual person wants.
[45:11] That's the dilemma here.
[45:13] And even then, of course, what an obstetrician was telling me is that he's finding that because our induction rate is so high, quite a lot of women who start their labour through induction find it's really painful, don't like it, and say they want a section at that point.
[45:28] So there's a recent paper that's come out that shows that there's a 30% section rate with induction now, even though the evidence was supposed to say that induction reduces cesarean.
[45:37] It's not what's happening.
[45:38] So if you didn't do the induction in the first place, you probably wouldn't have all the cesarean.
[45:42] But because you're doing the induction, you then get a maternal request cesarean.
[45:46] because the women aren't happy with the induction once it's started, also because they have to wait many days for the induction.
[45:50] Because so many women are being induced, they're all in a big queue.
[45:53] And so they're told their baby's at risk and they're like, well, you know, if I'm at that much risk, I'd rather have a section.
[45:57] Thank you very much.
[45:58] So, you know, there's a whole kind of skewing of the,
[46:01] nature of the dialogue and the evidence.
[46:03] And I think the things that we assume to be evidence and logical and evidence-based and like rational science, that isn't relevant.
[46:11] That's not relevant.
[46:12] And I think, and honestly, honestly, Mel, you know, it's what you're experiencing now in us telling you this.
[46:21] We've been living and breathing that for 10 years.
[46:24] So we've been almost like, because this isn't the first time that universities have been told.
[46:30] to do something.
[46:31] So there was a time when they were informed that they had to remove books that had anything related to normal birth.
[46:39] So that's Sue's books, for example.
[46:42] And so it is, you know, that kind of response that you've got is like what we've been going through all this time.
[46:53] Well, the other thing I have to bring you back to, what we find really mind-blowingly
[46:59] incomprehensible is that in any other area of health, you would always promote the normal, you know, normal healing, normal health, you know, trying to keep as near to physiology as possible.
[47:14] So, you know, try this way rather than having medication, for example.
[47:19] Everything's around promoting health, not just, you know, supporting health, you're promoting it.
[47:26] And you're promoting normal behaviors in every, you know, we've got a whole kind of world that's doing that at the moment and getting back to basics and looking after the environment.
[47:38] And yet we've got this narrative here in our country that is going directly in opposition to that.
[47:45] And the other thing is, this is another thing that's really frustrating, is that no one, no one except for Sue and I and a group of us just recently, only six months ago, no one is talking about it.
[48:02] you know, when I say no one, I don't mean people individually.
[48:06] I mean our professional bodies and organizations aren't, there isn't any...
[48:13] you know, outcry, what's going on here?
[48:16] You know, we need to look at our induction rates.
[48:18] We need to look at our cesarean section rates.
[48:20] It's almost if nobody speaks about it.
[48:23] So we've set up a collaboration of people to look to, you know, for a few reasons, really.
[48:30] And we did this before this.
[48:31] There's another national review being announced in England that's going to be starting.
[48:37] Well, it started.
[48:38] They've announced, they've got, they've actually, in terms of reference, have been published.
[48:43] And, you know, there's processes going on right now to undertake this national overarching review of maternity services.
[48:51] And that's when education was mentioned in the terms of reference.
[48:55] And it was actually mentioned in those terms of reference that there had to be a look at the promotion of normal birth ideology.
[49:04] Even before that national review was announced, Sue and myself and Anna and others were
[49:10] gathered together with obstetricians, with parents, midwives, and with politicians just to come together to say, what can we do?
[49:18] And various things are, we can lobby for change, we can support the staff because what's happening as well, Mel, at the same time that we haven't mentioned, midwives are leaving.
[49:29] So they're leaving in droves and they're not just leaving for this reason, but it's a big reason because what they're saying is they're not practicing midwifery.
[49:38] So I'm absolutely inundated on my phone with messages coming in constantly from midwives saying, I can't do this anymore.
[49:47] I'm like a, I don't want to be a theater nurse.
[49:50] You know, we're doing like 10 sections a day and I'm in theater nonstop.
[49:56] I'm not actually delivering care as a midwife and it's not what I wanted to do.
[50:01] So I'm leaving.
[50:02] I'm getting out of here.
[50:04] So it's, you know, we've got a really tricky situation.
[50:09] So what would happen if the promotion of normal physiological birth stopped in universities is that midwifery would cease in the UDIC?
[50:19] I mean, what's our job?
[50:21] And that's why midwives are leaving because we're not doing midwifery.
[50:27] I don't know.
[50:27] Is that too dramatic to say that if you were?
[50:29] No, no.
[50:30] Yeah.
[50:30] I mean, I would, to an extent, I agree.
[50:33] I think our job, again, we use this phrase both and, not either or.
[50:36] So I think our job is, this is in the ICM definition, isn't it?
[50:39] It's both those things.
[50:40] It's both the support of people, women, who want physiological labour and birth to have the best possible experience and the safest possible experience.
[50:48] It's also recognising complications and treating those where we can and referring where we can't.
[50:54] And that's the totality of our job.
[50:56] So you're right.
[50:57] If you strip out that support piece,
[50:59] then all you have left is the obstetric nursing.
[51:02] Nothing wrong with obstetric nursing, but, you know, that's not midwifery.
[51:04] So it's a different kind of thing.
[51:06] It's an American system.
[51:07] And, you know, America does not have the best results in the world.
[51:10] And of course, we do know that countries with low-sat-on-sexual rates and high midwifery input like Scandinavia have the best results in the world.
[51:16] But again, who cares about the adult?
[51:17] So...
[51:19] Yes, that is true.
[51:20] And I think that this is what people are beginning to realize.
[51:23] And I think, you know, certainly I was talking to, there was somebody I was talking to that was saying, who's a sociologist, and she was saying, just beginning to understand what's happening here, and saying, oh my God, she does a lot of work with parents.
[51:33] And she said, I don't think the parents I work with have any idea this is going on.
[51:37] She said, a lot of them are very positive about their midwives.
[51:40] She does work in mental health.
[51:41] You know, how amazing their midwife was, and how positive their midwife was, and how, you know, they depended on their midwife.
[51:46] And
[51:46] how it made all the difference to their lives, she said, if I told, and she's going to, if I told the parents I'm working with that this is happening, they would be absolutely shocked.
[51:56] And I think the trouble is they don't know.
[51:58] And you don't know what you've got until it's gone, kind of thing.
[52:01] Well, they couldn't know now because we're on the Great Birth Rebellion podcast.
[52:05] But...
[52:06] I think because all the research, I mean, the majority of the research shows that parents want access to midwives.
[52:16] They want continuity of care and midwifery-led models of care.
[52:20] And there's a proportion who don't want that, which is also completely fine because if a system is woman-centered, then each woman and family would choose the type of care they want and they would receive it.
[52:32] Yeah.
[52:32] However, it seems as though the UK system is trying to make a choice on behalf of parents to say we're actually no longer going to promote physiological birth as an option to you.
[52:45] It makes the fight for what the majority of women want that much more hard because midwives will leave because we don't want to be obstetric nurses.
[52:55] We want to be midwives.
[52:57] Yeah.
[52:58] And then women will find it hard to find appropriate care.
[53:01] And you're already seeing it, increase cesarean section rates, increase induction rates, increase in poor outcomes.
[53:07] I mean, logistically and logically, that's the direction it's going to go in.
[53:12] Definitely.
[53:14] It's already gone.
[53:16] Women have real difficulty now in many places, most places, I think, getting a home birth.
[53:21] often the birth centres are closed because the staff are being drawn back into the hospital because there's not enough staff to support the labour ward.
[53:28] The notion of choice is almost gone.
[53:32] Even if women make a choice early in the pregnancy, they can't guarantee they're going to get that choice unless it's a labour ward.
[53:36] Then they can guarantee to get that choice.
[53:38] Of course, many women, I think,
[53:41] If they were well supported of physiological labors and births, would be happy to go to a labor ward.
[53:44] But they don't want to go to a labor ward because they know, often because of previous traumatic experiences, that they won't be well supported.
[53:51] So then they will either choose a home birth or they'll choose an elective cesarean section.
[53:55] And if they can't have all that... You mean free birth?
[53:58] No, you mean free birth.
[54:00] So then if they can't get their home birth, then they will free birth.
[54:04] So, yes.
[54:04] Well, this is what we've seen.
[54:07] Yeah.
[54:07] I mean, that was my whole area of research too.
[54:10] Why do women free birth?
[54:12] They can't get access to the models of care they want.
[54:14] The midwives they prefer are not available.
[54:17] They can't afford a home birth.
[54:19] I mean, it's so obvious what's going to happen.
[54:23] So you're going to absolutely love this.
[54:24] Not.
[54:25] But, you know...
[54:26] If you go onto the NHS place of birth site now, there's a research session.
[54:32] And it's actually quite a nice order.
[54:33] So you can choose a home birth.
[54:34] This is the pros and cons.
[54:36] You can choose a birth center.
[54:37] This is the pros and cons.
[54:38] I mean, they can't always, but this is what it says.
[54:39] You can choose a hospital, pros and cons.
[54:42] You can choose a free birth.
[54:43] If you wish to have a free birth, then talk to your, you know, da-da-da-da.
[54:47] Nothing about the pros and cons of free birth.
[54:49] Just you can choose a free birth.
[54:52] So you can't...
[54:53] If you don't like it.
[54:54] You can't choose a physical labour birth in hospital.
[54:57] Honestly, honestly.
[55:00] And you can choose a free birth.
[55:02] Yeah, but you can't... And that's supposed to be about safety.
[55:06] You know, and you think, I don't think that's about safety, really.
[55:10] I mean, we're laughing about this, but in the most nervous way possible.
[55:15] It's chaos.
[55:18] Do you feel like we've covered off the main issues here?
[55:22] Yeah, I just have to tell you this lovely thing that's happened.
[55:25] So I've got to, I tracked down, it's a big story, I tracked down my mum's midwife.
[55:35] So I was born in 1955.
[55:39] My sisters, I've got four older sisters, and I was born in hospital actually because my mum wasn't well, but the others were born at home.
[55:47] And I found her midwife not alive.
[55:50] But I found her nephew, who is 84.
[55:54] And I've managed to get the...
[55:56] He's given me, he's gifted me her birth register.
[56:00] So one of her birth registers from 1929, pre-NHS.
[56:04] And so there's 400 births in this book.
[56:09] And out of the four, and actually they were all born, I think, I'm almost sure, they were all born in poverty because they were born in this house for poor people.
[56:21] So there's these 400 births and out of the 400, three of them died, babies.
[56:29] No mothers died.
[56:30] Three babies died.
[56:32] They were born premature.
[56:33] They wouldn't have died today because of this special care that they would have had.
[56:38] But you look at that now.
[56:40] I mean, that's just one small.
[56:41] You can't really say a lot about one small.
[56:44] But yeah, you can.
[56:46] And when you look at the ages, they range from 19 to 40.
[56:51] And you can see that these women had their babies in this house.
[56:55] It was a house.
[56:57] It wasn't a hospital.
[56:59] And they had to go there because they couldn't afford to have the midwife coming at home because they had to pay.
[57:05] So it's just...
[57:07] This is, you know, sometimes I just feel so sad.
[57:11] And what's happening in the UK, like the rest of the world, they're blaming women.
[57:16] This is why the cesarean section rate's going up and the induction rate, because women are too fat, too old, too ill.
[57:22] All the women told.
[57:24] And so Sue's analysed this concept, whatever you call it.
[57:28] So Sue, you tell... Well, it's just a few aspects, because it's being thrown out the whole time.
[57:33] It's like, this is the reason why, which means that all the other organisations don't have any responsibility.
[57:38] So I looked at, as I said earlier on, in the last 10 years, since the campaign for non-birth stopped and since the caesarean sexual rate went up, women's age has gone up by one year.
[57:47] Yeah.
[57:48] And in fact, in the Times article, first of all, the journalist quoted the cesarean section, right?
[57:54] It's 25% when it's 45%.
[57:56] And then he gave a graph to illustrate that it was to do with women being too old or too ill.
[58:02] And it showed that over the last 50 years, women's age has gone up by four years in the last 50 years.
[58:08] So unlikely to explain a 25% increase in cesarean section rate in the last 10.
[58:13] I looked at BMI.
[58:14] That's gone up hardly at all.
[58:16] I looked at type 1 diabetes again over the last 10 years.
[58:19] It's been a rise, but not over the last 10 years since the section rate has gone up.
[58:23] So those are the three things I specifically looked at.
[58:25] And actually, there are people now looking at other aspects to see whether this is true or not.
[58:30] Generally speaking, I mean, I don't know whether maybe IVF rates have gone up a bit.
[58:34] That might be something.
[58:35] But nothing like to explain that huge gap.
[58:39] So we'll explain some of it, but nothing like the whole lot.
[58:43] So it's a convenient message to say, oh, well, women are getting fatter and older and sicker.
[58:48] And so that's why it's gone up.
[58:49] But actually, there's no evidence to suggest that that's true.
[58:52] Not in the same proportion as the intervention rates gone up.
[58:54] Not in my eye looks at.
[58:55] And of course, you know, not over the last 10 years, but over the last 50 years, you've got less rickets.
[58:59] You've got less rheumatic heart disease.
[59:01] You've got probably less poverty.
[59:02] You know, there's a whole load of things that have got better.
[59:04] Less smoking.
[59:05] Less smoking than they used to.
[59:07] So, you know, a lot of things actually, but nobody seems to put that in the equation.
[59:10] Yeah.
[59:11] Well, in regards to all of those things, we're seeing an improvement if we're seeing it, surely.
[59:19] Yeah, you can.
[59:20] I just don't even know what question to ask because I can't even...
[59:24] I just can't even believe it.
[59:25] I can't.
[59:27] I just think.
[59:27] Believe it, girl.
[59:28] Believe it.
[59:30] Because, I mean, there should be riots in the streets.
[59:35] No, there is now.
[59:36] Well, so that's, you know, one of the things you wanted to ask is what can we do about it and what are people doing about it?
[59:43] Yes, let's do that because that would fill us all with a little bit of hope.
[59:46] If we could please have some.
[59:48] Yeah.
[59:49] So Sue and I, even though we're the ones usually kind of, you know, we're the ones pulled out as the naughty girls, we are the ones that are probably the most optimistic.
[1:00:00] Yeah.
[1:00:01] It's quite ironic, really, because we're the ones who are saying, no, but we can do this.
[1:00:05] And, you know, so it's strange, really.
[1:00:08] But anyway, that's just the way that it is.
[1:00:11] I can see a difference.
[1:00:13] So just for example, yesterday, very fortunately, I was going to a conference and it was about midwifery education, student midwives, and it was full of students and lecturers.
[1:00:25] And the feeling is very different now.
[1:00:28] People are...
[1:00:29] absolutely wanting to riot in the best possible way, whilst remembering, I have to always come back to this, is whilst remembering that people have been harmed having babies.
[1:00:42] You know, we can't
[1:00:44] We can't be insensitive to that.
[1:00:46] And, you know, there are people that have really suffered using our maternity services because they are overstretched, you know, unresourced, there's not enough resource put into maternity services and not enough attention paid to the absolute need of those services.
[1:01:07] And if we're talking about high levels of cesarean section, we need more money
[1:01:11] to look after because you know you've got midwives what like one midwife looking after five women that have had major surgery and their babies you know so it's it's it's really really really pressured it's like a pressure cooker you know in years gone by it's been sort of people have just been getting their nose down and their head down if they haven't left they've
[1:01:31] just been trying to work hard and not really thinking that this is will ever happen.
[1:01:36] But this is to me, it's been the final straw.
[1:01:38] Like Sue said, it's a tipping point.
[1:01:40] And I just hope now that we can we can keep that momentum going off.
[1:01:45] You know, we can't let this happen because sometimes, Mel, when it's so oppressive,
[1:01:52] people can start to feel, oh, I better just not do it.
[1:01:56] I better just give up, you know, I better just conform.
[1:01:59] But I feel that there's so much injustice, right?
[1:02:02] So I have to say this, there's injustice going on.
[1:02:06] For me, it's like a scandal, to be fair.
[1:02:09] And I sort of can't let it go because I know that it's not right.
[1:02:14] And we, Sue and I and others, many, many others are really willing to hold on to what we've got and try to reverse it.
[1:02:23] So I have to tell you that when I was a young midwife, the induction rates were very high.
[1:02:29] It was a medicalised system when I was training to be a midwife.
[1:02:32] Every woman was under a doctor completely.
[1:02:35] And we had to do what they said, you know, depended what kind of gloves we had to order gloves for him and a different pair of gloves for him.
[1:02:42] We had to rupture everybody's membranes.
[1:02:44] We didn't even ask them if we could do it.
[1:02:46] We just did it.
[1:02:47] Like it was just a completely different world.
[1:02:49] And like Suze often, you know, talks about this, how we brought it out of that world.
[1:02:55] into what we had.
[1:02:56] And then we seem to be going backwards, but we have to stop it.
[1:02:59] We have to, and we have to be courageous.
[1:03:02] I've had the most amazing leaders in my life, midwifery leaders.
[1:03:06] I've just done a, I've just done an Instagram story, not a story on my Instagram.
[1:03:11] I've just shared a courageous tale of my, my beautiful head of midwifery who died last year.
[1:03:18] And, you know, the courage that she had to shift the,
[1:03:22] maternity services from the 1960s to the year 2000.
[1:03:26] She didn't, she Sue, she did amazing things.
[1:03:28] And we, she taught us how to be courageous.
[1:03:32] So I'm not going to let that go because she's not here now, but she sat on my shoulder, like showing me, like, you're not going to let this go, Sheena, because she used to have to fight to not have peepholes in the door on the labor ward.
[1:03:45] And
[1:03:46] You know, she fought for birthing pools, birthing mats and, you know, all kinds of, she fought for middle-led care after changing childbirth.
[1:03:55] You know, everything she did, she had a real big struggle.
[1:03:58] So I just am following on with her and Sue's alongside me and Sue's championing in the way.
[1:04:05] And we just, and so many others are doing the same thing around the world.
[1:04:09] So people like you, Mel, inviting us today.
[1:04:13] And so we are sisters, right?
[1:04:16] We're sisters, midwifery sisters.
[1:04:19] And I feel that, like I feel that huge connection of people all around.
[1:04:24] And so we have to, Sue and I and others, have to keep this momentum going and think, right, right.
[1:04:32] we have to look after midwifery and we look after the fact so that we can look after the families and look after the women and the babies and make sure that you know that's what I talk to students about you know we need you to continue with this so that it doesn't disappear and we'll do it we won't let it go no absolutely and I think that's right and again it comes down to that I mean I I've said before that it I came into midwifery because I
[1:05:00] I had a road to Damascus experience in the middle of a Botswana a long time ago.
[1:05:05] In a maternity mission station, not that I'm a missionary, I just happened to be there.
[1:05:08] Watching birth for the first time, I was a kind of whatever I was, 21 year old, thinking if we get birth right, we get the world right.
[1:05:14] And I still believe that.
[1:05:15] You know, I do think that the maternity services have done harm for all kinds of reasons.
[1:05:20] And I think...
[1:05:22] in order for us to really get every woman and every child to have the best possible labour and birth experience.
[1:05:29] And we must talk about labour and birth because when we only talk about birth, people forget that most modifery work is done during labour.
[1:05:35] Because if we get that right, then it's actually not just about the labour and birth, is it?
[1:05:38] It's about the way women feel about their mothering and about their parents feel about parenting and their sense of self-esteem and how they relate to the world and this whole kind of sense of coherence that they get.
[1:05:49] and self-efficacy and all those things that actually have long-term effects for them and their families into the future.
[1:05:56] So, you know, safe, positive, physiological labour and birth where that's what the women want and need and good quality support and good quality referral where that's needed and wanted.
[1:06:06] is what we have to strive for and I think that's what we're both after isn't it really Sheena and the good thing this time like Sheena said the good thing this time is so many people have come to us spontaneously just kind of contacted us spontaneously and said what can we do to help so there is a movement I mean and so if you're a woman midwife journalist politician listening to this podcast and I hope you all are
[1:06:30] If everyone wrote letters of outrage and, you know, sent them to their local politicians and members and to the Nursing Midwifery Council and to Royal College of Midwives, I mean, maybe after this we can get a contact list of people who would...
[1:06:51] benefit from receiving these types of letters.
[1:06:54] I mean, the conversation has to be balanced because you're right.
[1:06:58] There's been devastating outcomes that have triggered off this cascade of events.
[1:07:06] And when we respond in an emotional way like that to single and individual and devastating events, it's.
[1:07:16] We fail to see a bigger picture of the impact on a population level.
[1:07:22] So what is going to happen now to 40% to 60% of women who have had cesarean surgeries?
[1:07:29] We know that there are long-reaching risks and impact on that.
[1:07:34] What's going to happen to those babies now who we know have a different microbiome, a different genome?
[1:07:43] There's epigenetic impacts of cesarean sections.
[1:07:46] Of course, when we need them and they're life-saving, we're willing to accept the downsides.
[1:07:50] But there's massive risk and downside to all of this intervention.
[1:07:55] And so, yes, we have to acknowledge that there are upsetting things
[1:08:01] disappointing and dissatisfying experiences that happen in hospitals that have devastating consequences.
[1:08:07] However, if we allow single and individual incidences to create this chain reaction where now nobody gets a choice, I think if you're listening and you're a woman who wants to birth in a system that...
[1:08:21] does not demonize physiological birth.
[1:08:23] You have to, this is the opportunity now.
[1:08:26] There's no, I mean, it'll go to, it's already going too far.
[1:08:30] And also, you know, for those women who want or need intervention or even have tragic circumstances, you know, having somebody to support you, having a midwife to support you through those experiences is probably going to be important to you too.
[1:08:43] So, you know, to you as well, really.
[1:08:46] Yeah, I agree.
[1:08:47] And it's just to say that as well to everybody listening,
[1:08:50] that Sue and I, we've ended up in the center of this storm.
[1:08:57] We don't know why we were chosen really, but we're just trying to share evidence and information so that we can help midwives, obstetricians, maternity support workers, doulas,
[1:09:11] to help and support families.
[1:09:14] And that's all we do.
[1:09:16] That's what we do.
[1:09:17] And we don't push anything on anybody.
[1:09:19] And we certainly do not talk about anything at all costs.
[1:09:25] So that wouldn't even be in our mindset.
[1:09:28] So it's not...
[1:09:29] you know, it's nothing to do with us.
[1:09:31] Any final words from you, Sue?
[1:09:34] I think there's a lot of sadness, a lot of fear in this space.
[1:09:37] And I think it's time for us to finally regain the joy of pregnancy and labour and birth for everybody involved, no matter what kind of labour and birth they want.
[1:09:49] And if we can do that, if we can, if we can
[1:09:52] turn this around so that those working in the, you know, obstetricians, midwives, doulas, support workers, women, families, partners, babies, you know, can experience labour, pregnancy, labour, birth, postnatal period joyfully and safely, then our job will be done.
[1:10:10] Beautiful.
[1:10:10] I'm still just in shock.
[1:10:13] And I knew it was going to, I knew this was going to be interesting, but I did not realise
[1:10:22] how reminiscent this was of early attempts to quash midwifery in the 1920s and 40s.
[1:10:29] It just feels like the playbook has been rehashed.
[1:10:35] And we're so grateful that you're both not going to give up because this takes energy and effort.
[1:10:41] Online vitriol, Sue, looks a lot more peaceful, having not been on social media, but
[1:10:47] The reality is that's where a lot of people are having these conversations.
[1:10:51] So I appreciate, Sheena, that you're putting your energy and strength into social media interactions.
[1:10:58] It's exhausting.
[1:11:00] So I guess, I mean, I can see some real opportunities here for people, individuals who are listening, thinking, well, what can I do now?
[1:11:11] So some service users and doulas got together and a midwife and they created a letter, an open letter.
[1:11:19] And it's going around now for people to sign.
[1:11:21] It's a beautiful letter.
[1:11:23] So we can put that there as well.
[1:11:25] Hopefully a link to that.
[1:11:27] Unfortunately, the people who are, again, our critics are now looking at the names on that and talking about reporting those people who signed the letter.
[1:11:39] Well, guess what?
[1:11:40] They can't burn us all.
[1:11:43] So if thousands and thousands and thousands of people sign that letter, it's impossible to report and act on that many names.
[1:11:55] Can I suggest that everybody sign that letter because they cannot burn you all.
[1:12:01] It's ludicrous to report a midwife for supporting people
[1:12:08] or endorsing physiological birth as an option.
[1:12:13] I'm so enraged.
[1:12:15] Oh, my gosh.
[1:12:18] The letter is incredibly balanced.
[1:12:21] It's a really well- Yes, a balanced letter.
[1:12:24] That's been today's episode of the Great Birth Rebellion podcast.
[1:12:28] You've been with me, Melanie Jackson, Sheena Byram, and Sue Down, and we're talking about the UK maternity care system.
[1:12:35] I would encourage you to sign that letter, and I will see you in the next episode of the Great Birth Rebellion podcast.
[1:12:42] To get access to the resources for each podcast episode, join the mailing list at melaniethemidwife.com and to support the work of this podcast, wear the rebellion in the form of clothing and other merch at thegreatbirthrebellion.com.
[1:12:58] Follow me, Mel, at Melody the Midwife on socials and the show at The Great Birth Rebellion.
[1:13:04] All the details are in the show notes.

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