A letter in this newspaper on April 3 surely caught the attention of readers who wish birth to be a safe and satisfying experience for mothers and babies.
Mark Formosa, a consultant obstetrician, refers to an interview he gave Times of Malta in 2011 where he stated that:
“Maltese obstetricians will not apologise for the perceived high rate of medical interventions in childbirth”. The latter were then described as featuring the highest rate of labour induction in Europe.
This situation led to a protest by midwives against the high rate of inductions and caesareans, making it impossible to organise their supportive work for mothers and newborns. They also felt the latter were being deprived of the empowering spontaneity of a natural birth even when it was safe. In his letter, Formosa says that, in 2022, “the time may be opportune to engage the midwifery community and start serious discussion, leaving power and control out of these talks”.
Like others who helped in the campaign for ‘Womb Ecology as a National Priority’, I am one of the many wishing an improvement in the environment in which life starts. The Malta Unborn Child Platform has lobbied politicians and is appealing to all concerned to assure the most welcoming environment possible for our newborns and their families.
The womb is our first environment. It can be a make or break for our future lives.
No one dares doubt what society owes mothers for launching us into life. Mothers deserve and babies need an environment throughout and after pregnancy in which health, peace and tranquillity reign, danger and violence and coercion are removed through prevention and protection, and poverty and lack of means are warded off by generous and dutiful material and service help.
Homely comfort, true empowerment and psychological and medical health must be assured by resources and skilled and professional help, within harmonious frameworks giving holistic support.
Amid this, a safe and satisfying pregnancy and birth is a core and a crowning of womb ecology. Welcoming wombs in a welcoming world should not be marred by insufficient attention or by considerations of power or profit.
Welcoming wombs in a welcoming world should not be marred by considerations of power or profit- Charles Pace
Why was this controversy revisited now, 11 years on? Formosa cited a recent Panorama TV programme on a series of enquiries into childbirth practice in a trust in the Morecambe Bay area in Lancashire.
Quoting Formosa, “midwifery-led practices were pursuing a completely natural approach to childbirth. The result was that, in 2015, an NHS trust where ‘a natural birth at all costs policy’ was followed, cost the lives of 11 babies.”
It is difficult to do justice to the lessons from the Morecombe reports in a short article. The health services in question at times did fail to refer to more medical intervention when this was called for. It is also true that the Royal College of Midwives was reassuring mothers ever more clearly that a medicalised birth can at times be the wise option.
But, from a careful look at the cited reports, it does not result the 11 babies died due to recourse to “natural birth at all costs”. The investigation concluded that, in the health trust in question, there was incompetent practice at all levels, including midwives, paediatricians and obstetricians.
The Morecambe reports found (citing Panorama) “nine areas where the trust had repeatedly failed. As well as low caesarean rates, they highlighted the excessive use of forceps, the repeated misuse of a labour-inducing drug, a failure to escalate concerns to senior clinicians and a lack of compassion and kindness in the delivery of care”.
Reports like this can tell us nothing of the long-term effects of unwise use of medication in pregnancy, be it Panadol or labour-inducing drugs, on babies and mothers.
This enquiry was not, then, a one-sided defence of medicalised birth at all costs. What it called for is a balance between a satisfying experience friendly to nature and spontaneity on the one hand, and the safety of expert medical intervention being at hand, as assessed to be needed. Mothers, babies and families, no doubt, do best in the best of both worlds.
It is remarkable that, in 2011, the voice most conspicuously absent was that of mothers. But nobody was surprised at Maltese women not speaking up to their doctors and carers – then. Remarkably, the Morecambe reports would not have happened without the insistence of the mothers (and fathers).
Also remarkably, the reports could not have appealed more for the humility to learn lessons. Let’s also take on their insistence on the creation of official, authoritative and safe channels (in Malta) for mothers and families to have a voice.
Let us be also proud of our humility and compassion to listen, talk together, learn. I am sure there is lot of that around, though a bit of birthing might help it too.
Charles Pace, specialist in social policy