Why midwives are sceptical

This blog is Part 2 in a discussion about on-going RCTs looking at induction of labour (IOL) at various gestations: Why midwives are sceptical about research on medical interventions

In theory, research like this is done in order to support clinical decision-making and to enable informed consent for proposed interventions. If midwives seem dubious about the merits of research concerning medicalised birth, it is because our experience indicates that truly informed consent is a rare beast. Once an RCT has decided that a certain course of action results in less risk for baby, any woman who wants to take a different course will most likely have a fight on her hands, with most health professionals, family, friends, even her partner.

Because it is socially unacceptable to say – It is okay for a woman to choose an option which appears more risky for her baby. Women are not just baby carriers. They live complex physical and emotional lives in which other factors are important too. – midwives end up in the awkward position of trying to argue with The Truth of big science.

Soon, someone will get funding to do an RCT looking at whether the outcomes for babies are better for low-risk primips who undergo elective CS at 39 weeks, or normal labour. And my guess is CS will come out on top for the Big Ones – reduced morbidity and mortality. And then what? Will all primips be offered a CS at 39 weeks? And those who refuse?

I’d like to think we could use the information from these trials to truly offer women an induction of labour, acknowledging that it will not be right for everyone, but as a midwife I see every day what happens to women who decline the Recommended Treatment. Take for example this recent Tweet:

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Is it really okay for an ‘anaesthesiologist’ and president of MSF-USA (Doctors Without Borders) to publicly discuss this tragic outcome, in a way which implies that a woman who declines a recommended CS is selfish, cold, heartless .. & uninformed (despite having definite, and accurate, reasons for refusing). Putting her own experience ahead of her baby’s life, as if losing a baby is ever a good experience, even for the most ambivalent. Are women who decline medical advice no longer entitled to respect and confidentiality? This so-called professional then used the MSF-USA twitter account to re-tweet this damning judgement to 361,500 followers. Midwives in the UK are struck off for less.

We need more research on how to increase the quality rather than the quantity of birth, and life in general; and the quality of women’s experiences will certainly improve with more compassion and less guilt-tripping. Childbirth is not a trip to Walmart.

I want women to have the choice of an early induction, or a CS, if research indicates it may benefit their baby. If they feel it is the best choice for them, so do I. But I want women who don’t want this to have their choices acknowledged as equally valid and equally supported. And I don’t have a lot of faith that will happen.

Finally, because it’s my blog: For me, going into labour was like falling in love. The agonising wait, wondering when it will happen. The brief period of terror when I realised it had. Followed by succumbing. Followed by a lot of hard work and ultimately, blessedly, joy. For me, it was worth waiting for.

Shawn

3 thoughts on “Why midwives are sceptical

  1. Pingback: How the consent process introduces bias into RCTs | The midwife, the mother and the breech

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