A British Maternity Scandal and the Danger of Dogma

At Shrewsbury and Telford Hospital Trust, Debbie Greenway was a victim. When she asked for a cesarean — her twins had been laboriously conceived via IVF — the doctor repeatedly denied her request: “We have the lowest cesarean rates in the country and we’re proud of that and we plan to keep it that way.” After a prolonged period of labor, Greenway lost one of her babies and was told that this was a most unusual occurrence.It was not.

Greenway’s natural birth was followed by repeated doses of Syntocinon, a drug used to induce labor after her extended labor. An earlier cesarean would likely have saved the life of the baby she had already named John.

Many other mothers-to-be were similarly turned away at Shrewsbury. No whistleblower at the hospital alerted authorities as death rates soared and babies were permanently harmed by unnecessary forceps deliveries. It took a campaign by some brave families to persuade a health minister to order an official inquiry after years of walls. Ockenden reported that “a culture of reluctance to have caesarean sections resulted in many babies dying during birth or shortly after birth.”

The scandal began with well-intentioned but unscientific thinking. In the 1980s, there was growing concern that childbirth was becoming over-medicalized, particularly by arrogant male doctors. Health lobbies began to advocate for fewer procedures. This development, one could argue, was a course correction.

But in 1985, the World Health Organization briefly threw its authority behind natural birth, declaring that health services should limit cesarean sections to 10-15% of all births. By 2007, this preference began to harden into dogma in the UK – despite the WHO’s quick reversal of its decision. The Royal College of Midwives, the Royal College of Obstetricians and Gynecologists and the National Childbirth Trust have set a target of 60% ‘normal’ births in UK hospitals.

It soon became fashionable for natural childbirth propagandists to ridicule successful women for being “too posh to push” by choosing to have a cesarean. Some midwives also put pressure on expectant mothers not to give birth without the pain relief offered by epidural injections. This reflects a larger public health problem where women’s pain is taken less seriously. Caesarean sections don’t come cheap, so hospital managers had a perverse incentive to restrict operations too – just as their NHS predecessors had saved money in previous decades by banning the mentally ill from their wards. (C-section rates vary in the developed world.)

Shrewsbury and Telford pioneered this movement. Expectant mothers were denied the right to choose to have a cesarean section, and only a senior physician was allowed to approve the procedure. By 2002, the Trust had the lowest cesarean rate in the country – eight to 12 percent lower than the national average of 30 percent. That year, David Redford, an obstetrician at the Trust, boasted to a House of Commons committee: “We have lower intervention rates and once that is known we will attract both midwives and obstetricians who are happy to practice this way.”

Mortality rates in hospital maternity wards rose more than 10% above the national average. But according to Ockenden, two Clinical Commissioning Groups gave the Trust a clean bill of health in 2013. This report states: “There is a robust approach to risk management, clinical governance and learning from incidents. It is clear that Shropshire has a maternity service to be proud of and the model of service delivery is safe and robust.”

Good hospitals measure, manage and hold physicians accountable through reviews and best practice benchmarking. But what if higher medical authorities also follow health fads and willfully ignore the evidence of failure?

Unfortunately, the natural movement of birth is not an isolated case of unscientific thinking in the medical profession. Homeopathy, a ‘natural treatment’ based on the use of highly diluted substances which doctors claim can cause the body to heal itself, was until recently funded by the NHS. In 2010, a House of Commons report declared that homeopathic remedies were performing no better than placebos (dummy treatments), but it was another seven years before the NHS dropped these useless (but happily harmless) treatments, promoted by the likes of Prince Charles and other establishment figures.

The Royal College of Midwives ended its campaign to promote natural childbirth in 2017. But just last month, the NHS announced it would no longer limit the number of caesareans it performs. The country’s longest-serving midwife, Jacqueline Dunkley-Bent, instructed health workers to “stop using total cesarean rates as a means of performance management” because it was unsafe to do so.

Despite the Ockenden report, three other hospital trusts continue to promote vaginal births over caesarean sections. An advertisement for Keighley Yorkshire Trust states: “Successful candidates will be able to demonstrate their commitment … to promoting the normal birth path and reducing intervention.”

The world’s best health protection systems will not work if there are perverse incentives – such as misguided cesarean goals and financial rewards – to override them. Other maternity wards across the UK are under investigation by the Department of Health. Fear the worst.

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This column does not necessarily represent the opinion of the editors or of Bloomberg LP and its owners.

Martin Ivens was editor of The Sunday Times from 2013 to 2020 and before that was its chief political commentator. He is a board member of Times Newspapers.

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