Liz Stephens

Promoting normality and providing a cost-effective service

I have recently returned from Royal College of Midwives (RCM) conference and, as always, it was a mixture of inspiring speakers, new evidence, great ideas from practice and a chance to network and meet up with old friends. What I have reflected on since my return is the enduring problem of the rising caesarean section rate, which does not fit well with the rhetoric of midwives as experts and guardians of normal birth. There is little doubt that the increase in caesarean sections is a result of the culture of medical dominance, fear of litigation and womens fear of the pain of childbirth, to name just three factors. However, as midwives we have been complicit in this; midwives are just as present as obstetricians on our labour wards.

A privilege to be there

I found the recent celebration of the International Day of the Midwife, profoundly moving; the lighting of candles and then extinguishing one every minute brought home, in a very symbolic way, the death of a woman in childbirth every minute of every day. It is absolutely right that we support women and midwives in countries that are less well-resourced than our own. The needless death of a woman in childbirth is a tragedy not only for her but for the family she leaves behind. This also led me to reflect on the fact that, in this context, we can see ourselves as well-resourced. Many of the lives lost in disadvantaged countries could have been saved, not with shiny new hospitals with state-of-the-art equipment and with one midwife for every 28 births. They could be saved by third stage drugs, antibiotics and birth attendants with little more training than our support workers.

Our duty of care is to mothers and babies around the world

A recent trip to Ethiopia has led me to reflect on how fortunate we are in western countries and yet how irresponsible we can be. Fortunate in that we are able to reflect on and investigate every incidence of maternal mortality, learning the lessons and making changes to ensure such incidents are unlikely to recur. Irresponsible in that we fail to understand how the way that we do things has repercussions around the world, especially in developing countries where the belief is that mortality rates in the UK are low because we have got it right. We also underpin this belief in the ways in which we offer aid, showing that we believe we know the right way to do things.