This article is the first of two that I will be reproducing from the print version of “Hospital Doctor” from 2006. I have reproduced it as a deliberate gesture against those illiberal enough at the time to have expected action against the original author for offending them. Apart from correcting one very minor error the article has not been altered or edited in any way.
Midwives get my goat
Over Christmas I saw an advert for a charity suggesting that instead of buying yet more wine and chocolates for our alcoholic lardbucket friends, we give a gift to someone in the third world on their behalf.
Such schemes are increasingly popular - and a good thing too. The ad listed suggested gifts. Apparently £25 buys you a goat, but a mere £48 allows you to purchase a midwife. I’m sorry - this is irresponsible. As soon as third world farmers realise this, we’ll be inundated with offers to exchange midwives for valuable livestock.
You may sense I am a little negative about midwives. It is the product of miserable years in labour wards as a trainee.
Having said that,there was always something quite satisfying about walking into a room that looked like a scene from the Exorcist, and leaving it looking like one of those mediaeval paintings of the birth of Christ, where everyone is serene and wearing little halos.
But now the Royal College of Midwives (RCM) - or, as comedienne Jo Brand renamed them recently, “The Royal College of Childless Fascists” - have excelled themselves, calling for women to be charged for epidurals in labour, “unless the mother has a definite need of it.”
And who decides? Well, the wise and righteous midwife of course. Can I ask the obvious question? What the hell is it to do with the midwife? Only the mother knows how much it hurts, and only she knows what constitutes definite need. All anaesthetists have seen that look of homicidal hatred in the eyes of a mother whose partner reminds her that the birth plan didn’t include an epidural.
The RCM points to the 40% increased instrumental delivery rate after epidurals, in a craven effort to disguise this naked ideological posturing as concern for their clients. All that shows is that, if you want a sensible appraisal of the scientific evidence on epidurals you’re better off asking the goat. Long, difficult labours cause epidurals, not the other way around.
If you want to disagree you’d better have hard evidence. That means a randomised trial, blinded to patient, midwife and obstetrician. Try getting that through your ethics committee.
How about another randomised trial? Midwives versus goats. After all, goats breed like mad so they’re experts on normal labour, cost half as much, are unlikely to tell someone they can’t have effective pain relief because they’re too poor - and, if they piss you off, you can kill them and eat them.
As a postscript it should be noted that the RCM recommendation mentioned above, quite rightly, sank without trace.