Midwives fear `backlash' over natural births

THREE INDEPENDENT midwives face tribunals this week in what some experts say signals a backlash by the medical establishment against natural childbirth.

The three, from the UK, France and Ireland, pioneer the non-interventionist approach to childbirth and run private "birth centres" outside hospital.

Today, Caroline Flint, a former president of the Royal College of Midwives, is to appear before the UK Central Council for Nurses, Midwives and Health Visitors on charges relating to the death of a baby three years ago.

Ms Flint, who set up Britain's first private birth centre, in the grounds of St George's Hospital, Tooting, south London, faces seven charges, including failing to call an obstetrician and paediatrician at the appropriate time. The case has twice been investigated, by the Chelsea and Westminster hospital and the local health authority, and dismissed.

In Dublin, Ann Kelly, a leading independent home birth midwife, is due to appear before the Nurses' Board of Ireland today. She is charged with bringing women into hospital too late, causing danger for them and their babies.

Ms Kelly says that her record for birth complications is better than that of any hospital in Ireland or the UK.

Tomorrow in France,Suzanne de Bearn is due to appear before the High Court in Bordeaux, appealing against a French law that babies should be born in hospitals having at least 300 deliveries a year. Madame de Bearn, who is in her eighties, runs a birth centre where the number of deliveries is below this limit.

The cases come after Lecky Thompson, an independent home birth midwife in Australia, was struck off by the Sydney Health Care Commission last year.

Yesterday, Ms Flint, 57, said all four midwives shared a determination to change childbirth. "We want to give women more choice and that makes people feel uncomfortable. I have rattled too many cages," she said.

Although it is a coincidence that the three European cases are being heard simultaneously, some experts say they are an ominous sign of the growth of litigation in maternity care, the costs of which dwarf those in all other specialties. They disagree, however, on the reasons for the trend.

Lesley Walker, professor of midwifery at Queen Charlotte's Hospital, west London, said: "It is something to do with the times, that three proven midwives are under prosecution at the same time.

"We are moving to a culture in which the majority of women have some intervention in childbirth. Large numbers have foetal monitoring, epidurals and Caesarean delivery. Normal birth is becoming rare."

Professor Walker was a member of the government advisory group that produced the 1993 report Changing Childbirth, aimed at increasing choice for women, but she said it had since "fallen off the agenda".

Ms Flint and Ms Kelly had set up in private practice to do what they could to provide safe care for women in labour without unnecessary interference. Professor Walker said: "They are being prosecuted and maybe even persecuted because of that.

"The system is not set up to support normal birth and to give women choice. It should be the system that is on trial rather than the individuals."

Professor James Drife, consultant obstetrician at St James' University Hospital, Leeds, and spokesman for the Royal College of Obstetricians, agreed that the three cases were a sign of the times, but said the reasons were different.

"They reflect the same pressures that obstetricians have felt very keenly for the last 10 years that people are not prepared to settle for anything less than perfection.

"For a while there was an assumption that midwives understood women better and there wasn't an anti-midwife feeling like we felt there was an anti- obstetrician feeling. But what has caught up now is that nobody is being allowed to slip up at all."