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March 25, 2015

It isn’t only pregnant women who end up traumatised after watching ‘One Born Every Minute’, it’s midwives too.

At the BJM awards recently, where excellence in midwifery was being celebrated, something was made apparent when a guest speaker mentioned the dreaded ‘One Born Every Minute’ TV programme … yup it was made clear that amongst the midwives in the room the common opinion was that the programme was worthy of nothing more than loud boos.

Whenever I dare to talk about the programme my colleagues reply with “oh I don’t watch that rubbish” and I have even heard some midwifery conference speakers giving out the call to switch off. I felt the same during the first series. What midwife wants to see women being subjected to that type of car crash childbirth.

However all it took was just one glimpse of a woman being shouted at during one episode and I was filled with rage.  All the hard work being done by myself and my colleagues around the country to improve birth, to prioritise informed consent, to empower women was being eroded by those midwives on my telly who for some reason turned into cheer leaders over women posing as stranded beetles while determined to chant their mantras of “keep it coming, keep it coming”.

“…it was made clear that amongst the midwives in the room the common opinion was that the programme was worthy of nothing more than loud boos.”

So as much as I hated watching how birth was being portrayed I HAD to see what women around the country were seeing on a weekly basis.  I was so appalled I set up a Facebook page, ‘One Born Every Minute – the truth’ to enable discussion around the clinical practice millions of women see on our screens each week.

I stuck my already shrapnel filtrated head above that parapet once more.

Week after week I pounded away on my laptop arguing the case for how each birth could have been better if only… During last night’s episode I decided to go one step further and live tweet my frustration during the programme. Now don’t get me wrong, I am not a novice when it comes to how TV production works.  I know about editing, I know birth does not unfold in the hour they have to put it on our screens but to answer those who use the edit to counter argue much of the criticism I raise, you can’t undo what IS being said or IS being seen!

Let’s start from last night’s programme with a very brave family.  Reve was in hospital for induction of labour. There was no explanation given as to why she was being induced but that’s no criticism of the midwife or the antenatal care because that certainly could have been in the edit but minutes before a medical process was going to begin, a process that carried risks to the woman and her baby she said she had no idea what was about to happen or if it would hurt.

My body tensed and the first GRRRRR came out of my mouth.
blog_OBEM_stony You cannot take that OUT of the edit and there is no conclusion to come to except this young women had been given no information and therefore was NOT making an informed choice to be induced. It was nothing more than a lamb to the slaughter blindly following the care givers who were making life changing decisions on her behalf. Women MUST be given unbiased information so they can give informed consent. It’s in the midwives’ rules as well as in law!

“she said she had no idea what was about to happen or if it would hurt.”

 

We don’t know the background here but as an example of how informed consent should work in practice in the case of post-dates induction, see Birthrights’ article here.

Tweeting continued and I saw a striking, metal-studded leather collar wearing woman appear on screen. Her story gave us an insight into a sad obstetric history involving the loss of two premature babies.  Again we have no explanation of why she may have been advised to induce labour with this baby but what certainly was NOT in the edit was the speed of how this labour unfolded and what opportunities were missed for a better birth.

We know that laying on your back will not only reduce the available space for descent of the baby and can cause hypoxia for baby, but it can also can make labour more painful leading to the use of more drugs and the request for an epidural.

This was an lost opportunity to show a fantastic off the bed upright birth to spread evidence based information. The next thing we see is the baby being passed to its mummy tightly wrapped in a blanket.  Where was the delayed cord clamping? the skin to skin? Both of these things we know, (we have the evidence) improve health to mother and baby.  It’s not just about being warm and fuzzy here or being critical for critical sake it’s about delivering safe and evidence based care. If optimal care is not given, is not the care substandard? Maybe it was in the edit? Maybe she had bothblog_OBEM_cantlook.

Another lost opportunity to show the mothers of tomorrow the best in birth practices and another cushion thrown at my TV.

“what certainly was NOT in the edit was the speed of how this labour unfolded and what opportunities were missed for a better birth”.

Enter Laura, the beautiful young mum whose partner sadly was on duty elsewhere. For me this was the best example of ‘how it could have been done’, of the night. From what we were told,  Laura was a low risk woman having had babies before.  No induction, no drip, drains or machines. She had a lovely gentle midwife who remained with her smiling and speaking gently.  It appears that Laura also was encouraged (for a few minutes) onto all fours, yippee!  My heart soared for a few seconds, but then NOOOOOO! once again flat on her back.

We saw the midwife discuss Laura’s progress with a colleague and say “I thought baby would be born by now” Laura still had some cervix remaining.  I began involuntarily shouting at my screen. blog_OBEM_cushion Help her upright, baby needs some gravity to rotate maybe, try a birth stool; show us what you can do midwife, show us evidence based practice for normal birthing women!  Turn off the light encourage Laura to relax, speak soft calming words, or no words at all. Then as baby finally was about to be born the same old cheer leading “PUSH” directions. BIG SIGH. Women don’t need to be shouted at or told how to push their babies out.  Have the midwives not had babies? Can they not know the force of a woman’s body, of that overwhelming surge of strength?

Laura’s baby was born and once again we saw no cord still attached as baby was passed to mum. It may have been in the edit but unless baby was kept on the bed between Laura’s legs rather than being passed straight to its mother, then the cord was cut far too soon for the optimum health of baby.

“We saw the midwife discuss Laura’s progress with a colleague and say “I thought baby would be born by now” Laura still had some cervix remaining.  I began involuntarily shouting at my screen.”

I’ve given up shouting at the screen and am banging my head on the wall now.  This is broadcasting at its worst, not in terms of viewing figures but in terms of social responsibility. Another lost opportunity to show the birthing women of tomorrow how wonderful birth can be. How the health of our babies can be improved by less intervention.

We are being naïve if we expect Dragonfly Tv and Channel 4 to change anything about their formula.  They are delivering a BAFTA winning television programmes to an audience of millions.  So who is there to protect the pregnant women left frightened after watching it?  What of the audience deprived of so many chances to see best practice in evidence?  What of the midwives who are angry about such a portrayal of their profession?

If Trusts and midwives are going to take part (and there is not time here to go into the reasons that they do) then at the very least they need to insist on some balance and some editorial control.  I agreed to film ITV’s Home Delivery only on condition that I had just that.  Why on earth would a midwife take part in anything which undermines evidence based practice, positive birth and a woman’s right to informed consent?

“I’ve given up shouting at the screen and am banging my head on the wall now. This is broadcasting at its worst, not in terms of viewing figures but in terms of social responsibility.”

And so we are back to Reve. I think even without the baby’s worrying heart condition, the induction process was marked up to fail from the beginning; bright lights, laying on a bed, brain being stimulated by emotional and social problems (and phones) without mentioning too much about the syntocynon effect on baby.  A caesarean section was always on the cards.

There is no criticism of the final outcome however because this was a fine example of the medical intervention which save lives.

While there is a long way to go in improving care for women having normal births, for those women and babies with REAL life threatening emergencies as Reve’s baby had, our NHS service is the best in the world and I for one would not want to be anywhere else in the world should I or my baby be in dire straits.

The key is in knowing, and seeing, the difference.

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At the BJM awards recently, where excellence in midwifery was being celebrated, something was made apparent when a guest speaker mentioned the dreaded ‘One Born Every Minute’ TV programme … yup it was made clear that amongst the midwives in the room the common opinion was that the programme was worthy of nothing more than […]

 
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