The meme of the moment in UK midwifery is “fight fear.” It is both hypocritical and immoral.

It’s the keystone of today’s piece in The Guardian by an anonymous midwife, I loved being a midwife, but bullying, stress and fear made me resign and at heart of the new book by UK midwives Sheila Byrom and Soo Downe, The Roar Behind the Silence.

I’ve already written about Byrom’s personal hypocrisy in editing a book about kindness, compassion and respect in maternity care, when she is on public record as treating with utter contempt a parent whose baby died at the hands of her colleagues. But the book itself is an example of the hypocrisy that is at the heart of contemporary UK midwifery theory. UK midwives are among the biggest fear-mongers around.

Before we look at what UK midwives mean by “fight fear,” it is worth considering the advice of security consultant Gavin de Becker who wrote the book The Gift of Fear.

True fear is a gift.

Unwarranted fear is a curse.

Learn how to tell the difference.

Or as this post on a Psychology Today blog explains:

Fear is helpful and safety-oriented whereas worry and anxiety are not helpful and related to phantom ‘possible’ events that often don’t happen. To that degree, worry and anxiety are distracting away from real fear signals that could help …

In other words, fear can be extremely beneficial in helping us avoid danger, while anxiety, generally related to possible events that don’t often happen, is harmful and may actually impede our ability to avoid real harm.

Indeed, fear of death (of the baby or mother) in childbirth has been the impetus for the interventions that have saved and continue to save hundreds of thousands of lives each and every year. In contrast, anxiety about interventions, from epidurals to C-sections, ruins the birth experience for many women and puts them and their babies at risk of injury and death.

What do UK midwives want to fight when they say “fight fear”?

Do they want to fight fear of epidurals?

Absolutely not. They encourage women to fear epidurals, wailing, “Drugs!” and emphasizing complications that are in reality less likely to occur than being killed by a lightning strike.

Do they want to fight fear of childbirth interventions?

Absolutely not. They encourage women to fear childbirth interventions by constantly invoking the dreaded “cascade of interventions.”

Do they want to fight fear of C-sections?

Are you kidding? Their efforts to demonize C-sections are notorious, and they don’t consider themselves restricted to the truth. From “C-sections interfere with bonding” (they don’t) to “C-sections change neonatal DNA” (they don’t), to the supposed “crisis” in maternity care represented by a C-section rate over 30%, no one can touch midwives when it comes to inspiring and creating fear.

So what do UK midwives really mean when they claim they want to fight fear?

Here’s what Sheena Byrom and Soo Downe have to say in the section ‘Fear as a driving principle of maternity care design and delivery’:

…For midwives and obstetricians, fear of recrimination, litigation, negative media exposure and loss of livelihood potentially contributes to defensive practice…

Of course, none of these things — recrimination, litigation, negative media exposure and loss of livelihood — occur UNLESS a baby or mother is injured or dies in childbirth.

The fear that UK midwives want to fight is PROTECTIVE fear of death of a mother or baby in childbirth.

They lament:

In maternity services in England, this issue has been exacerbated since the publication of the Mid Staffordshire Trust public enquiry, with a subsequent increase in internal and external service reviews and a fear of bad publicity of imposed special measures.

Why was the Mid Staffordshire inquiry undertaken?

According to The Guardian:

An estimated 400-1,200 patients died as a result of poor care over the 50 months between January 2005 and March 2009 at Stafford hospital, a small district general hospital in Staffordshire. The report being published on 6 February 2013 of the public inquiry chaired by Robert Francis QC will be the fifth official report into the scandal since 2009, and Francis’s second into the hospital’s failings. The often horrifying evidence that has emerged means “Mid Staffs” has become a byword for NHS care at its most negligent. It is often described as the worst hospital care scandal of recent times. In 2009 Sir Ian Kennedy, the chairman of the Healthcare Commission, the regulator of NHS care standards at the time, said it was the most shocking scandal he had investigated.

What did the Mid Staffordshire Trust report (Francis Report) find?

The very first sentence of the Executive Summary lays it out quite plainly:

Between 2005 and 2008 conditions of appalling care were able to flourish in the main hospital serving the people of Stafford and its surrounding area.

Byrom and Downe don’t lament the hundreds of unnecessary deaths that occurred in “conditions of appalling care.” They don’t even mention the hundreds of people who died unnecessarily, enduring horrific suffering. No, Byrom and Downe lament the extra supervision and scrutiny that were put in place to prevent another similar episode.

Byrom and Downe’s book went to press before the recent publication of the Morecambe Bay Report, often compared to the Mid Staffordshire report, which found that 11 babies and one mother died preventible deaths at the hands of midwives:

[M]idwifery care in the unit became strongly influenced by a small number of dominant individuals whose over-zealous pursuit of the natural childbirth approach led at times to inappropriate and unsafe care… [W]e heard that midwives took over the risk assessment process without in many cases discussing intended care with obstetricians, and we found repeated instances of women inappropriately classified as being at low risk and managed incorrectly. We also heard distressing accounts of middle-grade obstetricians being strongly discouraged from intervening (or even assessing patients) when it was clear that problems had developed in labour that required obstetric care…

Why did this happen? Because the midwives did NOT fear the inherent deadly dangers of childbirth. It is this fear that they are fighting.

Toward this end, they recognize no limits in encouraging fear of epidurals, fear of childbirth interventions, fear of C-sections (all of which, not coincidentally, they cannot provide), but they abhor fear of the very real risk of DEATH and serious injury in childbirth (which, not coincidentally, they can’t prevent).

UK midwives’ desire to “fight fear” in childbirth is both grossly hypocritical and stunningly immoral. They want women to fear everything they can’t provide and they want women to ignore the legitimate, protective fear that they or their babies will be injured or die in life threatening emergencies that are all too common in childbirth.

UK midwives are the equivalent of an auto manufacturer touting a car that doesn’t have seat belt, air bags or other safety devices:

It costs less!

Crashes are rare!

Seatbelts interfere with freedom of movement!

Seatbelts could trap you in the event of a car fire!

Fight fear of being killed in a car crash!

Most of us are savvy enough to recognize that such an auto manufacturer would have only its bottom line in mind and would be encouraging anxiety over unlikely possible events while discouraging the protective fear that saves lives by being prepared for a car crash.

Similarly, we should be savvy enough to recognize that UK midwives have only their own benefit in mind when encouraging anxiety over epidurals, interventions and C-section, while discouraging the protective fear of death and injury that saves lives by being prepared for life threatening events in childbirth.

As de Becker said, fear is a gift, unwarranted fear is a curse and everyone must learn how to tell the difference.

UK midwives discourage life saving fear, substitute unwarranted anxieties in its place, and women and babies die because midwives cannot or will not recognize the difference.