In response to Mr Carpenter's comment, what i meant by protectors of normal childbirth, is that when all is said and done pregnancy is a normal, physiological life event and should be treated as such. The medical model of care assumes illness until proven otherwise, as midwives we practice in the realms of normality until something indicates otherwise, at which point medical assistance is called. Midwives need to protect and more importantly promote childbirth as a normal life event, in which case i believe that the rates of medical intervention would be alot lower than they are today.
And in response to the final comment, we do not recieve any medical training as we are not medical staff. Midwives hold a unique position in the health care professions, we are neither doctors or nurses, we are midwives, we are trained to be "With Woman" (the literal translation of midwife), to facilitate a natural, physiological process.

Emma Rushforth, Bradford,

I think Emma from Bradford unwittingly hit the nail on the head when she espoused that "Midwives are practitioners and protectors of normal childbirth."

During my wife's pregnancy we met around half a dozen different midwives, each of whom expressed some kind of reflexive distrust of medical professionals in almost subconscious terms like that.

Since when is it the goal of anyone to 'protect' normal childbirth? I don't see other people describing their function to be to 'protect normal deaths' or carrying out 'natural tooth removal'. Surely the aim should be to ensure the safety of a mother and her child? Like the whole breastfeeding issue, midwifery often seems to become more of a political stance than a medical one.

Midwives have very little medical training - not even in anaesthesiology - but are given a large influence in issues with with major health implications. I think it is entirely fair (if a little emotive) to declare that they are the 'weakest link' in birth provision.

Paul Carpenter, Leeds,

As a student midwife who is in her final year of a three year course, one of the most intense, in depth courses i think exists, i can honestly say i am disgusted at Cavendish's opinion of midwives as being "the weak link" and "unprofessional". Midwives are practitioners and protectors of normal childbirth. I am in no doubt that our medical collegues are invaluable in ensuring safe care of women and their babies when problems arise. As midwives we are trained to recognise deviations from the norm and when to seek medical assistance, but to assume that we are unable to care for women under normal circumstances is completely unfounded. I think Cavendish needs to do alot more research before attempting another so called article and prepare herself for one very large backlash.

Emma, Bradford, England

The author would do better to focus her attention on the poor management on NHS finance as the weak link rather than to single out overstretched midwives who work long shifts mostly without breaks and often working additional unpaid hours.
The biggest problem is there are severly limited resources to employ many of the qualified midwives out there. Many qualifing midwives this year struggled to find any jobs.
Many women are able to achieve a perfectly normal birth, and often it can be doctors who are not experienced at dealing with normal birth who panic and medically manage birth because it enables them to feel they are more in control rather than trusting in womens ability to birth a baby themselves.
When there is an obstetric emergency fast access to care is what is required and women most at risk of complications or death are often those who are socially deprived. They are less likely with the creation of super units to be able to access the obstetric care they need in time.

Liza, London,

I am very sorry for the negative experience that Camilla suffered during her birth, and do not doubt what she describes, however I am disappionted to find that she bases her own experiences as the norm. This article appears to be poorly researched and quite frankly biased journalism. Every day midwives meet women who have a realistic expectation of childbirth, and who manage to appreaciate that for many, childbirth is a natural process, these women often go onto deliver their babies without interference from anyone, just the support and monitering of a midwife. Part of a midwives role is to recognise abnormality occuring within the process of childbirth. This is were our medical colleauges step in. However if Camilla is under the false impression that medical intervention for all will women will result in better birth outcomes, she is wrong. What is needed is good empathetic practioners, who are truely 'woman centered', but have an eqaul regard for the dangers child birth can present.

Mrs N Stringer, Tamworth, Staffordshire

It is a good job that CC researched the available evidence and was able to compose an accurate article regarding the true problems in the maternity services, otherwise I could have just read the type of drivel one may associate with daily papers that relies on images of near naked women to sell them.
Just one question CC, do they actually pay you to write this stuff?

Ian, Blackpool, England

I am really not sure distance is an issue. Most women, certainly for their first birth, have plenty of time between onset of Labour and childbirth. Those who are likely to need clinical assistance will be at the centre anyway.

In my experience, most women wouldn't go anywhere near a maternity unit for their subsequent births. Unless there was an identified medical reason, of course.

Camilla will no doubt be slated for her comments about midwives but I am sorry to say that in my experience, she is spot on. More's the pity.

Seasider, Portsmouth,

what is there to talk about midwives?Are they not doing their jobs well over there? In the USA they are adept at what they do The law suits will be astronomical otherwise

Corrina, minneapolis, MN, USA

The emotive language used in this article is not helpful in facilitating debate to improve maternity care in the UK.While sharing birth experiences is a necessity,this can be met by organisations like the Birth Trauma Association,to help women go forward positively.Implying caesarean rates are increasing due to poor midwifery care is not based on research;wrongly blaming midwives for a multi-faceted problem for which many groups may be responsible.We do need more good midwives.However,accusations wrongly levied against midwives will not strengthen a struggling profession,now wondering if it fails the very people it endeavours to serve.Opinions of the many families who have been cared for by a midwife recently would be helpful to see if Ms Cavendish’s opinions represent the population,or are a snapshot of a painful time for an individual with the power to reach many.If she would like to see more good midwives then the first step may be to support the profession that exists to be an advocate for women in a time of unknown,and holds high the aim that women have choice and support in childbirth.Without support from society the midwifery profession will inevitably decline.

Hannah Hind Woodward, Cheltenham,

Despite having some sympathy for the previous commentators, I think that Ms Cavendish has a point. Midwifery led care has become such a holy cow to government thinking on maternity services that obvious flaws are ignored. To be a truly independent practitioner, as midwives wish to be , requires a degree of talent, experience and sharp thinking which not all graduates of midwifery courses possess. Up to the mid -nineties such persons were covered by the presence of junior medical staff who by dint of extremely long hours acquired battlle front experience quickly. They also had the benefit of understanding any medical history which a surprising number of supposedly healthy women have. Now, every midwife is deemed equal...and therefore competent when many would struggle to write soundly grammatical English. Also, the medical staff have been banished from taking the initial history when the would-be mother "books-in" for care in a particular maternity unit. If you think midwives are as medically knowledgeable as junior doctors and that all midwives "cut the mustard", you do not have a problem. Reports from the frontline suggest that that version is just a little indigestible. If clinical nous were the only standard for doctor and midwife alike with cultural awareness, feminist politics and Blairite visions of perfection relegated to their rightful lowly position, things would improve.

Obstet-over-fifty, Sydney, Australia

I'm not quite sure what this columnist is saying here, is it that because midwives work part-time we are useless and can't provide one-to-one support in labour? Crikey, I knew that most maternity units are now reducing the number of whole-time equivalent midwives they employ but I hadn't realised that it was by as many as 10,000, no wonder I often feel so alone, I must be one of the few midwives left, no wonder it's difficult to provide one to one care.

midwifemuse, Buckinghamshire, England

as apraqctising midwife i am appalled by the belief that women feel 'safe' only in the hands of doctors. within in my practice i beg to differ and as a professional i have seen many doctors jump in far too soon so that they can finally get to bed or alternatively they perform a so called emergency c/section because they lack the confidence and ability to perform an instrumental delivery. of course women will feel the doctor has saved the day when offered a c/section as it relieves them of the pain they are suffering (for the time being) but the crucial point is that in todays society women approach childbirth as a complicated illness as opposed to a normal physiological state of well being. as far as finances are concerned... the government is trying to save money where the nhs is concerned, how do they expect to do this with consultants working 24hrs ??? would it not be better to provide to money to employ more midwives who will have the TIME to provide safe high quality care??? As a midwife i can vouch why many work part time. it is because they are burning out and are running a service out of good will. would a shop worker work through his/her break and work after the shift has finished without booking overtime?? thats exactly what myself and my colleagues do on a day to day basis. as far as closing maternity units goes, please remember that not all people have cars. if parents have sick babies in a neonatal unit it may well be there for many weeks, many of these parents have other children and cannot stay on site in hospital accomadation. to summarise. please get your facts right before you begin to criticise the midwives and their profession. would you like to have to run a 6 hour journey in 3 hours?? thats what if feels like to be a midwife - were doing an impossible job in impossible conditions, funnily enough the government feels that is ok

disgruntled midwife, wigan, lancs

"Midwifes are the weak link" I'm sorry but i've had three children and am pregnant with my fourth. When you are in labour the midwife is not a weak link at all, believe me.

Midwifes are responsible for many many successful births and really are professionals. When their hands are tied it is by the local NHS policies.There is a shortage of midwifes, yes, but its my understanding that the posts are been kept empty and are not been advertised due to funding shortages.

This article appears completely unfounded and i'm shocked that without any figures Camilla Cavendish thinks she can slate their profession like this.
.

Samantha Roberts, Shipley/Bradford, West Yorkshire

Independent midwife's Association stats - 75% of women who book with an IM have at least one 'risk factor' and 84% have a normal birth rate, and that is not just a vaginal birth - no induction, no episiotomy, no rupture of membranes and very little pain relief often....................

Deborah Purdue, Blandford Forum, UK