Albany independent midwives' contract terminated by King's College Hospital

The Guardian has reported that London's King's College Hospital has terminated its contract with the Albany group of independent midwives, 'alleging that a disproportionate number of the babies it delivered suffered damage during the birth.'

It says that 'King's decided to terminate the contract after commissioning a report from the Centre for Maternal and Child Enquiries (CMACE) [and it] is believed the investigation was triggered by the death of Natan Kmiecik, one week after he was delivered at Kings by one of the Albany midwives. His mother, who did not speak English, had a caesarean for the birth of her first baby but wanted a natural birth for her second. Her lawyers claimed proper procedures were not followed, because the baby's heartbeat was monitored only by a small hand-held device so she could have a water birth.'

Low levels of medical intervention
While a very positive aspect of the Albany group is its aim for all women to be delivered by a midwife they have built up a relationship with during their pregnancy, it is now in question whether some of its other policies (namely, enbcouraging - almost 50% rate - home births and reduced medical intervention) provide best practice care.

'King's says babies delivered by Albany midwives had higher rates of hypoxic ischaemic encephalopathy brain damage caused by lack of oxygen and lack of blood flow to the brain - than those delivered by midwives it employs directly over the last two and a half years.'

Unsurprising
This story reminds me of a UK medical study from 2004, which assessed 540,834 live births and stillbirths in 65 maternity units. It found that a ‘higher intervention score and higher number of consultant obstetricians per 1000 births were both independently and significantly associated with lower stillbirth rates' (Joyce et al, UK, 2004), so it is unsurprising to me that a practice of minimal intervention by the Albany group is reported to have led to negative health outcomes.

Clearly, those women who have enjoyed positive experiences at this midwifery practice are angry and sad to hear this news, and I do have some sympathy for them. But I think it is safe to assume that it was not their precious baby who fell between the cracks and suffered injury (or death) during a planned vaginal delivery.

Otherwise, they might well be interested in reading the Canadian study I blogged about yesterday, which found that 'life-threatening infant morbidity is lower with planned cesareans'.