I just had to post this comment on Morwenna Ferrier's article in The Telegraph today, especially given the way NHS maternity policy seems to be heading:
Let me start by saying that I think that the majority of midwives do a great job and I agree that there is evidence to show that midwife-led care can enhance the experience of women who would like to have a natural birth.
However, I would not describe midwifery-led care as categorically "uncontroversial", as it appears to be represented in this article's conclusion.
Listening to and reading the stories of women who have experienced birth trauma, it is very clear that the "care" provided by some midwives is extremely poor. They do not always respect women's feelings or birth choices, and their treatment of women, both physically and psychologically is sometimes described as dismissive and even cruel.
The Netherlands has a very long history of midwifery-led care, and was found to have one of the highest perinatal mortality rates in Europe, while another study there found better health outcomes with high risk pregnancies (cared for by obstetricians) than with low risk pregnancies (cared for by midwives).
Midwives tend to place a greater trust in Mother Nature than doctors do when it comes to the physiological nature of childbirth, and while this makes them the perfect care-givers for women who want to have a natural birth experience, and whose trust in the birthing process matches that of midwives, it does not make them the best care-givers for women like myself, who place a greater trust in medical intervention, fetal monitoring and obstetrician-led care.
Different women should be allowed to receive care from the maternity care provider that best suits their own perception of birth risks and benefits - rather than trying to create NHS maternity policies that prescribe one type of care (midwifery-led) as being the best option for all (supposedly) low risk women.
None of us know which pregnancies can truly be described as “low risk” until after the birth is over, and as too many birth stories can attest, for some, by then, it's simply too late.