In this episode, join Shellie, Kemi and Dr Stuart Fischbein as we explore how birth outcomes can be shaped by system design, not just clinical skill, or lack thereof.
We discuss how time pressure, immobility, fear, monitoring and routine intervention can create the very problems they are then used to solve. Epidurals, coached pushing, early admission and continuous monitoring can influence labour, malposition and intervention rates, while evidence is often focused on short-term outcomes and hospital-based measures rather than longer-term effects on bonding, breastfeeding, the microbiome, child development and future reproductive health.
From breech caesareans and synthetic oxytocin to postpartum decision-making, we ask whether the outcomes we measure are always the outcomes that matter.
We examine how induction thresholds, routine scans, escalation protocols and arbitrary time limits, such as the 24-hour waters-breaking and 42-week thresholds, have become rigid rules rather than prompts for individualised decision-making.
We also explore continuity of care, responsibility and professional power. Trust and familiarity can influence decision-making, while fragmented responsibility can allow harmful practices to continue because everyone is simply “following the system”.
Ultimately, this is a conversation about who owns birth knowledge: who controls the tools, who is allowed to learn and teach, and who gets to decide what is considered safe. From the historical secrecy surrounding forceps to the medicalisation of midwifery and restrictions on independent birth workers, we question when professional control becomes disguised as safety.
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