Mockingjay Midwifery

08/11/2025

As providers, our duty is to uphold and respect birthing people’s rights to informed consent and refusal. The duty is to our client, not administrators.

👏👏👏👏👏

07/31/2025

Recently, investigators published the results of a large randomized controlled trial* evaluating whether induction in the first 4 days of week 38 would reduce the incidence of shoulder dystocia (the head is born, but the shoulders hang up behind the p***c bone) when the baby was suspected of being large for gestational age compared with waiting until at least 39 weeks 4 days. The takeaway from the trial making the rounds is that induction at 38 weeks did, indeed, reduce the incidence of shoulder dystocia.

Did it?

Dr. Sara Wickham’s analysis of trial outcomes concludes:

“The main report of The Big Baby Trial highlights one marginal result while other important outcomes have been underexplored, ignored, or relegated to the supplementary data. It’s almost as if the authors so badly wanted the research to show a benefit to induction that they have interpreted the results in favour of induction even where the actual data don’t support this.”

Read her take down of the trial to find out more about its many flaws and weaknesses, to which I’ll add two more:

1) While shoulder dystocia is concerning, it is not in itself an adverse outcome. Almost all shoulder dystocias will be resolved without incident, and on the rare occasions when a complication results, almost all of those babies will make a complete recovery.

2) We don’t know the extent to which typical labor management provokes shoulder dystocia by such practices as pushing and delivery while lying on the back.

* Gardosi J, Ewington LJ, Booth K, et al. Induction of labour versus standard care to prevent shoulder dystocia in fetuses suspected to be large for gestational age in the UK (the Big Baby trial): a multicentre, open-label, randomised controlled trial. Lancet 2025;405(10491):1743-56.

https://www.sarawickham.com/articles-2/bigbaby/

07/13/2025

👏🏻👏🏻👏🏻

06/23/2025

Rage is the same place where love lives 🤍

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06/20/2025

Dismantling hierarchy and utilizing creative thinking is so important when considering how we can best serve our communities. Too often, proposals to offer reasonable care options are met with blanket refusal, or hostility rather than curiosity and collaboration.

This is such a great example of a provider reflecting on the initial defensive feeling, backtracking it to the source and managing themselves so they can make space for the next right thing. Chef’s kiss.

06/11/2025

“No, I’m not putting up with it”, is a perfectly valid response to being told that your birth choices are “banned”.

06/10/2025

If the risk of future placentation issues are not included in the informed choice discussion for cesarean (even medically necessary cesareans), then the informed consent process has not been adequately fulfilled.

Where is the informed consent?

I heard a medical provider dismiss accreta as a “theoretical risk.”

Aren’t all risks theoretical until it happens to you or your patient?

But their thinking reveals a lot about what they consider a “real risk” and why they almost always remain silent on the risks of accreta.

It’s also possible that they genuinely don’t know.

This is why we have courses for parents and continuing education for professionals.

The first time a mother hears the word “accreta,” should not be at her own diagnosis.

Yet that is the case for the majority of accreta parents.

They were just never informed on the risks of repeat cesarean, including accreta, “listened to their OB,” and “consented” to one or more repeat cesareans.

Get the facts so you can make informed decisions for yourself or provide the most ethical and accurate VBAC information and support for others: https://vbacfacts.com/courses

05/27/2025

Provider fear is not a valid reason to override client rights to informed consent and refusal. Why? Because there are NO valid reasons in which it is legally or ethically permissible for providers to override a person’s right to informed consent or refusal. Birthing people are under no obligation to manage provider feelings, yet so often, consent is coerced to do just that, under the guise of safety and “risk management”.

🎯

05/21/2025

Motivated hospitals, motivated providers, find a way to support VBAC, vaginal breech birth, twins, etc. If a site is not meeting their obligations to the consumers in their community, and consumers aren’t aware of the core issues, they can’t effectively advocate for the change they want to see. The story of “I’m not allowed” becomes lore. Families become socially conditioned to assume a role of compliance, out of fear that “stepping out of line” will put themselves and their babies at risk.

Every time a family makes a choice to advocate for themselves, it creates an opportunity for hospital administration and the providers who work there, to get clear about what the real barriers for access are, and decide whether or not they will continue to double down on an authoritative tug of war, or whether they will choose do the work to meet their ethical and legal obligations.

04/20/2025

Repost

04/19/2025

04/01/2025

Reproductive care must be gender-affirming. On this Trans Day of Visibility, we honour and uplift trans parents, trans families, and all trans people seeking safe, respectful, inclusive care.

Midwives have a role to play in building a future where reproductive justice includes everyone. Trans and non-binary midwives are helping to lead the way.