An email exchange with Julia Cumberlege

To: Julia Cumberlege Cc: xxxxxxxxx

Thank you Julia, I appreciate the honestly in your explanation.

Simon is clearly a gifted communicator.

Forgive me for noticing the difference in sentiment between ‘I respect and value your views and campaigning work’ and ‘…but the article! How does this man have the time to write all this stuff.’ !

All the best,


Sent from my iPhone


Sent from my iPhone
On 18 Aug 2017, at 13:20, Julia Cumberlege <xxxxxxxxxxxxx> wrote:
James I am very sorry. As you know I am on holiday. I wanted to get a reply to you as soon as I could and sought a helping hand. I meant every word I said in my reply to you. When I return I suggest we meet and have a coffee to talk through how we can work together to achieve our shared goals.
Best wishes
Sent from my iPhone

Begin forwarded message:
From: James Titcombe <xxxxxxxxxxxxxx>
Date: 18 August 2017 at 11:09:08 BST
To: Julia Cumberlege <xxxxxxxxxxx>
Cc: xxxxxxxx
Subject: Re: Midwives and ‘normal’ delivery methods | Comment | The Times & The Sunday Times
Dear Julia,

Can I hazard a guess that ‘Simon’ is the person who helped draft your response to my email and that you meant to forward my polite response to him, to congratulate him on a successful strategy?

It’s very sad & hurtful to see this Julia. One thing I value more than anything else in leadership is authenticity and honesty.



On 18 Aug 2017, at 10:33, James Titcombe <xxxxxxxxxx> wrote:
Hi Julia,

I think this response was intended for someone else called Simon and that you have sent me this by mistake?

I don’t know who Simon is but hope your comment ‘how does this man have time to write all this stuff’ isn’t referring to me?

If it is, happy to explain that losing a baby and wanting to ensure no one else goes through the same is quite a motivating factor.

Best Wishes,


Sent from my iPhone

On 18 Aug 2017, at 10:26, Julia Cumberlege <xxxxxxxxxx> wrote:
Simon. I think you have succeeded again, for the moment but the article! How does this man have time to write all this stuff.
Thanks again

Sent from my iPhone

On 17 Aug 2017, at 23:28, James Titcombe <> wrote:
Dear Julia,

Thank you for your response. I do very much respect your experience and commitment to making things better.

As you say, there is common ground.

The last few days have been interesting listening to what others have been saying & I’ve written a few more reflections here, including my hopes for the future.

If all maternity units could emulate the approach Morecambe Bay have adopted in recent years, all my hopes for system learning following Joshua’s death will have been realised.

I do really hope we can have more balanced messages around ‘normal birth’ and that you might consider helping to influence this.

Kind Regards,

Sent from my iPhone

On 17 Aug 2017, at 10:49, Julia Cumberlege <xxxxxxxxx> wrote:
Dear James

Thank you for your email.

I want to say how much I respect and value your views and your campaigning work, albeit that we do not agree on every point. I am not sure I will persuade you to see things differently, and you certainly know my own views.
We do, I believe, agree on familiar but crucial points that have once again been highlighted by The Times editorial and subsequent discussion.
Medical intervention that ensures the safety and well-being of a woman and her baby, in circumstances where that safety would otherwise be in jeopardy, is absolutely vital. Equally, unnecessary medical intervention is not in the interests of women and babies.
We agree on the importance of continuity of carer, specifically of midwife. Continuity is a pivotal factor in safer births. It is a real challenge given the pressures that exist in the service, but we must continue to strive for it.
We agree, I believe, on the importance of women being empowered to make choices about their pregnancy and birth. They must, of course, have access to good, impartial information and support in making their decision.
Like you, I do not want any woman to be labelled a failure because of her birth experience. I want women to have a safe and happy experience in pregnancy and childbirth, throughout to receive the best possible care and support, and to make choices that are in her – and her baby’s – best interests.
I know there will continue to be points on which we disagree, but I hope we will find a way to work together again on the many points where we do agree.
Best wishes
Baroness Cumberlege
National Maternity Review

From: James Titcombe <xxxxxxxxxxx
Sent: 15 August 2017 02:14
To: BARONESS Cumberlege
Cc: xxxxxxxxxx
Subject: Midwives and ‘normal’ delivery methods | Comment | The Times & The Sunday Times

Dear Julia,

I was saddened to see your letter in the Times in response to the leader (“Born Free”, Aug 12), which I’ve attached for ease of reference.

I thought the Times column was well written, balanced and made some important points that you don’t seem to acknowledge.

You make a point about WHO stating that 80% of women should be low risk at the start of labour and cite WHO again, talking about the ‘uncritical adoption of a range of unhelpful, untimely, inappropriate and/or unnecessary interventions’ being a risk ‘run by many who try to improve maternity services.’

I struggle to understand the point you are making. No one would argue that the ‘uncritical adoption of a range of unhelpful, untimely…etc…’ interventions was a good idea.

The Times column makes 2 clear arguments. The first being that the phrase ‘normal’ can lead to some women who do need interventions feeling ‘as if they have failed’. As a man and having only experienced my own children being born without intervention, I have no direct experience of this. But I have heard literally hundreds of women express these concerns. If you look at my timeline on twitter you’ll see many examples of women saying exactly this.

I note that alongside your letter, David Bogod, a consultant obstetric anaesthetic provides further testimony to this issue.

“…it leaves women needing epidural pain relief or caesarean section feeling that they had failed in what many, rightly or wrongly, regard as their most fundamental biological role.”

You may also be aware that after extensive work listening directly to mothers, Morecambe Bay changed their language and ceased using the phrase ‘normal’ some 18 months ago. To Cathy Warwick’s credit, she was quite frank about acknowledging these issues in the interview with the Times that triggered this media interest.

Your letter makes the point that ‘changing the name of birth will not improve outcomes’, of course it won’t – but the article didn’t attempt to link language to outcomes. Nor has anyone else.

I find it odd that your letter conflates this issue when the column was so clear. Is it the case that you don’t accept the point relating to how the language makes some women say they feel? Why not speak with the head of midwifery at Morecambe Bay and ask about the work they did with mothers there?

I would be very grateful if you would be kind enough to clarify this.

The second part of the Times column however, did discuss safety.

Your letter states ‘Midwives work on the basis that “normal” births are preferable for mother and baby where it is safe.’

It is of course, up to women to decide what kind of birth is ‘preferable’ for them – and women should be given the full facts, including (as the montgomery and lanarkshire case made clear) information about the risk of vaginal delivery. But the concept of ‘safe’ isn’t a binary. It isn’t possible for the birth of a child to be labelled ‘safe’ until after the event. Before then, there is only a spectrum of risk and uncertainly.

The concern which many people have expressed relating to the emphasis of the RCM ‘normal birth’ campaign, is that it takes a very laudable and worthwhile aim; to minimise the chances of unnecessary interventions, but attempts to achieve this aim with the bluntest of instruments and through only focusing on one part of the multidisciplinary team that we know is essential to providing safe maternity care – midwives.

Messages such as ‘wait and see’ and ‘trust your intuition’ aren’t helpful if we want to foster a balanced approach that succeeds in minimising interventions without increasing the risk of catastrophic outcomes.

Isn’t a better approach not to have a national campaign that only focuses on ‘promoting’ a mode of delivery, but instead focuses on influencing all healthcare professionals involved in delivering maternity care to work collaborative together, not towards some artificial intervention target, but to ensure the care of each individual women and baby is as safe and compassionate as it can be?

It was established beyond any doubt that an over focus on ‘normal’ childbirth was a significant factor in the deaths of 11 babies and a mother at Morecambe Bay. I can tell you that I have heard from literally 100’s of families who tell me they felt a focus on normal birth contributed to their, often deeply tragic circumstances.

Your letter rightly highlights the importance of continuity (not disputed) but then finishes with the statement:

‘Midwives are the backbone of maternity services. Supporting them is crucial to safer services; undermining their confidence is damaging to the National Health Service, parents and babies.’

I really don’t see how either of the points made by the Times column could be seen to ‘undermine’ midwives confidence.

The issue about language was embraced and adopted at Morecambe Bay 18 months ago and as I understand it, the service there is going from strength to strength.

The issue about safety is particularly around moving from guidance such as ‘wait and see’ and ‘trust your intuition’ to improving training (including obstetric emergencies), teaming work, multidisciplinary working and seeking a second opinion if there is any doubt.

Far from undermining the confidence of midwives, such approaches will build confidence, aid learning and improve safety.

The real risk of damage to the National Health Service, parents and babies, would be if progress wasn’t made to improve these issues.

As someone with a key leadership role, my view is
that you should be reinforcing the need for change and supporting this direction of travel. Just as charities like Sands, organisations like Morecambe Bay and the Secretary of State for Health have.

Accusing an article making important points that many people feel very strongly about of ‘undermining midwives’ and ‘damaging the NHS’, only fuels division and makes positive change and the job of saving lives, harder.

Best Wishes,


Leave a Reply

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s