Dangers of Hospital Birth

Why Birthing in a Hospital Causes More Problems
Than It Solves for Normal Birth

by Ronnie Falcão, LM MS

There’s a saying that birth is as safe as life gets.  Sometimes birth can become dangerous for the baby or, very rarely, for the mother.  This is when hospital-based maternity care really shines, and we’re able to save mothers and babies who might have died a hundred years ago.  Thank goodness that there are skilled surgeons who can come to the rescue when truly necessary.

There’s also a saying that when you’ve got a hammer in your hand, everything looks like a nail.  So it is that for hospital-based birth attendants, it is easy to become accustomed to treating every birth as a disaster waiting to happen. Many obstetricians have lost touch with the possibility of normal birth, so much so that even a pitocin induction with an epidural, fetal scalp electrode and vacuum extraction is called a “natural birth”.  Some hospital staff seem offended by the idea of minimizing interventions, as if preferring not to have a needle the size of a house nail inserted near your spine is the same as declining to have a second piece of Aunt Sally’s Fruit Cake.  Sadly, some of today’s younger doctors may never even have seen a truly physiological labor and birth—a birth completely without medical intervention.

This is how the saving grace of the hospital can become the scourging disgrace of maternity care.  In their rush to prevent problems that aren’t happening, hospital personnel may aggressively push procedures and drugs that can actually cause problems.  Pitocin can cause uterine contractions that are so strong that they stress the baby and cause fetal distress. [1] IV narcotic drugs affect the baby so strongly that the baby may not breathe at birth [2] ; there is even a specific drug that is used to counteract the narcotics to help these drugged babies to breathe . [3] There is considerable debate as to how epidurals affect the progress of labor, but they certainly affect a woman’s ability to get into a squat, which opens the pelvic plane by 20-30%; anyone can understand that this could affect the possibility of the baby’s fitting through the pelvis.  Epidurals can lower the mother’s blood pressure so that the baby isn’t getting enough oxygen through the placenta; this can cause fetal distress and the need for an emergency c-section to rescue the baby . [4]

In addition to the specific dangers of individual obstetric interventions, hospital births suffer the effects of any form of institutionalized care.  Perhaps the best-known risk of hospital birth is hospital-acquired infections.  Those most susceptible to hospital-acquired infections are those with compromised immune systems, such as newborns.  In particular, babies are born with sterile skin and gut that are supposed to be colonized by direct contact with the mother’s skin flora.  If antibiotic-resistant hospital germs colonize the baby’s skin and gut instead, the baby is at high risk of becoming very sick from infections that are very difficult to treat.  The overall infection rate for babies born in the hospital is four times that of babies born at home [5], and these infections are more likely to be antibiotic-resistant.

More people die every year from hospital-acquired infections (90,000) [6] than from all accidental deaths (70,000), including motor vehicle crashes, fires, burns, falls, drownings, and poisonings. An additional 98,000 people die each year from general medical error . [7]
Another obvious risk of institutionalized care arises from the piecemeal nature of the care.  Because there are so many different kinds of personnel performing so many different procedures, there is a lot of potential for miscommunication about critical matters.  In an astoundingly progressive admission of institutional shortcomings, Beth Israel Hospital published a paper [8] about a tragic miscommunication that resulted in a baby’s death.  To their great credit, instead of covering up this horrible mistake, they used it as a wake-up call to revise their protocols, in an attempt to reduce miscommunication and increase safety.  Unfortunately, other hospitals are slow to adopt the reforms of Beth Israel Hospital.

One of the most dangerous aspects of hospital care is that those providing most of the direct care (i.e. the nurses) are hierarchically subservient to those managing the care from a distance (i.e. the doctors). This kind of a power structure can prevent knowledgeable nurses from mitigating the potentially dangerous actions of the doctors.

Many people feel that the hospital must be the safest place to birth because of all the equipment they have. Well, the equipment is only as good as the people using it. In many hospitals, there are not enough Registered Nurses to cover all the patients, so they use Medical Technicians, who are trained to perform procedures but not necessarily trained to interpret fetal heart tracings. Most labors start at night, and women birthing second or subsequent babies often birth during the night.  This is the time when the senior staff are home sleeping in their beds, because their seniority allows them to opt for the more desirable daytime shifts.  A recent study confirmed that outcomes at births are worse during the night, because even the most sophisticated equipment is useless in the wrong hands . [9]

(For the record, many homebirth midwives now carry equipment that is as sophisticated as that in most hospital birth rooms.  This includes continuous electronic fetal monitors and equipment for performing neonatal resuscitation if necessary.)

Institutionalized care also suffers from the economic pressures of running an efficient organization, regardless of how this might interfere with the normal process of labor and birth.

Sometimes doctors recommend pitocin without true medical necessity, simply to hasten the birth.  This may be due to a need to free up a birth room to make room for other patients, or because the doctor has other responsibilities elsewhere.  Stimulating labor artificially overrides the baby’s ability to space out the contractions if the labor is too stressful.  This increases the risk of fetal distress.

Hospital staff have a strong bias towards confining the laboring woman to the bed and requiring her to push in a reclining position.  This often puts the baby’s weight on the placenta or umbilical cord, possibly restricting the baby’s supply of oxygenated blood from the placenta. In contrast, upright positions put the baby’s weight downward, towards the open cervix and away from the placenta and umbilical cord, reducing or eliminating fetal distress caused by cord compression.

A rush to clamp and cut the umbilical cord within seconds after birth is one of the most dangerous hospital practices. This premature severance of the umbilical cord cuts the flow of oxygenated blood to the baby before the baby has established the lungs as the source of oxygen.  Premature cord clamping also deprives the baby of the blood that would naturally fill the pulmonary vasculature as it expands in the minutes immediately after the birth.  This practice is documented to increase the risks of neonatal hypoxia, hypovolemia, and anemia, thus increasing the need for blood transfusions. [10]

There is some very new research showing that placental tissue itself may be a rich source of pluripotent stem cells, in addition to the blood stem cells in blood drawn from the umbilical cord. [11] We do not yet know whether premature cutting of the umbilical cord halts the migration of pluripotent stem cells from the placental tissue into the baby’s body to repair damage from even minor birth trauma.

Perhaps the most egregious and unnecessary interference with the normal birth sequence is the separation of mother and baby immediately after birth.  Even a ten-minute separation is too long during this critical first hour after birth – it prevents the natural nipple stimulation that increases the mother’s oxytocin to contract the uterus and prevent a postpartum hemorrhage.[12] Instead of baby-provided nipple stimulation, hospitals are now routinely using synthetic oxytocin by IV or injection after the birth to control bleeding.

Similarly, early cuddling of mother and baby stimulates oxytocin production in the newborn, thus raising the baby’s body temperature to help with the adaptation to the extrauterine environment. The mother’s body is the best warmer for the newborn. [13]

Because different personnel are involved in providing piecemeal care for mothers and babies, providers do not always see how their actions in one area may cause problems in another area. For example, because obstetricians are not involved in breastfeeding issues, they may not realize that cutting an episiotomy hampers a woman’s ability to sit comfortably in order to nurse her baby. Likewise, the pediatricians also are not involved in breastfeeding, so they may not realize that separating the mother and baby right after the birth in order to do a routine newborn exam also interferes with breastfeeding.  Nursery nurses often do not seem to appreciate the importance of minimizing the separation of mother and baby and thus also unwittingly interfere with breastfeeding.  They tend to ignore the World Health Organization’s recommendations to delay initial bathing of the baby until at least six hours after the birth, even though bathing causes the baby’s temperature to drop so dangerously low that they do not return the baby to the mother for an hour or more.  [14] [15]

I emphasize the hazards to the breastfeeding relationship because breastfeeding is so vital to a newborn’s well-being, reducing infant mortality by 20%. [16] This is a huge health benefit, and hospitals should be taking the lead in tailoring their routines to support breastfeeding.  But because the functions of caring for mother and baby are separated into the roles of maternity nurses (who care for the mothers) and nursery nurses (who care for the babies), sometimes the mother and baby are also physically separated.  Most of the time, there are no lactation consultants in the hospital – they are often only available during weekday business hours.  But babies need to be fed around the clock, and if a Lactation Consultant isn’t available to help a struggling mother/baby pair, it might become necessary to feed the baby artificial breastmilk with a bottle, which further interferes with successful breastfeeding.

Because the entire model of hospital birth is based on the birth as a medical procedure, hospital staff seem to miss the fact that they are interfering in a delicate time in a new baby’s life.  Perinatal psychologists describe the first hour after birth as the “critical period”, during which the baby will learn how to learn and whether or not it is safe to relax and to trust the outer world.  This has tremendous implications for mental health and stress-related disorders. [17]

There was a time when cesareans were acknowledged to be a risky surgery reserved to save the life of the mother or baby. Now even cesarean surgery has become almost routine.  Some obstetricians and hospital administrators are advocating for a 100% cesarean rate as a solution to liability and scheduling problems that are inherent in providing maternity care. [18] Unfortunately, cesarean surgeries increase risks for the mother and for this baby.  They also increase the risk for subsequent pregnancies, with higher rates of placenta previa and placenta accreta, and small but non-zero risk that a pre-labor uterine rupture could result in the baby’s or even the mother’s death.

When someone needs to be in the hospital and needs to be receiving medical treatment for a life-threatening condition, the risk-benefit tradeoff comes in heavily on the side of benefit.

But for women who are hoping to have a drug-free birth, it makes no sense to expose themselves to the infection risks associated with simply being in the hospital.  Most people know that it is unwise to take a newborn baby out and about in public because of the risk of exposing the baby even to ordinary germs.  It is even a worse idea to expose the baby to the antibiotic-resistant strains of germs commonly found in hospitals.

When a woman planning a homebirth needs medical care and care is transferred to a hospital-based provider, the phrase “failed homebirth” is often written in her chart, even if she goes on to have an outcome that is better than if she had started out in the hospital.  I would like to propose the concept of a “failed hospital birth” as any birth where hospital procedures specifically cause more problems than they solve.  When you consider hospital infection rates, surgical complications, and the damage to the breastfeeding relationship caused by routine separation of mother and baby, we might find that close to 95% of planned hospital births are failed hospital births.  They failed to support the mother in an empowering birth experience to better prepare her for motherhood, and they failed to satisfy the baby’s overwhelming need and desire to enter and adapt to the outside world as nature intended.

Our society has an obligation to improve maternity care services as much as possible.  Consider that the countries with the safest maternity care rely on midwives as the guardians of normal birth, reserving risky medical procedures for cases of true need. “In The five European countries with the lowest infant mortality rates, midwives preside at more than 70 percent of all births. More than half of all Dutch babies are born at home with midwives in attendance, and Holland’s maternal and infant mortality rates are far lower than in the United States…” [19] The United States needs to return to a model of midwives as the default maternity care providers, reserving the surgical specialists for the highest-risk patients.  We need to educate pregnant women so that they understand that the choices they make about drugs during labor affect their baby, just like the choices they make about drugs during pregnancy.  We need to offer women realistic pain relief alternatives to dangerous pharmaceuticals; warm water immersion during labor provides risk-free pain relief that many women find as satisfactory as an epidural.  (Mothers who are uncomfortable with the idea of waterbirth can easily leave the tub to give birth “on land”, while still deriving tremendous comfort and safety benefits of laboring in water.)  Hospitals need to develop new routines that protect mother-baby bonding and the breastfeeding relationship as if they are a matter of life and death, because they are.

Obstetricians would do well to practice according to the wisdom contained in the phrase, “If it ain’t broke, don’t fix it.”  This means supporting healthy women with normal pregnancies in birthing at home if they choose and encouraging women planning hospital births to work with them to minimize interventions that turn normal births into risky medical procedures.

[For references, see gentlebirth.org/original or e-mail midwife@gentlebirth.org]

Ronnie Falcao, LM MS, is a homebirth midwife in Mountain View, California.  650-961-9728

1)  Oxytocin for labor induction.
Stubbs TM.
Clin Obstet Gynecol. 2000 Sep;43(3):489-94.

2)  Neonatal Resuscitation Textbook from the American Heart Association and the American Academy of Pediatrics, p. 7-3, “Narcotics given to the mother to relieve pain associated with labor commonly inhibit respiratory drive and activity in the newborn.”

3)  Neonatal Resuscitation Textbook from the American Heart Association and the American Academy of Pediatrics, p. 7-3, “In such cases, administration of naloxone (a narcotic antagonist) to the newborn will reverse the effect of narcotics on the baby.”

4)  A comparison of the hemodynamic effects of paracervical block and epidural anesthesia for labor analgesia.
Manninen T, Aantaa R, Salonen M, Pirhonen J, Palo P.
Acta Anaesthesiol Scand. 2000 Apr;44(4):441-5.

5) Outcome of elective home births: A series of 1146 cases.
Mehl–Madrona, L. E., Peterson, G., et al.
J. Reproductive Med., 1977 (5), 281–290.

6)  http://www.cdc.gov/ncidod/dhqp/healthDis.html

7)  http://www.cdc.gov/washington/overview/patntsaf.htm

8)  A 38-year-old woman with fetal loss and hysterectomy.
Sachs BP.
JAMA. 2005 Aug 17;294(7):833-40. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=AbstractPlus&list_uids=16106009&query_hl=112&itool=pubmed_docsum
Articles at:

9)  Time of birth and the risk of neonatal death.
Gould JB, Qin C, Chavez G.
Obstet Gynecol. 2005 Aug;106(2):352-8.

10)  Neonatal transitional physiology: a new paradigm.
Mercer JS, Skovgaard RL.
J Perinat Neonatal Nurs 2002 Mar;15(4):56-7

11)  Stem Cell Characteristics of Amniotic Epithelial Cells.
Miki T, Lehmann T, Cai H, Stolz DB, Strom SC.
Stem Cells. 2005 Aug 9


13)  Randomised study of skin-to-skin versus incubator care for rewarming low-risk hypothermic neonates.
Christensson K, Bhat GJ, Amadi BC, Eriksson B, Hojer B.
Lancet. 1998 Oct 3;352(9134):1115.


15)  The effect of bather and location of first bath on maintaining thermal stability in newborns.
Medves JM, O’Brien B.
J Obstet Gynecol Neonatal Nurs. 2004 Mar-Apr;33(2):175-82.

16)  Breastfeeding and the risk of postneonatal death in the United States.
Chen A, Rogan WJ.
Pediatrics. 2004 May;113(5):e435-9.

There’s a newish book, “Impact of Birthing Practices on Breastfeeding” by Mary Kroeger

17)  This statement is a summary of a number of different books, papers, etc.  The two key books for someone interested in this topic are:
“The Magical Child” by Joseph Chilton Pierce
“The Scientification of Love” by Michel Odent, MD
There’s a group of psychiatrists dedicated to the topic:
Association for Pre- & Perinatal Psychology and Health
Summary of key points:
This last article contains numerous additional research references.

18)  Who is responsible for the rising caesarean section rate?
Usha Kiran TS, Jayawickrama NS.
J Obstet Gynaecol. 2002 Jul;22(4):363-5.


Phelan, J. P. (1996, Nov.). Rendering unto Caesar cesarean decisions. OBG Management.

Cesareans: Are they really a safe option? by Henci Goer

Bruce Flamm: “I have heard some doctors say that all women should have babies by C-section, that vaginal births are archaic. ” from Are Women Having Too Many C-sections?

19)  Midwives Still Hassled by Medical Establishment,” Caroline Hall Otis, Utne Reader, Nov./Dec. 1990, pp. 32-34

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Welcome to Freefall

There is something quite irrational about going 3 miles up in an aeroplane and opening the doors, and something quite insane about jumping out and hurtling towards the ground at 125mph…

At least I thought so, but then on Saturday I tried it.  

After half an hour of training, which is easily summarised as DO AS YOUR INSTRUCTOR TELLS YOU, we settled down to wait for the weather. Unfortunately Saturday 16th May turned out to be cold, windy, low cloud and scattered driving downpours.  Not ideal weather for flying, and not safe for skydiving!  Our very loyal support team stuck it out, and finally at about 6pm our scheduled lift was ready to go.  We met with our instructors and camera men.  Patrick was reassuringly due to be strapped to the very safe and sensible sounding Nick.  Clearly they thought I was already slightly bonkers and paired me with the somewhat less reassuring sounding Baldrick, who proceeded to say that he wouldn’t be strapping himself, and therefore not his parachute either, to anyone wearing a lilac jumpsuit, and would I please put on a blue one!  It seemed sensible to follow the training plan, and I duly did as instructed.  The guys were amazing, they kept us laughing and are clearly having a whale of a time!

I was so excited that I forgot to be nervous.

The plane took us to a little over 12000ft and then they opened the perspex roller door.  First out were a formation team of four and their cameraman, They took a little while to assemble themselves in the doorway and then they jumped in formation.  How cool is that!  Next out was Patrick and Nick.  Watching them jump was fab, and then it was our turn…

Kneeling in the doorway of the plane time stood still, I know it was only a matter of seconds, but just hanging there on the edge, far above the world was a feeling I will never forget.  Then we jumped.My first jump

There was little sense of the approaching earth and very little sense of just how high we were. The only reference for the speed we were travelling was the wind in our faces.  There is nothing to which I can compare the feeling of absolute freedom.  The wind in your face and the shear joy of freefall is truly amazing.  Your senses are heightened and you can hear nothing but the roaring wind.  It is awesome.  For a short while I simply shut my eyes and fell, it was wicked.  I was highly amused when I got the photos back to see that my instructor was doing exactly the same thing!

I wanted to see, to feel everything.  For about a minute I was at one with the air.  The signal was given and our cameraman fell away, Baldrick opened the parachute and we stopped falling rather abruptly and started a much more gentle descent under canopy.  My goodness, these guys do this as a job!

Baldrick then gave me the controls and I got to fly the parachute, all by myself.  After a couple of minutes Baldrick took back the handles to steer us away from an oncoming downpour and we started to head for the ground rather rapidly, and came to land in a field.  I joined the earth with the immediate request to do it again, and I haven’t stopped thinking about it since.

I can’t thank the guys at Target enough for an amazing time, the atmosphere at the Drop Zone is electric and I can’t wait to join them and do it all again.

Thank you to all those generous people who sponsored us, what an amazing way to raise a lot of money.  Marie Curie will benefit to the tune of almost £1000 and I had the time of my life.


Target Skysports

Target Skysports

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I believe I can fly …

actually I can because I did it.  I touched the clouds and I’m struggling to find the words to describe the feeling, so I’ll leave you for now in the capable hands of R Kelly…

If I can see it, then I can do it
If I just believe it, there’s nothing to it
I believe I can fly
I believe I can touch the sky
I think about it every night and day
Spread my wings and fly away
I believe I can soar
I see me running through that open door
I believe I can fly
I believe I can fly
I believe I can fly

Pictures to follow just as soon as they arrive.

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Free Falling

Oh my goodness!!! 

Charity Skydive

I will be donning a flying suit and and a helmet and going up in a perfectly serviceable aircraft with the sole intention of throwing myself out of it!

You will probably hear the scream from the Cathedral…

So, listen up!  On Saturday May 16th a bunch of slightly crazy friends will be doing a tandem jump from 10,000 feet.  I am assured that I will be strapped to an experienced parachute instructor, not Patrick or Stuart, so here’s hoping he (or she) lives up to my expectations!

We feel that cause is a great one, we are raising money for Marie Curie Cancer Care.  There’s not long left so I have to make a concerted effort to reach target (£1000+.)

If you want to see us jump please email, or leave a comment, and I’ll get back to you with some finer details.  There is already a huge ‘support’ crowd coming to watch, and it seems like the more the merrier.  We are certainly expecting a big cheer if we reach the finish-line :-)

Many, many thanks to those who have already sponsored us, particularly Granny Margaret and Clare for getting things started so generously.

If you haven’t yet sponsored us then please do so by clicking on this link – markham.ph/sponsor-me

We worked out that if every one of our friends on email or Facebook sponsors us £1 we will make our target.  If you are able to sponsor us more then you can feel great about that, and it will make up for those who didn’t get the mail in time, although you can still donate after we land if you wish, so don’t feel you’ve missed your chance.

That link again: markham.ph/sponsor-me

Thanks! :-)

Marie Curie Cancer Care

london-parachute-schoolSponsor us and raise some much needed cash for Marie Curie




UPDATE (Wednesday 13th)  Sponsorship is now in excess of  £750, which is great news, but we are still some way short of the round grand we want to raise. 

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Ivor the Engine

“…Not very long ago, in the top left-hand corner of Wales, there was a railway. It wasn’t a very long railway or a very important railway, but it was called The Merioneth and Llantisilly Rail Traction Company Limited, and it was all there was.
And in a shed, in a siding at the end of the railway, lives the Locomotive of the Merioneth and Llantisilly Rail Traction Company Limited, which was a long name for a little engine so his friends just called him Ivor…”

Here he is look, Ivor the Engine

Here he is look, Ivor the Engine

And so it was that we went to the real Llaniog, home of the engine of the Merioneth and Llantisilly Rail Traction Company Limited, where the real railway has an equally long and descriptive name. I’m sure that the late, great Oliver Postgate would be happy to see that things have not changed much since the 70s.

It made my day today to find that the gift shop at Ffestiniog was filled with Ivor merchandise, and that it overshadowed the usually over-exposed Thomas and Friends.

I’m sure we heard the Grumbly and District Choir in the distance, which was only to be expected as we had already visited Mr Dinwiddie’s gold mine and learnt how to extract precious metal from the unassuming hillside.

The only problem I can see now is maintaining a suitable environment for the Proper Red Heraldic Dragon we have brought home. Oh, for those of you who are interested he is called Idris after his imortalised ancestor.

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Did BT really hit their own tunnel?

Well! How on earth either navigation or mapping were so bad that a tunnel 32 metres (yes, I did say metres) underground was hit by another tunnel is somewhat beyond my understanding of basic SatNav!
I am left completely without connection to the Internet, my blog, my life… Or at least I would have been if I hadn’t had the foresight to buy an Iphone.
So, again, Apple comes out tops and I can at least blog, use Facebook and the wonders that the internet brings to my wonderfully sexy gadget.
However, the wonders of my super-gadget are limited … I fogot to pack the darned charger!

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The Producers

The ProducersThere was not a clever or witty title I could think of to do this show justice.  I have not laughed so much in ages, and have not seen such a fantastic piece of theatre in a very long time.  By the time Andy Morris gave us his Carmen Ghia half-way through first act I was beginning to regret having taken the time to apply mascara as the tears rolled down my face and I was laughing so hard I could hardly breathe.  Chris Hayes and Christian Norton as Max Bialystock and Leo Bloom worked brilliantly, a combination of clever casting, talent, great direction and probably hours of observation.  Leo Bloom was so over the top, and yet so believable that it was hard to see the real Christian under the blue blanket!  Sally Bean as Ulla was also, for me, perfect.  Her accent never slipped and her legs never ended.  Portraying someone whose talents are clearly supposed belong on the casting couch rather than the stage is a huge challenge and I was very impressed with Sally’s performance.

The whole show was as camp as Butlins in August, complete with cameos for all the Village People, Alice in Wonderland, Minnie Mouse and a large pink elephant, who was strangely not out of place at all!

Clearly the cast was having fun, and it shows in the magic and sparkle and some truly inspired performances, including a chorus of caged homing pigeons … what do you mean they weren’t real?  Clever casting and strong production sets this show a long way in front.  I can’t imagine any other place where an entire chorus can be chorographed with Zimmer frames in a style strangely reminiscent of Chim Chimney, or a showgirl can wear a giant pretzel on her head and get away with it.

The only thing amateur about LAODS performance of Mel Brooks’s The Producers is their paycheck.  It is a real must see, and those who miss it will have almost certainly missed out.

… but, please, oil those squeaky trucks:-)

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I probably shan’t be blogging for a little while, I shall be learning how to use my new iphone.  After that I may blog with it.

Many thanks to the very persistent and very patient O2 store in Lincoln.

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Today I am wondering if the reason Vodafone were unavailable for the whole of yesterday was because they all went on Customer Service training….

I have just finished speaking to the most courteous, polite and helpful Vodafone employee that I have spoken to in this whole saga.  I now have my PAC code, given to me with a thank you for being a Vodafone customer for so long.  She made no attempt to criticise my choice of provider or handset, she made no attempt to prevent me from leaving, she provided a thorough explanation of the transfer process and wished me a smooth handover.  If I had got that service from the start, perhaps I would still be their customer, and she alone has made me feel a little sad that I am switching providers after 10 years.  I wish she had given her name, so I could say an individualised thanks.

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Any News?

Today, despite several failed calls, I have been unable to reach anyone at Vodafone who could help, or provide any useful input, and, not unsurprisingly, they have failed to call me back….

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