In 2011 the UK National Institution for Clinical Excellence (NICE) recommended that women be allowed to make a request for a caesarean delivery, even in the absence of any recognised medical need. Despite this, a recent Freedom on Information request submitted by the Daily Mail found that:
- 21/91 hospitals do not offer maternal request caesareans
- In four hospitals where Maternal request was supported, bosses rejected requests on cost grounds
- Several hospitals insist on mental health counselling prior to giving agreement for a caesarean (this is unfortunately a recommendation in the 2011 NICE guideline – completely failing to recognise a whole group of women who have made an informed choice to request a caesarean)
- Only four hospitals offer Maternal Request caesareans even though their Clinical Commissioning Group do not fund it
Kim Thomas, of the Birth Trauma Association, says in response to the findings: “Women usually have very good reasons for requesting a planned caesarean. Often they’ve already had one traumatic birth and want a less frightening experience next time round. Denying these women their request is cruel, and goes against Nice guidelines.”
Similarly, campaigner Pauline Hull, said: “Women are increasingly choosing a caesarean birth because they’ve decided it’s safer for their baby and safer for them. The maternal landscape has changed. Women are older, heavier, and having fewer babies; babies are heavier.”
Incredibly, Trusts are still using cost as justification for these rejections and define policies to drive down their overall caesarean rate. Trust managers are failing to join the dots…
The costs associated with a straightforward, uncomplicated planned caesarean are actually less than many medicalised vaginal births. This is because unless a vaginal birth is totally straightforward and natural (i.e. not involving any form of medical intervention or pain relief and Mum and baby leave hospital the same day), the costs immediately begin to creep up. Over 50% of UK births involve some form of intervention (NHS Information Centre statistics). In the USA, 67% of births involve anaesthetic, 30% of women are induced and 13% have an episiotomy (Listening to Mothers – USA). You can see how the cost arguement immediately starts to fall apart.
As far back as 2003, studies revealed that just adding induction using pitocin “nullified any cost differences; if epidural anaesthesia was also used, total costs exceed the cost of elective caesarean delivery by almost 10%. The cost of a failed attempt at vaginal delivery was much higher than elective caesarean delivery.” Bost 2003
“A culture of choice has been promoted in recent years, but contrary to the anticipated demand for less obstetric intervention by those promoting choice, there has been an increase in demand for delivery by caesarean section. With the balance in favour of benefit for the baby from delivery by caesarean section, it is now difficult to sustain the argument favouring vaginal delivery…A critical evaluation of costs indicates that there are probably few grounds for denying women their request for caesarean section for economic reasons”. Morrison 2003
And this is before you start looking at the cost to Trusts of longer term issues arising from vaginal birth. Studies reveal the long-term risk of stress urinary incontinence and pelvic organ prolapse surgery is significantly higher for women giving birth vaginally and of course there are significant costs associated with each repair work.
Come on hosptial pencil pushers – JOIN THE DOTS!