For years hospitals have been asked to record data about caesarean births. The results of a Freedom of Information request revealed that the way in which this information was recorded varied significantly from one hospital to another.
- Inconsistency in criteria used for recording whether a caesarean delivery was emergency or planned
- Inconsistency in criteria for recording a delivery as a maternal request or performed as a result of an obstetricians recommendation
It is easy to see that in reality reports about current rates face an impossible task – the truth is hard to discern. Despite this many hospitals faithfully report their figures and face judgement for their caesarean rates – some praised for low rates, some criticised for rates that are considered ‘too high’.
In fact the WHO retracted their recommendation for an ideal caesarean rate back in 2009 because there was insufficient evidence to define one.
Despite this, UK hospitals have continued to be scrutinised and judged according to their rates. Loaded statements by official bodies and the press have pushed many hospitals into defining, formally or otherwise, ideal targets for themselves. Stories of women requesting caesareans and being refused are all too common and maternity litigation claims in the UK are now thought to run to billions every year. The personal cost to families of these arbitrary targets can be shown to result in: “loss of life, life altering injuries as well as obvious psychological distress.”
Now, finally as the Sunday Times reports “Inspectors have been ordered to stop judging maternity units on their caesarean rates after the care watchdog accepted that it had sent the wrong message on normal birth.”
Heidi Smoult, deputy chief inspector of hospitals – commenting on the report by P Hull which led to this directive – stated that “medical intervention, while important “should never be at the expense of a woman’s or baby’s health.””
The Sundays Times speaking to Alison Wright, of the Royal College of Obstetricians and Gynaecologists, recorded the view that: “The need for a medical intervention can vary dramatically across services and regions, depending on the local demographics and the health needs of women. Therefore, we believe the approach should be more nuanced than promoting a particular maternity indicator, such as a caesarean birth rate.”
A step in the right direction. However, if you are trying to investigate your own birthing options, whether that is to have or avoid a caesarean be aware that internal politics within your hospital may be an additional factor to consider. Despite this new recommendation, it is worth finding out whether your hospital still refers to target levels for caesarean births.