Dr. Sarah Jarvis speaking on the One Show on Monday 22nd August made two inaccurate statements regarding:
1. the latest status of the NICE guideline on Caesarean Section regarding planning a caesarean in the absence of any medical need
2. the WHO recommendation of a 15% caesarean target rate
Firstly, the NICE guideline has been under review for the last 18 months. The new draft of the guideline, which is publically available, clearly states in 1.3 ‘Maternal Request Algorithm’ “Where there is no identifiable reason, discuss the overall benefits and risks of CS and vaginal birth. Facilitate a discussion with other members of the obstetric team…If a vaginal birth is still not an acceptable option to the woman, her request for a CS should be supported within the health service” (pg. 7 NICE 2011).
In this latest version NICE have validated women’s right to make informed decisions about their own births following clear advice from practitioners. In otherwords NICE recognise that there are many ‘grey’ areas where women have the right to make informed decisions in favour of a prophylactic caesarean over vaginal birth even in the absence of a identifiable medical need. If practitioners are going to talk about this issue then they should at least be up-to-date with the current status of the guidelines they are quoting.
Secondly, the 15% caesarean target rate that has been repeatedly quoted by the media and government for the last 25 years was also quoted to by Dr Jarvis. The WHO target was in fact retracted 2 years ago. WHO removed it from their ‘Monitoring Emergency Obstetric Care: A handbook’ because they finally admitted that there is “no empirical evidence for an optimum percentage”, an “optimum rate is unknown,” and world regions may now “set their own standards.” Not only this but England has NEVER formally stated that they subscribe to the target rate. Once again if practitioners are going to make these statements about caesareans on national television they should do so accurately.
The One Show reaches a significant audience and advisors appearing on the programme have a duty to present information correctly. I believe this is particularly important in the arena of healthcare where lives can be severely impacted by the decisions people take, often as a result of the ideas they have heard in the media. It is great that the One Show has professionals willing to give advice and comment on important issues, but it is imperative that these professionals represent the information accurately and fairly.