Finally a UK hospital has had the sense to challenge targets handed down by others (in this case their Clinical Commissioning Group). The Royal Berkshire Hospital has been told that their current caesarean rate (27.1%) is too high and they must get it down to 23%. When asked whether it was cost driving this target the interim Medical Director Brian Reid said “That would be the driver.”
Unfortunately this target led approach to hospital care of pregnant women is typcial rather than unusual. Targets are a major factor driving policy and practise in many places. Where targets are based on cost cutting this can only mean that the health and safety of pregnant women and their unborn child cannot take top priority.
The NICE guidelines on Caesarean Section have clearly stated that:
- women wanting to request a caesarean where there is no medical need should engage in a detailed discussion with their practitioners. All the risks and benefits of both vaginal and caesarean birth should be fully discuss but if, after this, the woman still prefers a caesarean this should be granted
- women wanting to request a caesarean on the grounds of fear should be offered perinatal mental health support and if, following this, they continue to want a caesarean, this should be granted
So if more women are making an informed decision in favour of a caesarean birth (and it is not clear that this group of women can be ‘blamed’ for the continuing rise in the caesarean rate) then the targets need to reflect this need.
The target recommended by the World Health Organisation in 1985 is frequently quoted by policy makers and yet WHO retracted their target 4 years ago when the studies on which they had based it were found to be flawed. They have now stated: …there is “no empirical evidence for an optimum percentage”, an “optimum rate is unknown,” and world regions may now “set their own standards”. ‘Monitoring Emergency Obstetric Care: a handbook’
Despite this, official bodies continue to use such figures to beat their hospitals into submission by giving them unachievable targets, legitimising their requirements by quoting the old, unsubstantiated advice of WHO, when in reality the targets being handed down are based on cost cutting – putting the lives of mothers and babies at risk.
So if you are hoping to plan a caesarean, read the NICE guideline and arm yourself with the facts and references prior to discussing your ideas. Whether you are hoping to avoid a caesarean and need evidence as to why it is not necessary or you want to plan one and there is no clear medical reason for ir, you are likely to face a battle in order to make your choice about your body and your baby.