Leigh East interviewed by Sunday Times – Some PCTs ban planned caesareans

The Sunday Times reveal that a number of PCTs are now formally banning all planned caesareans that have no medical justication. (Linking to Daily Mail copy of the article because the Sunday Times is behind a subscription page).

As an advocate for informed choice I am disappointed PCTs are taking this huge step backwards in women’s birth rights all in the name of cost cutting. What is being forgotten is that the number of women falling into this category is not only incredibly small but that only a fraction of them, should they be made to have a vaginal birth instead, would achieve the totally natural birth. (e.g. no intervention of any sort and no over night stay) necessary to achieve the levels of cost savings being talked about. We know that over 50% of UK vaginal births currently involve intervention. The emotional trauma suffered by women forced to labour when they so clearly wanted a caesarean is akin to that experienced by many women wanting a vaginal birth but ending up with an emergency caesarean.

Attempting to save costs by banning all those planned caesareans where there are no recognised medical grounds totally fails to address the many, many reasons why women make these requests. It is certainly not all about ‘lifestyle’ for many of them and this ban removes the ability for women to make informed choices based on sound risk assessment.

‘Natural’ Caesareans

This wonderful video gives a thorough and sensitive description of a ‘natural’ caesarean. It is exactly the sort of thing that should be shown in all antenatal classes. Women should be told more about caesarean births not less. There seems to be a fear that by telling women more, more will choose a caesarean. I sincerely doubt that, but even were that the case, is this any reason to leave the majority of women in the dark given that 1 in 4 will experience one.

NICE update their caesarean guideline

NICE are updating their guidance on caesarean sections. The draft document has been reviewed by stakeholders (of which I am one) and a new version is due out in Septemer 2011.

At first glance the draft is a marked improvement on the previous version, particularly now that it includes assessment of maternal request caesareans, this following active lobbying by members of the CCA – of which I am a founding member. However there are still many gaps.

Of particular interest to me is how practitioners handle caesarean requests from women whose request does not fit in with any formally recognised medical reason. With regards tokophobia (fear of childbirth) improvements have been made – counselling is to continue to be available and now, where a woman continues to request a caesarean after this, her request should be granted. However, significant hurdles face those women who wish to discuss the possibility of a caesarean where the medical reasons are not clearcut or tokophobia cannot be proven. This is despite clear evidence that many requests originate from previous trauma and pregnancy complications.

The decision to request a caesarean is rarely taken lightly yet NICE currently continue to recommend that women undertake counselling. While balanced, comprehensive information and support during the decision-making process is of course crucial the guideline, as it currently stands in draft, implies that the role of this counselling is to change the minds of these women. It does not recognise that for some the most appropriate option is still a caesarean. These women will not be able to gain agreement for a caesarean till they near the end of their pregnancy, if at all. Resulting fear and distress may significantly impair their pregnancy experience, affect their emotional wellbeing and critically, in a small number of cases, may cause them to abort their baby.

The UK health service needs to be clearer in its recognition that women have the right to make informed decisions about the way they give birth. They need to be more prescriptive about the information that is provided to ensure that it is truly balanced, discussing the risks of both caesarean birth and vaginal birth. Failure to do so leaves many women poorly prepared for their birth creating extra unnecessary trauma for those unprepared for a caesarean outcome (after all, 1 in 4 will experience a caesarean – many in emergency situations) .

The NICE draft is a step in the right direction but there are still some major issues with it.

Funny figures from WHO on caesareans

An excellent example of how to really assess a scientific paper.

The World Health Organisation suggested that women ‘too posh to push’ were 3 times more at risk of death or other complications than those experiencing a vaginal birth. Nigel Hawkes of Straight Statistics looks at the details and finds “WHO believes too many caesareans are done without proper cause. But in interpreting these data, the authors appear to have bent over backwards to prove the point – a classic illustration of White Hat bias. The findings should be ignored.”