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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.

Birth Trauma Canada – book review

Birth Trama Canada have reviewed my book “…She also provides many compelling reasons to understand and prepare for a caesarean birth even for those planning a vaginal birth as an unplanned caesarean is a common end to many planned vaginal births.  She rightly believes that realistically preparing for a caesarean birth, even while planning a vaginal birth, allows women greater control of their birth experience should circumstances dictate the necessity of an unplanned caesarean. “

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.”

Book contributors – many thanks for your support

A wonderful network of specialists – midwives, obstetricians and anaesthetists, have participated in the development of my book. I am confident everything you read is accurate and based on up-to-date research.

My thanks to:

  • Dr Philip J Steer BSc, MD, RCOG Emeritus Professor, Imperial College London, Consultant Obstetrician, Chelsea and Westminster Hospital London
  • Fiona Knox MB ChB, FRCA, MD – Consultant Anaesthetist
  • Debbie Rhodes Registered Midwife RM (Hons)
    www.independentbirth.com
  • Dr Lena M. Crichton, Consultant Obstetrician Aberdeen Maternity Hospital
  • Dr Bryan Beattie MD FRCOG – Consultant in Fetal Medicine and Director of Innermost Secrets Ltd, Cardiff
  • Dr Fiona Schneider FRCOG, Consultant Obstetrician and Gynaecologist
  • Kim Hughes BSc (Hons) Registered Midwife RM www.yorkstorks.co.uk
  • Maureen Treadwell – Co-founder of the Birth Trauma Association
  • Penny Christensen – Executive Director Birth Trauma Canada
  • Chris Warren – Registered Midwife RM www.yorkstorks.co.uk
  • Christa Greenacre – NCT teacher (retired)
  • Professor James Drife FRCOG

‘Groundbreaking’ – book review

“This book is seriously good. It contains pretty much everything that a mother to be would need to know about caesarean birth and presents the wealth of carefully researched facts in a really practical way. It addresses the issues without any agenda other than to put women and their partners in the best position to make choices and have informed (and therefore empowered) discussions with the professionals. Every aspect is covered with total respect for the fact that every woman will have her own preferences, hopes and fears concerning the possibility of a Caesarean. There is not the slightest hint of any prejudice about what type of birth a woman ought to prefer. There is a chapter for partners too. It is written in a very lucid and straightforward style. If you are wondering which book to buy about Caesareans, get this one!” by Ms Knox Amazon reviewer talking about Caesarean Birth: A positive approach to preparation and recovery