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 are updating their guidance on caesarean sections. The draft document has been reviewed byÂ stakeholdersÂ (of which I am one) and aÂ 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 toÂ me isÂ 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 toÂ 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 ofÂ this counselling is to change the minds of these women. It does not recognise that for someÂ the most appropriate option is still a caesarean.Â These womenÂ will not be able to gain agreement forÂ a caesareanÂ till they near the end of their pregnancy, if at all.Â ResultingÂ fear andÂ distress may significantly impair their pregnancy experience, affect their emotional wellbeing and critically, inÂ a small number ofÂ cases, may causeÂ 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 soÂ leaves many women poorly prepared for their birth creating extra unnecessaryÂ 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 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. Â 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. “
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 â€“ a classic illustration of White Hat bias. The findings should be ignored.”
A wonderful network of specialists â€“ 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 â€“ Consultant Anaesthetist
- Debbie Rhodes Registered Midwife RM (Hons)
- Dr Lena M. Crichton, Consultant Obstetrician Aberdeen Maternity Hospital
- Dr Bryan Beattie MD FRCOG â€“ 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 â€“ Co-founder of the Birth Trauma Association
- Penny Christensen â€“ Executive Director Birth Trauma Canada
- Chris Warren â€“ Registered Midwife RM www.yorkstorks.co.uk
- Christa Greenacre â€“ NCT teacher (retired)
- Professor James Drife FRCOG