NICE Admits "Extra £800 Cost" Doesn't Add Up

A great deal is being made of maternal request cesareans (principle of choice aside) being a waste of tax-payers money and an unaffordable luxury in the current economic climate. 

But, and it's a BIG BUT, the reported estimated £800 extra cost is flawed.

Even NICE admits this in its 2011 Guideline Update (Draft), as indeed it did in its 2004 Guideline too (even though it was dismissed).

When both PLANNED modes of delivery (cesarean and vaginal) plus their subsequent intrapartum AND longer term health consequences are assessed, a "different cost-effectiveness result" could be produced, says NICE.

Maternal Anarchy or Human Evolution?

Quite by chance this evening, I came across this fascinating bioethics blog on the history of anesthesia, and it really struck a chord with me regarding birth choices.

Religion and ideology have historically hampered women's access to pain relief during labor (from chloroform through to modern-day epidurals), but I had no idea that such obstacles stood in the way of the very first surgical pain relief relief too.

According to the blog (based on a Boston Globe report on 7 June 2009), Prior to October 16, 1846 (the date of the first operations conducted under anesthesia) our view of the person seemed inseparable from the concept of pain: “the vast majority of religious and medical opinion held that pain was inseparable from sensation in general, and thus from life itself”. Thus, while the technology was available, the doctors and the patients were not ready for medicine: less painful medical care “required not simply new science, but a radical change in how we saw ourselves”.

Pivotal Moment in Obstetrical History - the NICE Caesarean Update

The 2011 NICE Guideline Update will ALLOW maternal request cesareans in NHS hospitals.

There are those who fear its coming, and there are those who welcome it, but in a few months' time (barring a complete U-turn), the blanket refusal of maternal request cesareans will no longer be considered acceptable maternity care.

"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." (quote from May 2011 Update Draft)

What's the Real Story Behind the Cesarean 'Ban' News?

I found last week's 'news' that a number of PCTs are banning maternal request cesareans very strange.

After all, the 2004 NICE Guideline already states that the request is not "on its own an indication" for surgery.

So why are PCTs suddenly re-iterating their long-established rule in such a public way?

I've joined The Mom Pledge Community

I came across this rather intriguing website recently, and decided to sign up. Its founder, Elizabeth Flora Ross, has written a book called 'Cease Fire', which she describes as a "call to end the war between women", and The Mom Pledge aims to eradicate cyber bullying among moms. Here's what she writes:

A Rare but True Risk of Planned Cesareans

War, Hurricanes and any other Disruptive Force.

I read two things this week that made me decide to write about this risk.

That is - if you want or need to have a cesarean birth, you really are reliant on the availability of your obstetrician, other supporting medical staff, and a hospital with a functioning OR.

Obviously, as a statistical risk, this is likely a very small one

My Interview with My Baby Radio is Now Live

You can listen to this 30 minute 'Planned Caesarean' interview with MyBabyRadio.com here. 

This was a great opportunity to talk through the many issues surrounding planned cesarean birth, and I really appreciated the professionalism of the team who invited me on.

Thank you! 

Interview on BBC Tees - Maternal Request Cesarean 'Ban'

I was interviewed by Ali Brownlee on his Breakfast Show (at 2hr 10min), with a second guest, Dr Michael Dixon, Chairman of NHS Alliance.

In all honesty, I was shocked by some of the answers Dr Dixon provided, and was very concerned that someone

Complaint to BBC's The One Show re: its Cesarean Coverage

Last night, I contacted BBC Complaints, and also the programme itself, to ask why 'news' of NHS Trusts banning maternal request cesareans was presented in such an unbalanced and one-sided way.

The guest being interviewed on Monday's show was Dr. Sarah Jarvis, someone who clearly had her own personal views about maternal request, and whose views went completely unchallenged during the live chat.

The programme will only be available on BBC iPlayer (20 mins in) for a few more days, so I have typed up the transcript of what was said below:

The Labor Ward 'Care' I Chose to Avoid

I may have chosen to avoid the unpredictability of Mother Nature and a trial of labor when I planned my cesarean births, but I know that many women are choosing to avoid the unpredictability of care in NHS labor wards too.

These poor families lost their babies, quite unnecessarily, and all because the care they received was utterly atrocious.

(Much Needed) Call for More Maternity Doctors

On August 10, the BBC reported on a Call for more maternity doctors in order to prevent mothers dying due to "substandard care".

Six obstetricians have written an editorial in the British Medical Journal, pointing out that "most maternal deaths are now caused by treatable medical conditions."

NHS Controversial Cesarean Cost Clampdown

Yesterday, I commented on this, one of many reports following up on The Sunday Times story this week: NHS in clampdown on Too-Posh-To-Push mums.

I wrote: Firstly, there is actually evidence that a planned cesarean is no more costly than a planned vaginal birth - when comparisons include costs beyond the immediate intrapartum period (e.g. treating infant and maternal birth injuries, but also litigation).

In terms of choice however,

Read this GP's experience of "Brutal" NHS maternity wards

This is a fascinating comment by GP Partner Katharine Morrison, which I saw posted on the Pulse report, PCTs impose restrictions on caesarean sections.

Perhaps this will help some readers understand just one of the meanings of PROPHYLACTIC in the context of planned cesareans.

Morrison writes: I chose to have two caesarian sections after witnessing the brutality of "normal vaginal deliveries" that are the culture of the NHS.

Interview on BBC WM - Maternal Request Cesarean 'Ban'

This morning I was an invited guest on BBC WM's Phil Upton's Breakfast Show.

News of NHS Trust 'bans'* on maternal request cesareans has been receiving a great deal of media attention, and it was my job to explain why I think the NHS should be supportive of this legitimate and prophylactic birth choice.

It was certainly a heated debate, and for the next week at least, you can listen to it here on BBCiplayer (scroll through to about 1hr 50min duration).

BBC London's Vanessa Feltz phone interview with me on RCOG

On the morning of RCOG's publication of its maternity "proposal for change", I was listening to Vanessa Feltz on BBC London and decided to call the producers with my comments.

They took my number and then a few minutes later, called me back and put me live on air with Vanessa - fantastic.

To hear our discussion on Thursday 14th July, just click here.

Private hospitals in Iraq say women are requesting c-sections

If you only read the headlines last week, on the Rise in Iraqi C-sections, with rates reaching 79% in private hospitals, you may not have seen this:

"Officials at private hospital say it is not greed that's driving the C-section boom but the patients themselves."

The Associated Press report continues: "Dr. Aseel Ahmed Salman

Not just Too Posh to Push says Australian doctor

This article about an upcoming study being carried out in Australia is well worth a read, and this is the comment I've written:

I'm curious. Is the author of this (most welcome) article about the need for greater clarity, in the comparison of risks and benefits of planned maternal request cesareans versus planned vaginal births, the same Stephen Robson that co-authored this in 2003?

Should obstetricians support a 'term cephalic trial'?
Aust N Z J Obstet Gynaecol. 2003 Oct;43(5):341-3.
I am co-author of an upcoming book on the very subject of "Choosing a Cesarean", and while Dr. Magnus Murphy and I believe that there is already sufficient evidence to support the legitimacy of prophylactic surgery, we agree that further studies, which SPECIFICALLY compare maternal request surgery with other birth plans and outcomes, without bias, can only help to inform the ongoing debate and controversy that surrounds this birth choice.

New study on how to reduce post-cesarean infection

U.S. researchers claim to have found a way to reduce the likelihood of women having complications such as endometritis and wound infections after cesarean surgery.

A reported study from the University of Pennsylvania used a "preoperative skin prep protocol that combines a 3-minute povidone iodine scrub with povidone iodine paint", and it was discovered that this application is better for preventing wound infections than povidone iodine paint alone.

Review ordered into baby death at Victoria hospital

Could a cesarean delivery delay - because an anesthetist was not readily available - have led to a baby's death this month?

This is what the Vancouver Island Coastal Health Authority will investigate in a review of the events that took place in a public hospital in Canada on August 9.

According to a doctor quoted in the Globe and Mail this week, “B.C. is the only province in the country that doesn’t have, in high-risk units, a dedicated anesthesiologist just working in obstetrics and nowhere else... “Everywhere else in the country, there is one available at a moment’s notice. “And things happen fast in obstetrics...”

I personally know of women for whom a planned cesarean birth was delayed