Thursday, September 29, 2011

Pay (Not) To Push, says Northern Ireland's health minister Edwin Poots

I am not going to criticize the Northern Ireland's health minister Edwin Poots here just yet - despite the fact that yesterday he said that cesarean births should be paid for by women who choose them (see BBC and Belfast Telegraph reports).
This is because I am not convinced that he has heard all sides of this debate, and as such, have contacted his office and am awaiting his response.

Northern Ireland has the highest rate of cesarean births in the UK, at 29.8%, and this is one of the reasons why
Mr. Poots is launching a consultation on a review of maternity services (ending December 23, 2011).

Low Risk and Natural

According to the BBC report, "Women at low risk will be encouraged to consider having their baby in a midwife-led unit or at home, if appropriate." 

And Mr. Poots insists, "This isn't about saving money per se, what we want to encourage, is more people to give birth naturally because it has better outcomes for the mother and the baby.


I have a number of concerns about Mr. Poots' ideas, and it will be very interesting to see how the gauntlet he appears to have set down will play out over the coming few months.

Especially given NICE's publication of its Caesarean section (update) guideline...

But also the fact that women are already asking (e.g. on BBC Radio Ulster's Talkback programme 'Maternity Shake-up' yesterday, with Wendy Austin) whether "non-medical" epiduarals will be next in the firing line for maternity cost savings...?

Choice is Choice is Choice

I just wonder, when will some MPs, maternity care professionals and birth commentators realize that if you're going to advocate genuine choice in childbirth, then they cannot be prescriptive about limiting women to a menu of choices that support their own ideology or experience.

Remember - most women choose a cesarean birth for prophylactic reasons.

That is - they choose to avoid the known risks associated with vaginal birth plans (for their babies and themselves), and are more tolerant of the risks associated with planned surgery.

I think it's dangerous, naive and irresponsible to keep referring to planned vaginal birth as categorically "safe" in the context of birth choices.

It isn't - and it never has been.


According to the Belfast Telegraph*:

"A spokeswoman from the Department of Health, Social Services and Public Safety stressed the possibility of being charged for an elective C-section is not in the current consultation document.

She said this is an option the minister may consider in future and any move to introduce a charge would be subject to normal consultation."

*I have posted two comments at the end of this article.


little88 said...

It is a shame that you have given this response to this changed in NI.. i feel that this is only a positive set forward and i hope that all of the uk follow.

I would like to know these risks with vaginal births you talk about?

cesarean are very costly due to the fact they use a lot of operative staff one of which is the most costly.. because of this the money cannot be spent to employ new midwifery staff or be used to put back into the service of the midwifery unit.

A caesarean section is MAJOR abdominal surgery. it should not be taken into lightly it is NOT the easy option and it is not always the SAFEST.. ask women there retrospective view on how they felt and now feel after a cesarean .. i promise you it will surprise you.. just ask them how it felt to pick up a full kettle!..

Do you research and come back with a more balanced argument rather than trying to please those who have little knowledge in this area!

Mrs. W. said...

Pushing for home and natural birth based on cost considerations alone is misogynistic. Home birth is not as safe as hospital birth - there is just no way that it can be as there is no way to convert to a caesarean as quickly if one is needed. The Skeptical OB has all sorts of data on this in the US. Further, deny women epidurals when patients undergoing other procedures are charged for their anesthesia use as apparently it's not really medically neccessary in Mr. Poots' eyes.