Would you wear one of these t-shirts?

I've just been shown these t-shirts being sold by Asda - one with the slogan 'Too Posh to Push' written above a picture of Miss Piggy and the other with the words 'Keep Calm and Push'.

And mmmm... I must admit that I'm in two minds about how I feel about them.

On the one hand,

Baby dies in NHS Trust with 'normal birth' targets

DO NOT INTERVENE

Another day, another story of a baby dying because a supposedly 'low risk' pregnancy became high risk without appropriate action being taken - but this was at an NHS Trust that has been praised for its success in increasing normal births.

Just when are hospital staff and politicians going to understand that a normal outcome is NOT more important than a healthy outcome??

When are we going to see a shift in policy that focusses on birth outcomes and NOT the birth process??

The BBC reports today of a Warwick Hospital apology over death of newborn baby who was starved of oxygen during labour in May 2012. It says,

The unpredictable, understaffed and unofficial birth risk

In discussions about different birth plan risks - comparing the likelihood of maternal and perinatal mortality and morbidity outcomes - you won't often hear the risk that is 'your maternity ward care'. And yet this is a risk I've talked about in the past - because when you plan a vaginal birth in the UK, you don't know what the staffing levels will be like in the maternity ward you enter, how many other women will be there with you, or what level of experience your carers (midwives or doctors) will have. It's an unpredictable risk that is all too often unrecognized.

 

I raise it again tonight because, published anonymously in the Daily Mail this weekend, a London midwife has written, 'The secret midwife: Psychotic mothers, exhausted doctors and nurses asleep on the job: A whistleblower reveals the desperate truth behind those rose-tinted TV shows'.

Instrumental deliveries ↑ but c-sections headline

This week saw the annual publication of England's maternity data by the Health and Social Care Information Centre, and as always, the cesarean rate made headlines - for example, Caesarean sections now account for a QUARTER of all births - and older mothers are the reason why.

But for anyone interested in maternity care outcomes beyond the 'controversial c-section', there were far more concerning rate increases to be found in the HSCIC's NHS Maternity Statistics, 2011-12.

Filmmaker asks, 'Can anyone argue with this?'

This evening, I came across the article, Freedom for Birth - Can Anyone Argue Against Respecting Women's Rights in Childbirth?, written by "filmmaker turned birth warrior" Toni Harman.

 

This was my response:

Is the obsession with doctor-free births risking lives?

This is the question posed in the Daily Mail this morning, as Carol Sarler asks, Is the NHS’s obsession with doctor-free births putting babies at risk?

Here is the response I've just posted beneath it:

"Considering the DM has published some of the most vociferous criticisms of planned caesareans in the past (including reference to the outdated 1985 WHO recommendation), incl. articles like those of Jenni Murray (Sep.2012 Get real, girls! Pain is part of childbirth, and Nov.2011 The madness of Caesareans on demand), it's about time that the balance is being redressed.

A normal birth and a baby's death

Yesterday I posted the comment below in the Daily Mail article, 'Mother-to-be lost baby after staff at midwife-led birthing centre failed to spot rare pregnancy condition', and you can scroll down further to read a comment posted by another reader, who also lost her baby during labor in a midwife-led birth unit.

Please note that I am not against birth units as a birth choice, but I do not agree that they be encouraged as standard maternity care and policy for all women deemed 'low risk' in the UK.

 

My comment:

Support for tokophobic women

Following yesterday's blog on tokophobia, I came across another article today, this time by the BBC, with some positive news for women.

Dr. Malcolm Dickson, a consultant obstetrician at Rochdale Infirmary, is quoted as agreeing that cesareans "are often the best option for women who are terrified of delivering their baby for months beforehand.

Tokophobia support - am I right to be concerned?

"More needs to be done to help women who have a morbid dread of childbirth...", says expert.

I am trying very, very hard not to be cynical about this call for midwives to recognize tokophobia as a legitimate issue affecting as many as 10% of women. Firstly, why has it taken so long and why have so many educated health professionals never even heard of it? But secondly - and more importantly, - why the concern NOW?

Is it ethical to promote normal birth?

Dr. Amy Tuteur's blog yesterday is a must read. She reflects on an article published in the journal Birth the bioethicist Professor Anne Drapkin Lyerly, who writes about social and moral issues in women’s health and reproductive medicine.

Dr, Tuteur says, "[Lyerly] has dared to question the ethics of “normal birth” within the pages of the premier journal of the normal birth industry."

RCM annual conference starts tomorrow...

The 'Midwives Calling' conference and exhibition in Brighton, which will last two days, bills itself as an event for "everyone with an interest in maternity services today". Well, that includes me, but while I'd hoped to watch some of the presentations online, the £49 price tag means that unfortunately, I will likely miss out.

In fact, during ongoing email correspondence with the RCM over the summer, I volunteered to speak at the conference in person - especially since the publication of updated NICE guidance on maternal request cesareans is not fully understood (and is not being properly implemented) by all midwives - but unfortunately, I haven't receive a response to my offer. Maybe next year...

Maternal request cesarean a "societal and professional failure"? I don't think so

Readers of this blog may recall an earlier post in which I reported the reason given by Lamaze International's journal Birth for declining to review our book, Choosing Cesarean: A Natural Birth Plan. Reading no further than the book's summary, our publisher was told, "The content of this book does not match the philosophy of our journal."

It may come as little surprise therefore to read this article by Professor Michael C. Klein, which was published in Birth last week:

The best and worst places to give birth

In the midst of her recent article on Parenting.com, The best and worst places to give birth, Lisa Selin Davis -  who's personal preference, influenced in part by her own mother's experiences, is natural birth - states that, "infant mortality rates from voluntary C-sections are higher than they are for vaginal births". To which I posted the following comment:

Sometimes birth satisfaction is spelt c-e-s-a-r-e-a-n

Just a very quick post this evening - if you get a chance to read this birth story, posted on mothering.com, please do.

It's about a woman who had an extremely 'normal' birth with very few complications, and medical staff all around her satisfied with how it went.

Yet she was left feeling "violated, betrayed and abandoned" and describes it as "the worst experience of my life".

Why? Because she wanted (and had scheduled) a cesarean but her choice was not respected.

'Stillborn' baby actually died after being born alive

I have just added a comment to this horrendous story of the suffering and pain parents Emma and Terry Charlton have had to endure.

According to reporter Nazia Parveen, "Ava Mae Charlton was born by emergency caesarean section but she struggled to breathe and died after only 32 minutes. Hospital officials tried to claim the baby was stillborn and so her death did not need to be investigated."

My comment:

Health Secretary promise: I'll be guided by science.

Just a week before the story, Jeremy Hunt: I'll be guided by science, appeared on BBC News online, I met with the Health Secretary in his South West Surrey constituency to talk about maternity care issues in this region, and also nationally.

Albeit a very brief meeting, I have been corresponding with Mr. Hunt MP in writing since June 2011, and

Peeing yourself as a mom - a rite of passage?

In her article, A Vaginal Birth Means Your Baby Isn't the Only One Who'll Need Diapers, author Mary Fischer does something a little different when reporting on recent birth research (showing less pelvic floor muscle strength in women who've had a vaginal birth compared with a cesarean)...

For example, she doesn't deny it's true, and she doesn't tell personal stories of sneezing then peeing herself in the context of eliciting sympathy from or extending empathy to other women. Instead, Fischer almost celebrates incontinence-related pelvic floor damage as something to be taken entirely in your stride - something "actually pretty hilarious".

RCOG reinstates controversial document

Anyone can make a mistake, and I believe that's what RCOG did in publishing this document. Yet despite the criticism that followed, and despite initially removing the document from its website, RCOG last week reinstated the document via this statement.

RCOG says media reports were "misleading", and so wants "to clarify" some of the controversy that arose - you can decide for yourself whether these statements, for example, clarify RCOG's guidance:

*"It is not meant to restrict services to women."

New guidelines underline low risk for planned CS babies

New guidelines published this week state that for low risk planned cesareans, "the need for vigorous resuscitation is no different from that which occurs in an uncomplicated vaginal birth", further supporting the case Dr. Murphy and I make in our book.

The New Zealand Newborn Services Clinical Guideline, 'Paediatric Attendance at Low Risk, Elective Caesarean Deliveries', reviewed by Malcolm Battin, states [my bold]:

BBC's Jenni Murray says 'Get real!' about birth pain

With the controversial headline, As plans to cut down on epidurals cause a furore, JENNI MURRAY says... Get real, girls! Pain is part of childbirth, Jenni's point of view will undoubtedly have its critics.

But there's a part of her story that might elicit sympathy too, which is something we talk about in our book, and that is the possible adverse effect on a child growing up with a mother who had a traumatic birth. Jenni writes of her own mother, "She never hesitated in regaling me with the horror story of my arrival and the damage it had done to her physically and emotionally."

What is a 'normal' birth? asks BBC Woman's Hour

This morning I was interviewed on BBC Radio 4's Woman's Hour alongside Cathy Warwick, General Secretary of the Royal College of Midwives, by presenter Jane Garvey. The topic, 'normal' birth, was chosen on the back of this guidance document for CCGs (still on the RCM's website but removed from RCOG's website last week following complaints) and the subsequent press release from organisations opposed to its contents. You can read the documents above and listen to the Woman's Hour interview here to make up your own mind about what the guidance says.

BBC London and WM radio interviews

On Friday morning (August 31), I was interviewed by Adrian Goldberg on BBC WM and Vanessa Phelps on BBC London. The interviews are only available for a few days on BBCiplayer (although the Vanessa show is not available yet).

Media response to news of guidance for CCGs

Aug 24, Pulse Today: GPs urged to discourage women from 'unnecessary' hospital births, caesareans and epidurals, Sofia Lind

Aug 25, The Skeptical OB: New document on British maternity services is fundamentally unethical, Dr. Amy Tuteur
Aug 28, BF without BS: If this is cost-cutting, just be honest, please

Aug 30, The Sun: Grin ‘n bear it, Plan to cut childbirth pain relief and caesareans, Emma Little and Martyn Halle

RCOG removes controversial guidance from website

Following vehement opposition from maternity organisations and doctors, the Royal College of Obstetricians and Gynaecologists has today removed its guidance for CCGs ('Making sense of commissioning Maternity Services in England', published August 14) from the RCOG website.

 

I don't know yet whether revised guidance will be published, and if so, whether RCOG will collaborate with organisations other than the RCM and the NCT, but in the opinion of many, this would be the appropriate action to take.

Meanwhile, in the Sun newspaper today, Emma Little and Martyn Halle report:

'Cathy Warwick, of the Royal College of Midwives, defended the proposals, insisting: “There are women who do not want to have caesareans or epidurals who are having them at the moment.”' 

Lowest scalp injury risk with planned cesarean

Scalp injury during birth is a risk commonly associated with all cesarean deliveries, and therefore good reason to discourage women from choosing surgery, when in fact the vast majority occur following a planned vaginal delivery.

I explained this in the comments section of today's Daily Mail article, Caesarean 'superknife' that could spare thousands of babies from injury when surgeons cut through the mother's womb:

Mumsnet users angry at maternity guidance

Women posting on Mumsnet have quite rightly got their knickers in a twist after reading Friday's press release on RCOG's (and the RM and NCT) guidance proposing increased rates of 'normal birth' and cesarean rates of 20%.

There are two threads - one in Childbirth and the other in Feminism/ Women's Rights - and here are just few examples of what's being said:

"...I'm utterly appalled by this. It seems to be in direct opposition to what NICE, NHSLA and others are saying. And the trouble with targets is they completely neglect individual care, and create a conflict of interests for doctors & midwifes - and ultimately put woman last."

PR response to RCOG's 20% cesarean rate guidance

"New RCOG guidance urges CCGs to increase births without epidurals and reduce caesarean rates to 20%"

Controversial guidance contained in a new document published by the Royal College of Obstetricians (RCOG) could result in worse health outcomes for mothers and babies, and greater costs for the NHS, say maternity campaigners (left) and doctors (below).

You can read the press release in full HERE.

Perception of risk is everything...

...and birth is no different. Most women perceive greater risks either with a trial of labor or surgery.

This struck me again today while at our local gym play session, and where a sign reads, 'one child at a time on the trampoline'.

It's no exaggeration to say that every single time we go, parents do not adhere to this rule, allowing children to all jump randomly around the trampoline together. As one mother said to me today as our son waited his turn,

The sexual revolution continues...

...in the battle for reproductive choice.

The death of Helen Gurley Brown, long-time editor of Cosmopolitan magazine and advocate of women's sexual freedom, reminded me of these words, which I wrote in one of the first ever pages of my website.

While (in many countries) women now have greater freedom than ever before in terms of sex, their own bodies and their reproductive choices, until planned cesarean delivery is widely accepted as a legitimate birth plan, this journey will not be complete - as we discuss in Choosing Cesarean, A Natural Birth Plan.

Maternal request study: women are satisfied and educated

The main focus of this new U.S. research was on which nonmedical factors might be addressed in order to reduce record-high rates of cesarean delivery.

As such, the research is presented in terms of which factors affected the risk of having a cesarean most (e.g. "higher educational attainment was associated with an increased risk").

But look again at the study of 1308 Californian mothers;

Diabetes could bankrupt the NHS - and maternity care?

The Health and Social Care Information Centre have released a report showing that "Diabetes prescriptions have for the first time topped 40 million in year, a rise of nearly 50% on six years ago."

And in an interview with the Daily Mail, Barbara Young, Chief Executive of Diabetes UK, warns: "About 2.5 million people in England have been diagnosed with the condition and the number of people with diabetes is expected to reach 4.2 million in England by 2025.

"We face the real possibility of diabetes bankrupting the NHS within a generation."

What does this have to do with maternity care?

Brazilian women rebel against c-section births

Some, but not all.

The Associated Press article published this weekend, Rebelling against Brazil’s record C-section rate, women rediscover virtues of natural birth, makes for very interesting reading.

I'd like to draw attention to the reported information about how obstetetricians are paid - i.e. THE SAME for a cesarean as for a natural birth (and in fact the article provides an example of doctors being paid R$10 more for a natural birth).

Why is this important?

Israel: greater risk of PTSD with natural birth

This postpartum study of 89 women will not come as a surprise to organizations such as The Birth Trauma Association and Birth Trauma Canada, but more generally, the sometimes very traumatic experiences of mothers can be lost in descriptions of 'empowering and beautiful' births.

Study questions cesarean 'financial incentive' role

A frequent accusation in the cesarean debate is that doctors are carrying out more cesareans because they can earn more money this way than with a natural birth.

But a new study from Michigan State University in the U.S., which asked, Does medical insurance type (private vs public) influence the physician's decision to perform Caesarean delivery? has concluded that no, it doesn't.

10% risk of cesarean infection

There have been a number of articles reporting on the BJOG study today, and this is the comment I've posted on many of them:

Firstly, the study has shown a 9.6% rate of infection for ALL caesareans, the vast majority of which were emergencies and/or medically indicated. Of these, 88% were minor infections; which leaves us with a 1% total caesarean risk for serious infections.

Compare this with the risk of pelvic floor trauma in women who deliver vaginally:

Membership of The White Ribbon Alliance

My organisation, electivecesarean.com, has joined The White Ribbon Alliance For safe Motherhood, whose Mission, Vision and Principles include working to create a world where:

*It is a woman's basic human right to achieve optimal health care throughout pregnancy and childbirth for herself and her newborns.

*Women are empowered to demand quality, safe and respectful motherhood services and to help other women to do the same.

Turkish doctor's perspective on c-section rates

A very interesting interview with Professor Atıl Yüksel, head of the Istanbul branch of the Turkish Society of Obstetrics and Gynecology, was reported by journalist Barçın Yinanç this week, in the Hürriyet Daily News. Well worth a read if you've been following cesarean developments in Turkey recently.

He gives answers to questions such as:

£2.25m settlement for devastating birth injuries

Mother: “I begged, pleaded and cried for the Caesarian, thinking it was meant to be the mother’s choice, but it just fell on deaf ears”...

Reporter Hannah Upton, writing in the West Morland Gazette, describes how Mrs Hall, mother of Zak, who is now five-years-old, had "asked for a planned Caesarian for Zak’s birth when scans showed he could be as big as 12lb by his due date."

Cesarean live online chat transcript now available

Last Thursday 12 July, Dr. Murphy and I were invited to answer questions during a live online chat. The Canada.com chat was moderated by Ruth Dunley (left) of Postmedia Digital, and you can now scroll through and read the entire Q&A transcript of "Should caesarian sections be more widely available?"

Is Turkey law playing chicken with doctors?

I've been researching the cesarean situation in Turkey for some time now, and this latest news about the government introducing legislation in order to reduce its countries high rates has really captured the attention of the media. This is the comment I've just posted on this Guardian article:

Doctor: Offer cesarean to women 40 years +

In a letter to the editor published in June's J Obstet Gynaecol Can, Dr. Venu Jain argues that with the increasing numbers of women giving birth at older ages, and the fact that they are more likely to experience obstetric problems, doctors should consider discussing and offering them an elective cesarean birth.

In 'Elective Caesarean Section for the Mature Nullipara', Jain concludes:

Centralised maternity care - but who's it for??

The Press Association, Guardian and Telegraph have reported today on the president of the Royal College of Obstetricians and Gynaecologist's strategy for the future of maternity care. But while the focus has been on Dr. Falconer's idea to centralize care into fewer and larger obstetric units - giving rise to concerns about the distance women might need to travel to hospital, - an even more important issue is being missed.

Worrying statement by RCM's new President

"...midwifery led care is safe and is associated with a lower intervention rate and is more cost effective than care by a team of doctors and midwives gives an impetus to developing more midwifery led care including out of hospital care. Perhaps it is time for this to be the default path for healthy women."

This is an extract from a statement by Professor Lesley Page (my bold), who is the new President of the Royal College of Midwives.

Did the cesarean section originate with Caesar?

I don't usually post information on 'cesarean history' articles, but when I came across this one earlier in the week - "DID THE CESAREAN SECTION ORIGINATE WITH CAESAR?????", written by Dr. Michele Brown OB/GYN - I made a note to blog about it because I think it provides a very interesting and easy-to-read historical overview.

Take a look and see what you think.

Canadian mother files 'denied cesarean' case

If you haven't read this blog yet, it's a must. On July 4, 2012, Mrs W, who lives in Victoria BC (Canada) posted: Filed. Let the legal process begin.

It reads, "As of this morning - I filed my case regarding the denial of my maternal request c-section in July 2010. The legal process begins...

Do C-sections "cause" childhood asthma?

In her blog today, "Do C-sections "cause" childhood asthma?", the Skeptical OB discusses the importance of understanding that in scientific studies, cause and correlation are two very different things. It's a very interesting post on this topic, and well worth a read. I commented:

Maternal mortality rates are in sharp decline

Charis Gresser, writing in the Financial Times' Care: Maternal mortality rates are in sharp decline (July 7, 2012), reports that around 287,000 women die each year "because of complications from pregnancy or birth", but although this marks an improvement, Gresser reports that nearly two million babies still die every year "either during labour or shortly thereafter".

The article is certainly worth reading as it outlines what's working well and discusses how further improvements could be made.

Two babies die - but 'normal birth' is achieved

This week, two separate stories appeared in the news describing the devastating loss of babies and their parents' anger at the maternity care they received. An inquest recalled a verdict of natural causes in the first report (below) and an investigation is pending in the second, but I think it's fair to say that both examples demonstrate that no matter how 'low risk' a pregnancy first seems, all pregnancies and births are inherently risky, and a mothers' instinct that her risk has escalated deserves due attention.

(July 3, 2012 Kingston News) Heartbroken mother whose baby died at Kingston Hospital 'denied Caesarean section'

Live Chat: Should C-sections be optional?

Next Thursday, July 12, Canada.com is hosting a live online chat with me and my co-author Dr.Magnus Murphy. It begins at 8pm UK-time (3pm Eastern, 12pm Pacific), and asks, Should C-sections be optional?

Montreal radio interview today

Earlier this evening I was interviewed about our book by Suzanne Desautels, a presenter on CJAD 800 AM's The Ric & Suzanne Show, and you can listen to the Podast here.

Suzanne told me she'd had three vaginal births and was completely non-judgemental about women who choose surgery instead. Definitely one of the most open-minded and honest interviewers I've experienced.

Also worth a listen if you get chance is Dr. Murphy's interview on CBC's Calgary Eyeopener radio show, which also aired today. Podcast here.

Doctor advocates informed choice for mothers

An interview with my co-author Dr. Magnus Murphy appears in the Calgary Herald today, and here are some examples of what he says:

"We're not saying what women should choose," he said. "We're saying there should be a choice."

Murphy, whose urogynecology practice deals with these issues, said pelvic floor injuries include serious vaginal prolapse, urinary and stool incontinence and sexual dysfunction. "I have many patients who wish they did have a caesarean. Some of my patients are pelvic cripples at a young age because of damage sustained during childbirth."

Definitely worth a read: Discussing elective cesarean

This interview with my co-author, Dr. Magnus Murphy, appears in the University of Calgary's 'Medicine' publication (Summer 2012 Dean's Edition). In it, he discusses the risks of pelvic floor injury that can occur during a vaginal birth, and why he feels that women should be given the choice of a planned cesarean if this is their preference.

Wait a few days for cesarean babies' hearing tests

The authors of Birth by Cesarean Delivery and Failure on First Otoacoustic Emissions Hearing Test (Tatiana Smolkin et al) evaluated 1,653 babies born at 35 weeks' or more gestation, and found that those born via c-section (CD) "had significantly higher failure rates" when their hearing was first tested.  They "speculate that CD is accompanied by retained fluid in middle ear which may impair neonatal hearing", and recommend that the timing of first otoacoustic emissions "should preferably be postponed beyond 48 hours of age to improve OAE passage and minimize maternal anxiety and costs."

Criticism of obesity link study published in BMJ

Two weeks following submission, my letter in response to the obesity study was published, June 6, in the BMJ Archives of Disease in Childhood. Titled, "Findings do not inform maternal request caesarean risk", it reads:

As far as I can ascertain (having not yet accessed the full text), this study did not specifically examine maternal request caesareans, and in fact found that "after all factors were taken into account there was a stronger link with emergency caesarean than with pre-planned ones, although the numbers were small for this calculation."(1)

It is very concerning therefore that

The world's news gorged on obesity hypothesis

For the record, recent research suggesting (not proving) a link between cesarean-born children and obesity in pre-school children concluded that those "delivered by caesarean section may be at increased risk of childhood obesity". 

Yet not only has this study (which found no causal link with ANY c-section type, much less maternal request in healthy pregnancies - despite the authors' statements in reports that the findings might "provide an important rationale to avoid non-medically indicated caesarean section") been reported by virtually every major news service, a large number have failed to include the words "may be".

Even TIME magazine for example wrote, "babies born by c-section are twice as likely to be obese by age 3", which is not strictly true.

Yes, women need to be fully informed of planned c-section risks, but they should be relevant and proven, not just a hypothesis born of mixed cesarean data. Please...

BBC London interview on c-section obesity study

This evening I was interviewed by Eddie Nestor on his BBC London Drivetime programme. You can listen again here until May 31, 2012.

We were discussing the reports today about an American study citing a possible link between cesarean birth and obesity in pre-school children.

Letter published today in the British Medical Journal, titled, 'Elective caesarean has also been shown to reduce stillbirth risk'', in response to Scottish research published last week, which provided information about reducing the risk of stillbirth.

This coincides with other important news about new research about to get underway in Cambridge, led by Professor Smith. The Pregnancy Outcome Prediction Study (POPS), which aims to involve 4,500 women who, as "well as their routine ultrasound scans at 12 and 20 weeks, [they will] have blood tests, and additional research scans at 28 and 36 weeks, and when they give birth a sample of the placenta is kept and stored. Combining all this information will, Professor Smith believes, provide a clearer picture of how best to identify women at increased risk of stillbirth."

A look inside our new book: Choosing Cesarean

If you don’t reach targets, collect your P45

I've just read this article in The Scotsman this morning, and while I have no evidence that this has happened with cesarean rate targets in Scotland, I do think that it's an important article to read in order to see how medical professionals can end up swayed by "an aggressively target-driven culture", and give advice that is not necessarily in the best interests of mothers and babies.

In our book, we highlight the example of a British doctor who apologises for trying to force a woman to have a natural birth, solely because of target rates (a midwife and GP intervened and he allowed a cesarean).

One member of NHS staff here says,

Another c-section refused, another baby dies

Lynn News reported the loss of Zoe and Robert Rust's son Lincoln, stillborn on July 22, 2010, and the fact that managers at Queen Elizabeth Hospital "have apologised and paid compensation... following a catalogue of errors during his birth."

The couple had wanted and requested a cesarean for Lincoln's birth because Zoe "had endured difficult births with her two older sons", but the hospital wanted Zoe to deliver him naturally. They've now been told that Lincoln’s death "was avoidable [with an] elective caesarean", but instead he was delivered stillborn by emergency caesarean section. Zoe recalls, "It seemed unbelievable to me that all this time we had been begging for a caesarean section and that request had been refused by all sorts of people and now Lincoln was dead.”

I took a look at the hospital's website, and intend to contact its staff about their policy on maternal request cesareans, but interestingly, in a leaflet titled, Working with us, I found this

My interview for Toronto Star article

Journalist Andrea Gordon told me when she interviewed me a couple of weeks ago that she found our chapter, "The Day of Surgery: What Happens, Step by Step", particularly helpful when researching for her article, Caesarean section: The Star goes inside the operating room for this look at why C-section rates matter, which was published today. Here's what she says about our book:
"Pauline McDonagh Hull says while it’s a small number, women should have the right to request a planned C-section covered by health insurance. The British journalist, who opted for caesarean birth for her two children, makes the case in a new book she co-authored with Alberta obstetrician Dr. Magnus Murphy.

No financial incentive behind Michigan's CS rate

Researchers in the U.S. asking the question, Does medical insurance type (private vs public) influence the physician's decision to perform Caesarean delivery? concluded that "No significant disparity was found in the odds of Caesarean delivery between privately insured and Medicaid patients in Michigan after adjusting for other Caesarean risk factors. A positive disparity would have provided de facto evidence that financial incentives play a role in physician decision-making regarding Caesarean delivery."

Cost-effectiveness of saving lives with c-sections

It's a shame that it's so very often 'money talks' above all else, but if this new research on the cost-effectiveness of MORE CESAREANS in the developing world means that fewer women and babies die or are injured, then I'll certainly accept it.

Obstructed Labor and Caesarean Delivery: The Cost and Benefit of Surgical Intervention is summarized well in this article, in which lead author Blake Alkire says,

FIPO condemns Bupa over its caesarean policy

A day after my blog post about Bupa's decision to only pay for cesareans in private hospitals if the mother's life is at risk (not the baby's), the Federation of Independent Practitioner Organisations (FIPO) strongly condemned Bupa’s policy changes in this press release: "In a letter sent to obstetricians and hospitals Bupa has advised that it will no longer pay for caesarean sections unless “there is a risk to maternal life”. This contradicts the NICE guidelines, which clearly state that emergency Caesareans should be carried out not only if the life of the mother, but also if the life of the baby is in danger, or

If birth is a marathon, not everyone wants to run

Last week, I came across this article: Midwife uses marathon running principles to coach women through childbirth, and the birth-marathon comparison is something I've discussed in the past to demonstrate that while marathons can be an amazing experience for people who want to take on that challenge, it's perfectly understandable to us as a society that others would rather opt out of the challenge - and not spend a single day of their lives feeling as though they've missed out on anything.

Similarly, most women who choose to have a cesarean simply never have any desire to experience natural birth and shouldn't be criticized for this.

Bupa refusing to pay for life-saving emergency c-sections?

In a letter titled "Caesarian conflict", published in The Scotsman yesterday, Dr John Cameron claims that Bupa will only pay for an emergency cesarean that saves the mother's life, but not the baby's.

I'm genuinely shocked. Can this really be true? I hope not.

Here's the letter in full:

Letter published in BMJ - Birthplace study flaws

My letter to the BMJ outlining concerns about flaws in the Birthplace study was published today.

Titled, "Concerned that flawed analysis may be used to restrict birth choices", it reads:

This analysis of the 2011 Birthplace study(1) suffers from some of the same inherent flaws in the study’s collection and analysis of comparative data. But while all research has its limitations and weaknesses, the current economic climate and imminent restructuring of the NHS mean that the promise of “cost-effectiveness” here may well be used for political and ideological influence. As such, these are my concerns:

Eliabeth Ross, creater of the wonderful website that is The Mommy Pledge Blog is sharing a series of interviews with women about their birth experiences over a period of two weeks. She says she hopes to "explore birth options and choices in an objective, balanced way".It's a really great series, and has so far included a number of very different birth experiences, which makes it a great read for first-time mums to be, or even mums who are looking to read about shared birth experiences. Elizabeth has interviewed me for the series too, with my story appearing on Thursday - do take a look if you get a minute, and at the end of the series, readers can add their own birth stories too!

Fears women could be forced to give birth without doctors

This article, published in today's Telegraph newspaper, is worth reading as it raises some very important issues, some of which I touched on in my letter to the BMJ on April 18, 2011.

It is very concerning that UK policy or guidelines may 'instruct' ALL women with "low risk" pregnancies to be cared for in midwife-led birth centres.

Aside from the fact that no one knows which birth will be low risk until it's over, the fact is that many, many women DO NOT WANT to give birth in a place where doctors and an emergency operating room are not immediately available.

Providing choice for women that want a homebirth or exclusive midwife-led care is dangerously turning into an ideological push for all women to give birth in the place (not necessarily the way) thought to be most appropriate for them.

Why cesarean? Because celebrities have them!

I've often read the accusation that the reason some women are choosing a c-section birth is down to our increasingly celebrity copy-cat culture, and even though I still believe that for the majority of women, this is not the case, I do think that there may be a risk of this becoming a more frequent occurence - especially now that greater media attention is being given to the issues surrounding cesarean choice.

Just recently, I watched the January 11, 2012 episode of One Born Every Minute (Series 3, ep.13), and listened to a very happy stewardess talking about her birth plan. She said,

"I want to have a c-section because I think it'll be less painful.**

Probably because all the celebrities have them, and they seem to be stick thin after they've had them,.. and that's just why. I didn't fancy the natural birth to be honest. I'm a bit squeamish; I don't like blood or anything like that. Um, so that's why I chose a cesarean."

As someone who is a strong advocate for cesarean choice, I support informed cesarean choice, with a woman fully versed in the risks associated with surgery (and subsequent surgeries), and not someone who is solely 'following the latest trend', so when I first heard this, I was a little concerned to say the least.

However, watching it back again, I noticed that there was a programme editing point at ** above (just after "less painful"), and realised that a portion of that particular interview had been cut. Therefore this woman may well have talked about other reasons for wanting a cesarean (after all, she was a 38-year-old woman, pregnant for the first-time with twins, and likely to have been advised by doctors). We simply don't know.

But I do know that if (for example) some of my perceived benefits of planning a cesarean were taken out of context, they would sound like very weak justifactions for making this choice too, which is what an individualized consultation betwen a woman and a health professional is for.

Properly discussing the risks and benefits of surgery versus a trial of labor, whether that woman's perceived benefits have come straight from the pages of a celeb magazine or via an online medical journal. After all, some women are just as likely to be swayed by the natural birth choices of celebrities too...!

(...ironically, this episode involved a celebrity visit, causing great excitement amongst hospital staff.)

Driving after a c-section - how long did you wait?

Did you wait 6 weeks? 3 weeks? What were you advised to do? It seems that there is some confusion about when you should start driving again following a cesarean, and new research from Australia shows that confusion reigns there too.

"Women receive conflicting advice, and current recommendations are not reflected in women's behaviour. Women are driving earlier than advised with minimal reported complications." 65% had been advised to wait for 6 weeks or longer, yet 72% said they'd driven before 6 weeks, and 35% before 3 weeks; "women reported minimal discomfort and rarely discontinued driving".

When staff were asked what advice they give women, this was inconsistent, "ranging from no advice to 8 weeks of driving abstinence. Other recommendations included following insurance company guidelines (of which there were none specific to postcaesarean) (34%), 'listen to your body and be able to perform an emergency stop' (27%)."

Back in 2005, I wrote about this subject,

Nigerian CS choice more likely in tertiary care

New research from Nigeria suggests that tertiary educated women are more aware of c-section on "demand", and that maternal request is more common in tertiary health care centre'; these women are also more likely to "favor a woman's right of autonomy to choose her mode of delivery."

Against a background of reported increased rates of maternal request cesarean, researchers NS Okonkwo et al set out to "determine the perception and attitudes of Nigerian antenatal clients towards MDCS, their willingness to request MDCS, and the relationship between willingness to request MDCS and sociodemographic characteristics."

They found that:

The proportion of women aware of MDCS was 39.6%.

Doctors were major sources of information on MDCS (30.8%) as well as friends (24.3%).
Common reasons reported for MDCS were fear of labor pains (68.9%), and fear of poor labor outcome (60.1%), and fear of fecal (20.2%) and urinary incontinence (16.8%).
However, willingness to request MDCS was low (6.6%).
More than 50% of those willing to request MDCS would likely be criticized, mainly by their husbands.

And they concluded that:
"Provision of epidural anesthesia and improved safety of vaginal delivery is recommended." This may prevent Nigerian women from making a difficult choice for MDCS based on fear of pain and poor labor outcome. The role of the male partner should be taken into consideration in order to make sustainable policies or guidelines for MDCS in developing countries."

Philosophy vs. Facts - 'Birth' journal declines our book

Like many other publications, Birth was offered a review copy of our new book, Choosing Cesarean: A Natural Birth Plan, but the Lamaze International journal declined, stating:

"The content of this book does not match the philosophy of our journal."

I thought readers ought to be aware of this because Dr. Murphy and I disagree with the premise that birth plan information and education should be based solely on any particular philosophy or ideology. All birth choices should be better understood and supported.

We do not advocate cesarean births for all women, but we do believe that many women - and indeed medical professionals - are simply not being made aware of the risks associated with planned vaginal birth, and it is disconcerting that a major publication such as Birth should decide that what we've written is irrelevant to their readers - before actually reading it.

Cesarean Choice in China - one woman's story

We've written about c-section rates in China in chapter 8 of our book, Choosing Cesarean, and in the Shanghai Daily this week, new mother Michelle Qiao writes about her birth plan decision.

It's a very interesting look at some of the reasons why women choose a cesarean there, and also why ultimately, Michelle decides to have a vaginal delivery with an epidural.

And while I'm not convinced that this birth "experience increases her love for her baby" (or at least, I don't believe that not experiencing vaginal birth by default decreases a woman's love for her baby), her story (and the opinions of friends, family and medical professionals in China) is one that we don't often get to hear.

Inquest into brain injury and death of child whose mother requested a c-section

This story appeared in The Australian this week, and while the inquest is clearly ongoing, and therefore the report is based on alleged claims, Pia Akerman writes how (my bold):

"Dishita Madamshetty died at the age of one month after being delivered in an emergency caesarean at Sunshine Hospital in Melbourne's western suburbs in 2007."

"An inquest investigating the circumstances of Dishita's birth yesterday heard that a midwife had left her mother, Shashi, alone for 25 minutes before returning to find the fetal heart rate monitor showing "non-reassuring" levels. Mrs Madamshetty was rushed into surgery and gave birth by caesarean about an hour later, but the baby was not breathing and had suffered multiple organ failures.

"Mrs Madamshetty told the inquest she had repeatedly asked for a caesarean delivery throughout her pregnancy. She had been worried about her baby's health as Dishita was conceived through IVF in India with the help of an egg donor.

"This baby was very precious to me and I believe that if she had been born by caesarean when requested by me that she would still be with us today," Mrs Madamshetty told the inquest. "Every month I had a checkup and I requested for the caesarean."

Read more here.

MedicalScienceBooks.com reviews our book

Read what they say below (or click here for more info):

"Choosing Cesarean: A Natural Birth Plan gives an honest assessment of the risks and benefits of both vaginal and cesarean births.  The book is one of the first to support elective cesarean as an important option for women, citing circumstances when planned cesarean is a healthier and even more economical option than vaginal delivery.  The authors present evidence disproving much of the accepted thought on vaginal and cesarean delivery, giving us all something to think about.

"Most of the information available until now has been in support of a vaginal delivery, with cesarean as a last option.  Therefore, when the mother is unable to deliver vaginally, she can become disappointed, feeling less adequate than a woman who delivers vaginally.  In Choosing Cesarean, the authors give evidence proving that elective cesareans can have much more desirable outcomes, and should not be considered a last resort, but rather a suitable option to prevent complications of all kinds.

"It is worth mentioning that the authors are not against vaginal births, but rather present factual evidence to support the medically acceptable option of a scheduled cesarean delivery.  When weighing all of the options for delivery, this is an important, often overlooked method.  Any woman making a birth plan should add this book to her reading list, while healthcare professionals and policy makers would also benefit from the information presented in this book."