Latest £3.35m NHS settlement for 1985 birth - Millions more still to be paid

No one knows how any birth will turn out, and no one knows how much more money the NHS (tax-payers) will have to pay when mistakes are made. But what we do know is that NHS litigation bills are already at unaffordable levels (and millions of pounds are yet to paid for claims already made), and that when it comes to birth (in the eyes of the law), the delay or absence of cesarean surgery is the most costly mistake of all. Perhaps if maternity budgets were directly affected by these litigation costs, then more hospitals might remove their target driven pressure to 'reduce cesarean rates'. The NHS can't afford it, and more importantly, mothers and babies deserve better care (you can read the BBC story about 24-year-old Adam Spinks here).

NHS bailed out of litigation black hole - Obstetrics Claims Cost the Most

And things can only get worse...

As the British Medical Journal reports that the NHS compensation fund gets £185m bailout as claims rise by 30% in a year, it's important to remind readers that the largest litigation costs for the NHS arise from OBGYN claims.

When planned vaginal birth goes wrong, and especially when a baby is injured, the financial costs are substantial - and the backlog of these claims is huge.

When will maternity care policy makers understand that it's not a focus on "normal" birth that's most important (or cost-effective), but rather a focus on best health outcomes?!

Perhaps it'll take cash-strapped MPs to understand this first.

Why do I keep writing this blog? Because of emails like this...

Photo: allaboutincontinence.co.uk

I receive many emails from women, and especially from those who are facing difficulty in having their cesarean birth choice understood, respected or supported.

But there are other emails too, telling of the devastating consequences of a cesarean birth request that was ultimately denied.

Here are just two of the most recent I've received - from courageous women who are willing to speak out about the often downplayed risks of vaginal birth, and who don't want other women to suffer in the way they have.

Transfer risk from midwifery-led birth centers is real

A wait of just under two hours for an emergency cesarean transfer, and now brain damage is suspected.

The Braintree & Witham Times reports that a full internal investigation has been launched by the East of England Ambulance Service NHS Trust, and that parents Sarah Jenkins and Jamie Murray say "they have been “failed” by the NHS after what should have been a straight-forward birth in Braintree ended with baby Riley Murray being starved of oxygen and eventually being taken to intensive care at Addenbrookes Hospital, Cambridge."

Last April, my criticism of current thinking to encourage all 'low risk' woman to give birth in midwife-led birth centers' was published in the BMJ, as it's a policy I am wholeheartedly against.

Mother and baby would have died if VBAC was attempted elsewhere

Photo by Simon Finlay

This birth story was quite rightly reported as a good news story in last week's Norwich Evening News: 'Our little boy is just cool after 72 hour fight for life'

But there's also something very troubling about the story if you consider the fact that had this VBAC been attempted in a different hospital - one without the specialist life-saving equipment that was needed - both mother and baby would have died (according to the report).

Baby Adam's mother, Marie Jermy, is quoted as saying, “I wanted a natural delivery with Adam, as my other two kids were born by C section, and the hospital were very supportive.".

Yet despite being considered 'low risk' enough to attempt labor, Marie's experience emphasizes just how quickly problems can escalate during labor, leading to possible death or disability.

Cesarean delayed and denied. Baby dies.

The photographs in this South Wales Argus report by Alison Sanders. are just heartbreaking, and while the investigation into the death of this baby, at just 2 days-old, remains ongoing, anyone
involved with maternity care in the UK needs to read.

In Sanders' report, the baby's mother alleges that she requested a cesarean during labor.

As readers of this blog will know, this is not the first time a mother has requested a cesarean in order to save her baby's life, only to have her request ignored or refused, with the same tragic outcome.

The circumstances surrounding this birth were reported in Gwent News just two days before the birth of Blue Ivy Carter - and of course it was the latter that captured the world's attention, as is so often the way.

Why are people so quick to judge and vilify obstetricians?

It's an issue I could write more about if time allowed, but in Viv Groskop's article, Welcome to modern motherhood, Beyoncé..., I've just posted the following comment:

Why are so many commentators so quick to judge and vilify obstetricians, the absolute majority of whom should be applauded for the amazing work they do, while simultaneously placing midwives on a pedestal when it comes the antenatal advice they give to women? Do we really, as a society, distrust our doctors SO much?

It’s also worth remembering that celebrities are all individual women with their own perception of birth risks and benefits - so regardless of what advice their money can buy, they may also have their own personal preference for one birth plan over another, and this would be exactly the same even if they weren’t famous.

Call the Midwife: 'There isn’t much comedy delivering a baby'

I just had to post this comment on Morwenna Ferrier's article in The Telegraph today, especially given the way NHS maternity policy seems to be heading:

Let me start by saying that I think that the majority of midwives do a great job and I agree that there is evidence to show that midwife-led care can enhance the experience of women who would like to have a natural birth.

However, I would not describe midwifery-led care as  categorically "uncontroversial", as it appears to be represented in this article's conclusion.

Listening to and reading the stories of women who have experienced birth trauma, it is very clear that the "care" provided by some midwives is extremely poor. They do not always respect women's feelings or birth choices, and their treatment of  women, both physically and psychologically is sometimes described as dismissive and even cruel.

IMPORTANT INFORMATION: The NICE c-section handout for pregnant women

Are you thinking about choosing a c-section? Are you worried that you will not be taken seriously when you attend your antenatal meetings? Have you already tried to discuss a cesarean birth plan and been refused point blank? Are you unsure of your rights as a patient in the NHS?

If so, please read the NICE (National Institute for Clinical Excellence) NHS patient leaflet: Understanding NICE guidance

Also see: NEW GUIDELINES YOU SHOULD BE AWARE OF

First-time moms' unrealistic views about having uncomplicated births

An Australian report by Evelyn Yamine in the Daily Telegraph discusses a new study showing an increased risk of post-natal depression in first-time mothers with "unrealistic views about having uncomplicated births".

This does not surprise me in the least, and I think that women are often not being helped in forming realistic expectations during their antenatal care.

Beyonce Gives Birth to Blue Ivy and Colorful Debate

Jim Spellman/ Wire image (TIME Healthland)

I've posted this comment on TIME article, Beyoncé's Baby: C-Section? Natural Childbirth? Why We Care So Much:

Bonnie Rochman picks up on some interesting points in this article - namely the hierarchy of c-sections, and indeed the perceived hierarchy of all birth types.

Unfortunately, birth plans and birth outcomes are often discussed within a context of mixed data and anecdotal evidence, and when a celebrity has a baby - however she has it - this provides a fresh opportunity to discuss and debate issues surrounding the birth choices women make (or want to make).

What has proved particularly interesting in the case of Beyonce's birth experience is the way different people have reacted to different information about whether it was natural or surgical.

Personally, I believe that choosing a cesarean is as natural a birth plan in the 21st century as planning a vaginal birth - as long as the woman is fully informed of both sets of risks, is planning a small family, and schedules surgery at 39+ gestational weeks (assuming no medical indication for earlier delivery). Of course, not everyone agrees with this, which is why there is so much debate on the subject.

What I would say is this: It's not celebrities that have been leading the way with cesarean birth choices. Rather, it is doctors, as demonstrated in a number of research studies on their birth choices, and the choices of their wives and partners.

Finally, however Beyonce gave birth, it is her business (unless she chooses to discuss it) and she should be neither condemned nor put on a pedestal because of it. What matters most is that this mother and daughter are healthy, and that as a society we do everything we can to give other mothers and babies the same chance of healthy outcomes too.

November and December 2011

A very busy few months, filled with completing the final stages of our new book and ongoing cesarean campaign work.

I've highlighted some of the main activities below, but plan to post more details about many of these as soon as possible.

December 09, 2011
Contacted BBC Complaints and Woman's Hour programme makers in response to Jenni Murray's November 23 report on the NICE Caesarean section guideline (update), in light of her Daily Mail article, published just weeks earlier.

November 30, 2011
Attended the NHS Alliance Conference in Manchester, speaking with many representatives from many healthcare organizations on the subject of cesarean rate targets and maternal request. Request made for information (incl. DoH letter, below) to be handed to Health Secretary Andrew Lansley; response was affirmative by NHSA staff but no confirmation yet that it was received.

November 24, 2011
Interviewed on BBC Scotland's Call Kaye programme on the subject of the NICE Caesarean (update) guideline

November 23, 2011
Interviewed on ITV Daybreak, Sky News, BBC London 94.9, BBC Radio Leeds and BBC Radio Humberside on the subject of the NICE Caesarean (update) guideline recommendation on Maternal Request, published today

November 22, 2011
Interviewee for BBC 1 The One Show's cesarean request film, presented by Angellica Bell.

November 18, 2011
Submitted an open letter to the Department of Health outlining my concerns with target cesarean rates that are in place in many hospitals throughout the UK. Both Jeremy Hunt MP and Daniel Poulter MP have agreed to forward my concerns to the DoH. On November 22, Jeremy Hunt MP contacted me to confirm that my letter has been forwarded to Anne Milton, Minister for Public Health. As at December 11th, no confirmation yet from Daniel Poulter. MP.

November 04, 2011
Together with co-author Dr. M Murphy, submitted a formal request to FIGO for a review of its 1998 statement regarding Ethical Aspects Regarding Caesarian Delivery For Non Medical Reasons: “At present, because hard evidence of net benefit does not exist, performing Caesarean section for non-medical reasons is ethically not justified.”

November 04, 2011
Interview (and pictures) by Associated Press journalist Maria Cheng, "Too posh to push? More C-sections on demand in UK", published online.

November 03, 2011
Research published in the British Journal of Midwifery: Why do some women prefer birth by caesarean? An internet survey. By Pauline Hull, Carol Bedwell, Tina Lavender (BJM, Vol. 19, Iss. 11, 02 Nov 2011, pp 708-716)

November 01, 2011
The NHS Litigation Authority formally confirmed that in response to my request for claims data to be separated into births relating to an emergency or a planned cesarean, it will "introduce a system for recording this information on new claims in future."