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 (undated but pre-March 2011) statement by Barbara James, Head of Midwifery:
"Over the next year we will focus on lowering our caesarean section rates, this will include a new VBAC clinic, where will we support and encourage vaginal birth after caesarean for those women who would like to attempt a normal birth..."
How many times have I written about the risk of striving to arbitrarily reduce c-section rates at all costs...?
She continues, "March 2011 will see the birth of the much awaited Midwifery Led Birthing Unit which will be a very exciting time for us as it will mean that we will be able to offer all women a full range of choice about when and how they would like to give birth." I hope this is now the case...
The leaflet also reads, "The Queen Elizabeth Hospital King’s Lynn has been named as one of the top four best-performing hospitals in the East of England for ‘excellent’ maternity services, in a review by the Healthcare Commission."
Now this is really interesting - the latest report I can find on its website is
the Healthcare Commission Review of Maternity Services 2007, where the hospital scores 3 out of 5 in the measured indicator "Appropriate use of caesarean sections". The document states, "There are some known interventions which tend to reduce caesarean rates and this indicator considers trust practice in the two areas of; turning breech babies using External Cephalic Version (ECV) and offering vaginal birth to eligible women who have had a previous caesarean."
It then goes on to describe how the measurement and scoring works:
*Start at 1 point
*If trust have been able to provide data on vaginal birth after caesarean, ECV turn rates or caesarean rate for primips add 1 point.
*If caesarean rate for a primip ((sum of delivery units non-elective caesarean deliveries for primips + sum of delivery units elective caesarean deliveries for primips) / (sum of units in trust deliveries for primips) *100) is less than or equal to median (24.38) add 1 point (Fig 3a).
*If % women who have previously had a caesarean who have a vaginal birth (vaginal births for women who had had previous caesarean / Women with previous caesarean * 100) is greater than or equal to median rate (31.53) add 1 point (Fig 3b).
*If % of women who are diagnosed with a singleton breech prior to labour who undergo ECV (Breeches identified at 36 weeks and beyond where ECV attempted / Breeches identified at 36 weeks and beyond * 100) is greater than or equal to median (27.09) then add 1 point (Fig 3c)
I spoke to someone from the Healthcare Commission about the problem with scoring hospitals' maternity care in this way, and the danger that many women are then encouraged and even forced to make a birth choice that is not in their best interests but rather in the best interests of the hospitals target rates, and its desire to score highly on its next review. I was promised that this particular scoring system is no longer used, but it does demonstrate how hospitals truly are being influenced by cesarean rate targets, and Lincoln's stillbirth is one example of many where the opportunity to save a life was missed.
Furthermore, I read in the minutes of a Queen Elizabeth Hospital Trust Board meeting on September 25, 2006 that "areas to note" (following a presentation by Barbara James) included, "low caesarean rates [and] adherence to National Institute for Clinical Excellence (NICE) guidelines.
Again, the focus on cesarean rates, but also, the promise to adhere to NICE guidelines. As I say, I will endeavor to find out whether the hospital is therefore following NICE's 2011 updated recommendations on maternal request.