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: