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."*"...achieving the 20% rate of caesarean sections is meant as a guide and not a target."
*"RCOG supports patient choice in the place of birth but reiterates that choice is not always feasible."
*"Normal birth refers to birth without medical intervention. There may be the need to think of changing this nomenclature in future."     

Many members of RCOG remain unhappy with the reinstatement of this guidance, as do women on Mumsnet; and while it may have taken broad shoulders and a strong ethical compass to admit even just some revisions to the guidance are necessary (e.g. "It is important to try to increase [the rate] of vaginal birth, which includes delivery by forceps and ventouse."), this is exactly what I expected of an organisation responsible for the health and wellbeing of mothers and babies.

This is the statement in full:


"The Royal College of Obstetricians and Gynaecologists (RCOG) published a joint guidance document with the Royal College of Midwives (RCM) and National Childbirth Trust (NCT) in March this year.

It was removed from the RCOG website for a week for further scrutiny following misleading media reports but has now been reinstated.

To clarify, this document sets out the areas for the new Clinical Commissioning Groups (CCGs) to consider when commissioning local maternity services from providers.  CCGs are not obliged to follow such advice and would indeed need to tailor their services to meet local demands and needs.

It is not a clinical guideline for doctors.  It is not meant to restrict services to women.

Key points:
 •The RCOG supports the concept of ‘normal birth’ for women where clinically appropriate.  Normal birth refers to birth without medical intervention.  There may be the need to think of changing this nomenclature in future.     
•Pregnant women should have access to the full range of obstetric services, including pain relief and epidurals.  
•Access to caesarean sections should be based on guidance set out in current NICE guidelines.

Reference in the document to achieving the 20% rate of caesarean sections is meant as a guide and not a target.  This should be viewed in the context of adequate resourcing and consultant presence in hospital labour wards.

Likewise, increasing the vaginal delivery rate can only be achieved with enough midwives providing the service.  

The role of the GP is integral in health services since for some women, their GP would be the first health professional they would approach when they suspect they are pregnant.  The RCOG believes that closer working is required between midwives and doctors to ensure that women receive high quality care and good evidence-based information about the risks associated with each option.

The RCOG supports patient choice in the place of birth but reiterates that choice is not always feasible.

In July this year, the NHSCB published new advice to support CCGs on commissioning maternity services  .  This updated document references the older joint RCOG/RCM/NCT guidance. The RCOG would recommend that CCGs refer to this document to aid in their decision-making. 

6 September 2012

Notes

This story first appeared in Pulse magazine on 24 August 2012 based on a press release by electivecaesarean.com.

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Date published:06/09/2012
Published by: Anonymous"