It's about knowledge and empowerment

I plan to write about Piper Newton again - she's written a courageous book called, 'And Then My Uterus Fell Out', which is due out on October 1st - but for now I'd like to share the blog post she published a few days ago:

"It's about knowledge and empowerment"

She describes how her vaginal delivery has left her "with permanent disabilities, an inability to return to the workforce (at 30 years old) and... facing many high risk surgeries as [she tries to] cope with my disabilities."

Obstetrician changes his mind about Maternal Request

Admiration and respect. These are the words I would use to describe my feelings towards Dr. Silvio Aladje, an OBGYN and maternal fetal medicine specialist at Michigan State University in the U.S.  In his blog posted yesterday, 'Caesareans Section On Demand', he describes how, after reading our book, he has changed his position in the debate over maternal request caesareans. I don't admire and respect him because he has changed his mind, but rather because he is willing to say so publicly (which not everyone would be brave enough or gracious enough to do) and because his actions are one step closer towards wider recognition that maternal request caesarean is a legitimate birth plan.

Birthrights organisation highlights maternal request refusal

Birthrights website reads: "We believe that all women are entitled to respectful maternity care that protects their fundamental rights to dignity, autonomy, privacy and equality."  And on August 9, 2013, in its response to the Care Quality Commission consultation on changes to the ways the CQC regulates, inspects and monitors care services, Birthrights included the issue of maternal request caesareans being misunderstood and refused, alongside the issues being faced by women with various other birth choices (e.g. epidural and home birth).

The document is certainly well worth reading; and I can only hope that the CQC takes serious note of Birthrights' comments, and that its response leads us one step closer towards true autonomy and respect for the woefully misunderstood prophylactic caesarean.

Why women often don't get the birth they want

The answer to why women often don't get the caesarean birth they want is this: Their requests are blatantly refused.

The answer to why women often don't get the vaginal birth is more complicated, but there was an interesting debate today on BBC Radio 4's Woman's Hour, hosted by Kirstie Allsopp.

I have much to write about it, but due to other more immediate commitments tonight, I will leave any comments for another day, and simply post the programme link here and encourage you to have a listen.

Feedback welcome!

NICE says a planned caesarean section SHOULD be offered to women who request it

My letter (title above) was published in the British Medical Journal today; I wrote it in response to another letter, NICE says caesarean section is not available on demand unless clinically indicated, sent in by Mandie Scamell, a lecturer in midwifery, Alison Macfarlane, a professor in women’s and child health, Christine McCourt, a professor in women’s and child health, Juliet Rayment, a research fellow, Judith Sunderland, a lecturer and programme lead in midwifery, and Mary Stewart, a research midwife.

It reads:

Refusal to follow NICE caesarean guidance is unjustified

My letter (with the title above) was published in the British Medical Journal today; I wrote it in response to another letter, NICE promises on infertility and caesarean section are unmet, sent in by Lawrence Mascarenhas, a consultant obstetrician and gynaecologist, Zachary Nash, a medical student, and Bassem Nathan, a consultant surgeon.

It reads:

Midwives worth their weight in gold

Every now and then, I meet or read comments by a midwife who is completely and utterly supportive of women who request cesareans, who understands and respects their motivations, and who is willing to speak up about the very real risks associated with a vaginal birth. This is what one midwife wrote on one Australian blog: 

The wrong debate about cesarean sections

Following a comment I left on his article this week, What Is A Normal Pregnancy?, Dr. Silvio Aladjem invited me to comment on an article he'd written in May 2012, titled, The wrong debate about cesarean sections.

 

Here is what I wrote:

Royal Congratulations to William and Kate!

It's great news today that the Duke and Duchess of Cambridge have become new parents to a baby boy.

No news on the name yet - only that he was born at 4.24pm at St Mary's Hospital in London, weighing 8lb 6oz.

Now, I haven't been particularly enamoured by many of the political and ideological debates about what Kate may or may not have wanted in her (private) birth plan, but I thought I'd share a very short anecdote from my experience of talking with other mums this morning.

Australian Royal Birth debate this month



I'm not keen on the title of this debate (it's not for anyone to say how a woman "should" give birth), but in the context of talking about the risks and benefits of different birth plans, the debate below (more information here) may be of interest.

New NICE Quality Standard Reinforces Support for Maternal Request

electivecesarean.com  2013 NICE Quality Standard Reinforces Support for Maternal Request Caesareans and Mothers’ Satisfaction with Maternity Care PRESS RELEASE

Embargoed until 00:01 Tuesday 11^th June 2013 (GMT)

Published by electivecesarean.com

Following the National Institute for Health and Care Excellence (NICE)’s publication of its Caesarean Section Guideline (update) in November 2011, which recommended ultimate support for women who choose to plan a caesarean birth without any clinical indication, and highlighted a cost difference of just £84 with planned vaginal birth when the adverse outcome of urinary incontinence was considered,[¹] electivecesarean.com welcomes NICE’s Quality Standard for Caesarean Section, and hopes that it results in greater adherence by hospitals and health professionals to its 2011 caesarean recommendations.

Guess which makes headlines - Birth Orgasm 0.3% or Perineal Tears 39.9%?

The fact that some women experience an orgasm during birth is not a new concept, as one midwife commented at the bottom of yesterday's Daily Mail article: "Can I please state in 1984 when I became a midwife this was well known so its not a new study, but in 30 years I have never seen it NOT ONCE." (lizzy2511 Swansea, United Kingdom, 2/6/2013 23:41)

But a new study by Thierry Postel has highlighted the possibility once again.

Prolapse surgery unsuccessful for almost one third of women

A new study from the University of Utah School of Medicine (lead author Ingrid Nygaard, M.D), which followed the experiences of 215 women following reconstructive surgery for pelvic organ prolase, has concluded:

"Results after seven years of follow-up suggest that women considering abdominal sacrocolpopexy (surgery for pelvic organ prolapse [POP]) should be counseled that this procedure effectively provides relief from POP symptoms; however, the anatomic support deteriorates over time; and that adding an anti-incontinence procedure decreases, but does not eliminate the risk of stress urinary incontinence, and mesh erosion can be a problem..."

Hooray for the c-section vacation!

Above is the title of a recently posted blog on the U.S. babycenter website by mum of two Kristina Sauerwein.

Kristina's post begins by asking, "Dare I admit that I enjoyed my c-section birth experiences?" and she goes on to describe with relish what she enjoyed about her hospital stay.

Some of what she writes will certainly be controversial for some tastes, but I really felt it was a blog post worth highlighting here as it's a perspective I haven't really seen anywhere else.

Of course, see what you think.

Midwives in Switzerland want greater influence over women's birth choices

Julie Hunt, swissinfo.ch May 13, 2013

Pregnant women are faced with a whole range of birthing options, which can make choosing how to have their babies pretty difficult. An increasing number of Swiss women are opting for caesarians, mostly on the advice of their doctors.
 

The Federal Office of Public Health recently published a report that neither criticised nor supported C-sections. But health care professionals in Stans, canton Nidwalden, are clearly against them. At the cantonal hospital, 29% of births are C-sections, around the national average. Birthing staff want to reduce that number. And at the nearby privately run birthing house, ‘caesarian’ is almost a dirty word. 

Cesarean Cachet or Status Symbol for Brazil Women?

An NPR report this past week, C-Sections Deliver Cachet For Wealthy Brazilian Women, by Lourdes Garcia-Navarro, is available to listen to here, and a few days later, this report by Nicole Stevens was published: Elective Cesarean Sections Seen as a Status Symbol [in Brazil]. I posted the following comment on the NPR news article:

I'd firstly like to agree with the OBGYN below, that it is very important that women are advised of planned cesarean risks, and in particular, the risks of repeat surgeries. This is precisely why CDMR (cesarean on maternal request) is only advised for women planning small families. Additionally,

Two things strike me about this umbilical cord cesarean story

On Sunday, the following story appeared in the Daily Mail: The baby who cheated death by 30 minutes: Doctors spot umbilical cord strangling foetus during routine scan and carry out emergency caesarian at 32 weeks, and two things jumped out at me.

Intervention in childbirth: What’s wrong with letting women choose?

On Tuesday 11th June, Bournemouth University is hosting a DEBATE with free entry, which promises to be interesting.

Intervention in childbirth: What’s wrong with letting women choose? is scheduled to take place between 10am and 12.30pm, and the organisers have told me that a summary will be published afterwards.

Details are as follows:

Hospitals 'are ignoring advice on caesarean sections

This was the headline in last week's Guardian article in which the Royal College of Obstetricians and Gynaecologists (RCOG) and the NCT criticised hospitals for not following NICE guidance on elective cesareans.

Absolutely! I agreed with them.

Just this past week I have been trying to help the latest of many women who have contacted me over the years to say their maternal request cesarean is being blatantly refused.

New ACOG Committee Opinion on Maternal Request

ACOG has just published a new Committee Opinion on Cesarean Delivery on Maternal Request (Number 559, April 2013), and says, "In the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended."

Cesarean rates UP since the 70s and 80s... AND...?

Countless articles, news reports and media interviews begin with an introduction along these lines... "Back in the 1980, the CS rate was just X but today it's risen to Y. Evidently, this is bad."

But surely the CS rate is not all that readers and listeners need or want to know? For example, why not inform them that over the same period, rates of infant deaths have decreased significantly.

Antibiotic risk for all births, but especially planned CS

On Monday, the Chief Medical Officer in England, Professor Dame Sally Davies, warned that unless we "tackle the catastrophic threat of antimicrobial resistance", we could see more people dying following even minor surgery.

The Department for Health press release reports that an infectious disease has been discovered nearly every year over the past 30 years, very few new antibiotics have been developed, leading to concerns that as diseases evolve, they can become resistant to existing drugs.

Dr. Magnus and I wrote about this issue in our chapter on 'Planned Cesarean Risks',

Are women who choose a cesarean LAZY?

Yesterday, Australian radio presenter Jason Morrison hosted a discussion on whether women who choose a cesarean are 'too posh to push'.

His co-host, pregnant and planning a natural birth in a few weeks' time, agrees with some of her friends - that women who choose a cesarean are 'lazy'.

But what I find most interesting about the discussion is this: Jason is very understanding and balanced on the subject - largely because his own wife had a cesarean birth.

Two letters to BMJ editor published today

In response to the publication of a new research paper on the Maternal and fetal risk factors for stillbirth, I wrote two Rapid Responses, and they were published today.

In the first, I ask the researchers whether there is any other data available (in addition to that published) on the gestational ages of the stillbirths that were analyzed in their study, as this information is very useful for women deciding on delivery mode:

Gestational ages at which stillbirths occur and maternal or fetal risk factors observed at term

And in the second, I talk about the caesareans, stillbirth and maternal mortality in Greece and the Netherlands, and question whether the push for 'normal' birth and minimal intervention is the best approach in maternity care:

Reducing mortality is not as simple as low cesarean rate good, high cesarean rate bad

This is  a very quick post to reassure readers who may have read the story making worldwide headlines yesterday: Caesarean deliveries and formula feeding linked to lifelong diseases: research

Incredibly, and despite the fact that it only involved 24 infants, 6 of whom were delivered by cesarean (and we don't know what type of cesarean), one Canadian paper (The Edmonton Sun) even went as far as to call it "the first large study of its kind in North America."

Thankfully, the NHS choices website has produced an excellent 'Behind the headlines' appraisal of the study: Caesarean birth link to asthma lacks proof.

It concludes, "The study does not provide any evidence that the mode of delivery or feeding pattern was the cause of the bacterial levels measured. Neither does the study provide any evidence that being born by caesarean delivery leads to developing asthma later on in life."

Busy blogger

I'm conscious that I haven't blogged for more than a month now, and I have a number of saved drafts that have accumulated here in recent weeks, but I'd like to assure readers that this is only because I have been inundated with birth research and other deadlines throughout January.

As just one example, NICE is currently writing Quality Standards on numerous areas of healthcare, and my organisation recently submitted feedback on the 'Caesarean' Quality Standard draft and there are two others ongoing this month. Each one requires vast amounts of reading and research, and together with other ongoing projects, my blog often ends up taking a temporary back seat.

Apologies for this, but rest assured that I am working hard to ensure that there is greater balance in both the delivery of maternity care, and the information that is provided to pregnant women.

Petition for Ultrasound Scan in Third Trimester

I'd like to highlight the work being done by Rachel Buckley (@rachelbuckley88), who (along with others, including Robbie Devine at POAC) is trying to raise awareness about the benefits of a late term scan in terms of assessing potential problems for your baby or for you.

 

I've just signed her petition below, and if you'd like to do the same, please click here.

 

"In the NHS, pregnant women will be scanned at 12 and 20 weeks gestation. ( First and second trimester). A simple ultrasound scan in a woman's third trimester could save their babies life. This scan should be done as a precaution to check the baby's amniotic fluid is not falling low. The scan can check the baby's growth and can check what position the baby is in! My baby's life could have been saved if I had had an ultrasound scan late on into my third trimester. Women need to be monitored more closely near the end of their pregnancies as this is where things can go wrong and stillbirth could be the devastating result."

Does the NCT tell women the truth about birth?

This is the question posed by New Scientist journalist Linda Geddes, author of the new book, Bumpology, in her new blog, and below is my response:

The impression I have of the NCT recently is that it has had to respond to the huge amount of criticism it's received (whether at the end of news articles, on sites such as Mumsnet or elsewhere), and ensure that its public message is one of support and choice for ALL women -- and not concentrated on the importance of natural or 'normal' birth (or breastfeeding for that matter) for as many women as possible. But while I welcome this change in attitude, my concern lies in how genuine the organisation's assurances really are.  Here's why:

Debate on TOKOPHOBIA broadcast Jan 2

On December 7, 2012 I was fortunate to be a guest at the Voice of Russia broadcast studios to pre-record a five-strong panel debate on the issue of tokophobia. An edited 28 minutes of this discussion aired on January 2, 2013 and can be listened to here, and here is a summary of who was on the panel and what we were asked about:


Too posh to push or too scared to give birth? Latest figures from the Health and Social Care Information Centre reveal that last year 25 per cent of mothers in England had a caesarean. Why so many? Are these mums-to-be squeamish, scared, or sensible? Listen in as VoR discusses the question with midwives and other birth experts. So, does pushing for normal birth always give the best psychological outcome for mothers and babies?

 

VoR's Juliet Spare is joined by Pauline Hull, co-author of ‘Choosing Caesarean: A Natural Birth Plan; Toni Harman, co-creator of the One World Birth film; Virginia Howes, an independent midwife; Zara Chamberlain, who is an NHS midwife counsellor in Kent; and Maureen Treadwell, co-founder of the Birth Trauma Association.

NEWS: Northern Ireland endorses NICE guidance

On December 31, I received this reply from the DHSSPS, in answer to my question about whether its new Maternity Strategy would include the evidence-based NICE recommendations on maternal request cesareans, as published in November 2011:

"Following a Departmental process, the guidance was endorsed for the HSC in November 2012. As set out in Circular HSC (SQSD) 04/11, the Health and Social Care Board are currently considering how best to commission services in line with this NICE guideline.

Is this the cutest cesarean pic ever?



(...our own babies' aside of course!). As reported by LifeNews.com, this "Photo of Baby Reaching Out From Womb During C-Section Goes Viral".
 

I just love this photo of a baby gripping a doctor’s finger during a cesarean, and it's reported that the parents of baby Nevaeh are delighted with it to.