Saturday, January 5, 2013

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:

1) In 2010, in the midst of lengthy and ongoing correspondence between myself and the NCT, I was requesting its help to support my campaign for support for women who request a cesarean, and I supplied some of the same evidence I submitted to the NICE caesarean guideline development group.
I was told in no uncertain terms that I would not be receiving its support. Instead, the NCT maintained that maternal request (MR) would likely increase rates of maternal and infant mortality and morbidity, and compared it to someone demanding a hip replacement with no medical need.
Of course in the following year, NICE published its updated CS guidance recommending that a MR should be supported within the NHS -- a recommendation that could never have been made had there been insufficient evidence to support its comparable safety and cost (with a planned vaginal delivery). To my knowledge, there was no public outcry from the NCT that NICE had made a dangerous or unethical mistake and on the contrary, it seemed to support the guidance.

2) In August 2012, there were was an outcry following the publication of a collaborative document from RCOG, the RCM and the NCT, which contained guidance on the importance of increasing 'normal birth' birth, even if it leads to more ventouse or forceps deliveries (i.e. no epidurals, no cesareans, and defined health outcomes that are NOT considered a gold standard to pursue in many doctors’ and women’s view).
Information on its contents was criticised by a number of maternity charities, organisations and medical professionals (here).
Further, responses (in comments) from news reports of this story were overwhelmingly AGAINST the document's recommendations (here).
And two separate Mumsnet threads expressed overall anger (here).
But yet... although initially removed from RCOG’s website, the document was later reinstated.
My point is that the content of the NCT's antenatal classes may be the least of women's worries. Obviously, it should be of a high quality and presented in a balanced way, but what's far more important is what happens in the labour wards throughout this country and in hospital antenatal consultations where decisions are being made about each woman's birth plan.

This is because you can attend the most informative and balanced antenatal class in the world, but if your request for an epidural or cesarean is ultimately denied (for example), or your pregnancy or labour are allowed to continue for a longer time than you feel comfortable with, or believe to be safe (e.g. late gestation or prolonged labour with warning signs of potential problems), then this will ultimately have a far greater impact on your birth experience and satisfaction.

We need to make sure that the NCT is speaking up for ALL women and ALL choices 'outside' the antenatal classroom too - i.e. when it comes to influencing maternity policy and strategies, hospital targets and political decision-making. Currently, the NCT is relied on far too heavily by the government (and organisations such as the RCOG and RCM) as being the 'representative voice' of women in this country, and there clearly needs to be far greater communication with the many smaller charities and organisations whose members provide them with equally legitimate (and sometimes different) information about what women want from their maternity care.

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