National Maternity Review Silent on Life-Saving, Prophylactic Cesareans

Opening the pdf of 'BETTER BIRTHS - Improving outcomes of maternity services in England' today, I was reminded of the faulty Shopkin packet my daughter opened recently - EMPTY, with No Surprises At All.

Not a single mention of how a timely, planned cesarean birth can save lives (especially full-term babies at risk of stillbirth), protect against pelvic floor damage, and result in high maternal satisfaction for women who choose it.

'Safety' on pg.23 reads: "There was evidence from the data of opportunities for improvement in the safety of maternity services. For example: stillbirth ... instrumental deliveries resulting in third and fourth degree perineal tears...[and] almost half of CQC inspections of maternity services result in safety assessments that are either ‘inadequate’ (7%) or ‘requires improvement' (41%)"

And despite the fact that a cursory glance at NHSLA obstetrics cases demonstrates significant (and costly) mortality and morbidity of mothers and babies when cesareans are carried out too late or not at all, England's new National Maternity Review contains just three mentions of cesareans:

Pg.3 refers to an anecdote about watching a twin caesarean delivery.

Pg.27 refers to RCOG Clinical Indicators project data on emergency caesarean sections rates.

Pg.77 cites 'rates of caesarean section' as a marker of quality in South West Trusts.

Compare this to pg.99:

Feedback For Baroness Julia Cumberlege

On February 12, 2016, just ahead of the National Maternity Review being published, I commented on this post by Baroness Julia Cumberlege: "We are shaping services for years to come."

"The focus on natural or normal birth at any cost, and targets to reduce caesarean rates (as though a low percentage rate alone is a measure of good health outcomes - it is not) have endangered - and lost - the lives of countless mothers and babies giving birth in our maternity care system.

Women and their partners are not always listened to - be that a request for a caesarean birth during pregnancy or a request for intervention of any kind after the onset of labour - and all too often there are adverse consequences as a result.

A fleeting glance at the cost and causes of obstetric litigation in the NHS will confirm this, and even this doesn't reflect all the families who decide not to pursue a legal route.

Women who are at full-term in their pregnancy are rarely advised of the risk of stillbirth,

2015 Consultation Comments Submitted to National Maternity Review

On October 31, 2015 my organization electivecesarean.com (also a Stakeholder for various NICE guidance), submitted the following comments during the National Maternity Review consultation:

4.1 Which users/groups/organisation do you represent?
The organisation electivecesarean.com represents women who choose to plan a caesarean birth and also the wider group of pregnant women who don't have a specific birth plan in mind, but deserve access to balanced information on the risks and benefits of different birth plans as they relate to their individual circumstances.

4.2 What do you think are the barriers to providing high quality maternity services?
- The push to reduce caesarean rates to arbitrary levels at any cost (in 2009 the WHO admitted that there is no known optimum rate yet in 2012 the RCOG, NCT and RCM published recommendations to CCGs of a 20% rate).
- There is an emphasis on process (i.e. achieving 'normal' birth) over outcome, positive experience and patient satisfaction.
- Lack of balanced information during antenatal care - risks of planned caesarean are over exaggerated and risks of planned vaginal delivery are underestimated and/or not communicated at all (e.g. stillbirth and pelvic floor damage). 
- Research that does not gather and report on maternity data in a way that best informs both national research and evidence, and women (e.g. the Birthplace Study only compared place of birth and not mode of birth, which is unhelpful; it also excluded stillbirths that occurred prior to the onset of labour).

4.3 What do we need to do to make maternity services better?