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?

- Listen to women.
- Listen to smaller organisations that represent women.
- Emphasise less the importance of the birth process, and wanting as many births as possible to be 'normal', and focus more on safety and patient satisfaction.
- Learn from mistakes.

- Ensure that caesarean on maternal request NICE guidance (and quality standards) is followed in ALL hospitals; too many women are still being refused (most recently my organisation was made aware of case in which the phrase 'too posh to push' was used during a woman's antenatal con- sultation - this is unacceptable).
- Recognise it is not simply staffing shortages that are an issue (though more consultant obstetricians are needed and one-to-one midwifery care is beneficial) but rather the attitude that all women 'should' give birth naturally - restricting access to epidurals and caesareans (whether these are requested before or after the onset of labour).