Sunday, July 31, 2011

In sorrow thou shalt bring forth children? (Genesis: 111,16)

This is how Dr Han Dong-up, who works at a Christian hospital in Korea, has described the bonding benefits of vaginal birth, in an article criticizing the high rate (36.8%) of Korean women choosing c-section births:

"We persuade the mothers to endure the pain and see the baby in a more natural state."

"The more painful the whole experience was, the more attached you would feel to the child," he said.

This point of view has been around for centuries, and as anyone who knows their birth history, pain relief in labor (from chloroform through to modern epidurals) has been frowned upon by many health professionals for being "unnecessary".

Perhaps it's only natural that the criticism would extend to prophylactic cesareans too.

Friday, July 29, 2011

TV documentaries Sing from the Same Song Sheet

Barely more than a month after ITV broadcast its programme, "Maternity in Crisis", this week saw BBC Panorama air "One Born Every 40 Seconds".

The message in each programme was the same - maternity care in the UK is failing too many women and babies - but the question is, what can be done about it?

The shocking and horrific stories described in each programme speak for themselves, but what concerns me is the over-riding message (i.e. lyric) that the only way forward is to employ MORE MIDWIVES throughout the NHS.

In my view (and others), what we also need is MORE OBSTETRICIANS - many more obstetricians.

This is the media message we need to be communicating more effectively - please.

Saturday, July 23, 2011

I didn't tear, so you won't tear - if you do it properly

At least this seems to be the advice of Rikki Lake, while talking about her new doc, More Business of Being Born.

When asked her reaction to women who choose cesareans 'to protect their “vaginal integrity”', Rikki is reported to have said,

"It’s a joke! I didn’t tear with either of my children and they were both over 8 pounds. In fact, my midwife came back to my apartment the next day and she looked down there and said that it didn’t even look like I’d had a baby. My body recovered so quickly. That’s what happens when you’re not given a drug that numbs you from the waist down. You can feel what you’re doing."

This type of anecdotal 'informing' women is at best, naive and at worst, irresponsible - perineal and pelvic floor damage caused by vaginal birth is a REALITY for some women.

Wednesday, July 20, 2011

Going Up... 34% U.S. C-Section Rate reported in HealthGrades study

More accurate and relevant information on c-sections is needed - begins my comment on the HealthDay News article, C-Section Rate in U.S. Climbs to All-Time High: Report:

Year after year, we see the same report - cesarean rates hit all-time high. And year after year, the very simplest action is not taken in the USA, which would help us to better understand exactly what's going on and where - so more can be done to target and reduce the most dangerous surgeries, and leave the others well alone.

What am I referring to? Compiling data that is more relevant and precise to different birth plans and outcomes.

Why, when many other developed world countries have been doing this for years, do U.S. hospitals not separate emergency and elective cesarean data as standard

Tuesday, July 19, 2011

My interview with the Western Mail newspaper

Are you too posh to push? asked reporter Rachel Mainwaring, in her article on Sunday.

She was exploring the reasons why some women choose to plan a cesarean birth, and put together her list of cesarean pros and cons.

I was invited to answer some questions about the topic of choosing a cesarean, and you can read the article in full and comment on it here.

Sunday, July 17, 2011

Dr Miriam Stoppard, you disappoint me

Click on Dr Miriam Stoppard's website and you'll read: "I have always aimed to give people the confidence to follow their instincts - whether planning for a healthy and happy pregnancy..."

Well, choosing to plan my two prophylactic cesarean births was a completely natural and instinctive choice for me. My babies arrived safely and I was satisfied with my choice.

And yet during her article, Victoria Beckham had a caesarean - is it the right choice for you? (Daily Mirror 14 July), Dr Stoppard not only strongly criticizes maternal request cesareans, saying they're not natural, but appears uncharacteristically determined not to even entertain the possibility that this choice is a legitimate one.

Critics round on Turkey's 45% c-section rate but are they justified?

A report in Istanbul's Today's Zaman begins: Caesarean births in Turkey at 3 times WHO limit, and has been re-tweeted by critics of c-section surgery.

But aside from the fact that we now know the WHO has admitted it has no empirical evidence for ever having recommended a 15% cesarean rate threshold, this report is sadly lacking in its provision of a more balanced description of what's going on in Turkey.

For starters, there is no mention of the perinatal or neonatal mortality rates in the country, which from my reading of UNICEF and WHO data, have been falling during the last 20 years.

Saturday, July 16, 2011

Media headlines misinterpret RCOG but make good point on Home Birth

The Daily Mail has gone with the headline "Big push for home births: Too many babies are being born in hospital, say doctors", and The Guardian, We need a cultural shift on homebirth - If women are to opt for homebirth over hospital-based care, we must teach them about the benefits of choosing to stay at home.

Unfortunately, according to RCOG's president Dr Anthony Falconer, some media reports may be getting the wrong end of the stick following its maternity "shake-up" proposals yesterday.

I heard Dr Falconer stress on BBC radio yesterday that the RCOG is NOT suggesting more home births, but rather, more births in midwife-led centers.

But what RCOG may have failed to recognize is the fact that women perceive the SAME risks (see below) with both, which is why its proposals are not feasible.

Friday, July 15, 2011

Cesarean Infearmation is Unnecessarily Frightening

Is it really necessary to instill SUCH levels of cesarean fear in women?

During the last two episodes of 'One Born Every Minute' that I have watched, I have seen women writhing in agony, labor not progressing, baby's heart rate decelerating, and they cry out, "I don't want to be cut. I don't want a cesarean. Please.
Surely this is a sign that we are failing in antenatal care?

Thursday, July 14, 2011

Shaken, Not Stirred: RCOG's proposed maternity shake-up hard to swallow

It's been reported right across the media today (e.g. BBC news online) that the Royal College of Obstetricians and Gynaecologists wants to shake-up UK maternity wards.

But as far as I can tell, the proposed new model mirrors the maternity care system in The Netherlands rather too much for my taste - where the perinatal mortality rate is NOT something I think we should aspire to.

The problem is this (as outlined in my letter to the BMJ, which was published earlier this year): who is capable of identifying - without the benefit of hindsight - low risk pregnant women?

Wednesday, July 6, 2011

Researchers want to know Reasons why women Choose Cesareans

Sign up to volunteer information on the reasons YOU decided to request a cesarean birth here.

Australia's Herald Sun has reported today that: James Cook University and Australian National University researchers are trying to recruit 1000 women planning their first vaginal birth or planning an elective caesarean birth.

Read medical studies - but Beware Bias

I came across this article yesterday, which offers a wonderfully simple explanation of how bias can creep into the medical studies you might read about.  Interestingly, the author mentions the WHO's heavily criticized survey on cesarean births,

Monday, July 4, 2011

Old School versus New Science - Birth Advice

There is no getting away from the fact that different medical professionals hold very different views about what constitutes optimum maternity care for women and babies.
Women need to understand this fact - your information will almost always come from someone with a personal and professional view of birth risks and benefits, and so it's important to do your own homework too.

Just yesterday, I came across this post on a nursing website: "C-section vs. letting Mom go naturally", in which a nurse (I believe) criticizes a doctor's offer of a planned cesarean to her friend, whose baby might be macrosomic at birth (large).

Sunday, July 3, 2011

Job satisfaction for midwives - should it matter?

I understand why people are drawn to working in the maternity services, and I understand how welcoming a new life into the world as part of your regular day's work must be very rewarding.   
But a question that comes up in my mind again and again, is whether some midwives (and indeed some OBGYNs) are focusing too much on their own personal job satisfaction - and not enough on the birth satisfaction of the mothers in their care?

Has AIMS misunderstood what women in labor want? You decide...

While listening to a recent episode of Woman’s Hour last week, it struck me how even the most basic research can be misunderstood by its interpreters - and in this case, Beverley Beech, the Chair of AIMS.

Beverley was talking about the subject of 'Birthing Buddies' (which is where a supportive, trained carer stays with a woman throughout her labor), and wanted to emphasize that in this role, the 'buddy' does not necessarily need to take an active support role in the birth - it is merely their presence in the room that is of importance.

However, the research example that Beverley provided as proof of this assertion communicated something completely different to me.