Last night, I contacted BBC Complaints, and also the programme itself, to ask why 'news' of NHS Trusts banning maternal request cesareans was presented in such an unbalanced and one-sided way.
The guest being interviewed on Monday's show was Dr. Sarah Jarvis, someone who clearly had her own personal views about maternal request, and whose views went completely unchallenged during the live chat.
The programme will only be available on BBC iPlayer (20 mins in) for a few more days, so I have typed up the transcript of what was said below:
You can draw your own conclusions about what was said:
Alex Jones: But some news today that the NHS Trusts are restricting cesarean births, aren’t they?
Dr Sarah Jarvis: They are, but that does not, absolutely does not, mean if you need one, you’re going to have problems getting one. This is about women who make a choice. They say, I want, not I need, I want to have a cesarean. And NICE, the National Institute says, 'Actually, it’s got to be done on clinical grounds.'
Now, to put it into perspective, the World Health Organization says, ‘No way should more than 15% of women in a country be having cesareans.' In our country, it’s 25%, so they can’t all need them. There has to be a yummy-mummy, a too-posh-to-push effect out there. I have to say. And that’s what…
Alex Jones: And the too posh to push – that’s pushing up that percentage is it?
Dr Sarah Jarvis: Well, I don’t think it’s all to do with that.
Alex Jones: Come on Sarah… (smiles)
Dr Sarah Jarvis: Well I don’t think it’s all to do with that, but I do think that there is…(trails off) People forget - cause, you think of cesareans, you think of having a baby, and you think, 'Oh I’m going to come out of it with a wonderful baby at the end.' Actually, this is really major surgery. If it was any other operation, and you weren’t having a baby, you know, you’d have taken to your bed for a couple of weeks, you wouldn’t have lifted anything for three months. This is big stuff, don’t take it lightly.
(Dr Jarvis then turns to Luol Deng, who is seated next to her)
Dr Sarah Jarvis: You would never take a cesarean section lightly, would you? (laughter)
In my opinion, this was one of the most unprofessional examples of maternal request cesarean news coverage I've ever seen, and that's saying something.
So...is Dr. Sarah Jarvis really a medical doctor?? Maybe she has her PhD in something like Geology or Sociology? She doesn't seem to know anything about obstetrics or cesareans.
I watched this episode and there was valid advice, It is a major abdominal operation with all the risks associated with any major surgery. I had 2 C-sections one for a Placenta Previa (potentially fatal to mother and baby. The other due to feotal distress.
What would you have like Dr Jarvis to add to make this more professional?
Do you disagree with the NICE guidlines? If so, what evidence has led you to disagree?
Not surprised, there are people in this world demanding that their healthy limbs are surgically amputated. Sadly, there are so called "ethicists" who think if that's what they want it's ok and there are surgeons not in the hypocratic tradition willing to do it! non medical caesarian is on the same continuum. publish if you dare!
Dr Sarah Jarvis is a registered general practitioner, and a specialist in women's health. As such, her views - while perhaps unpopular as far as this blog is concerned - are valid. I agree with Gill that the overall advice is also valid, based on the reasons Gill gives above.
Just a short update - I am still in communication with the BBC regarding this complaint, and once this is completed, I will write another post that should answer all of the above questions and comments.
Thank you for your patience.
I suffer from tocophobia and very nearly complained at the same story. I found her attitude very distressing and neglected to address the reasons why women are actually choosing c-sections. The reason I didn't is more to do with taboos, and not feeling as if my complaint would be taken seriously anyway, so big thank you for doing so.
The whole drive to ban elective c-sections is very worrying. If anything it makes me look towards going private (which I can't afford), or not having children at all as I feel as if the NHS is increasingly unable and unwilling to help people like me. Not to mention that women just don't realise that mental health issues are a medical need or simply feel unable to get their fear diagnosed as being a clinical need.
There is a massive hole in research here - the reasons why women are choosing to have elective c-sections on maternal requests (either on the NHS or privately) is not being recorded. My suspicion, is that women are not "too posh to push" and making a lifestyle choice, but are genuinely afraid for whatever reason and are not finding support elsewhere within the system.
All in all, I just feel that tocophobia is regarded with a general level of contempt as a middle class made up condition to justify elective c-sections and from experience on how it affects me, it really isn't. We need more awareness, genuine support and professional acknowledgment.
I really feel her comments feed the ignorance and prejudices against people like me, by reinforcing them. It certainly isn't helping the situation and encouraging people to speak out about their fears. I do not think this is in the best interest of women. We need to know WHY women are really making this choice before policies are being made. If it wasn't for the NICE draft being encouraging, I think I would be giving up all hope of ever being able to have children.
P.S. The recent Swedish study lead by Gunilla Sydsjo at the University Hospital Linköping, has some very interesting results regarding fear and outcomes of birth. Well worth a read when discussing electives, costs and outcomes.
...."They are, but that does not, absolutely does not, mean if you need one, you’re going to have problems getting one."....
is what Dr Jarvis stated, and those with tocophobia ARE in need.
There should not be a problem in those cases.
Dr Jarvis could indeed have explained in a more sensitive manner but was reporting on NICE's decision to be more stringent against those who ELECT to have a caesarian,
NOT those with a genuine need, such as tocophobia
The informed decision to choose a planned cesarean with no medical or obstetrical indication is perfectly legitimate.
Legitimate decision indeed but maybe not the sort of operation which the public would be happy was routinely funded out of public funds without justification.
Which is what NICE was set up for and has adjudicated on.
The attitude Dr. Jarvis had towards those who do legitimately choose a planned cesarean with no medical or obstetrical indication, however does indeed leave something to be desired, but she was as I said in my previous blog REPORTING on NICE's policy
The current 2004 NICE Guideline does not list tokophobia/fear of childbirth as a legitimate indication for CS. It states:
“When a woman requests a CS because she has a fear of childbirth, she should be offered counselling (such as cognitive behavioural therapy) to help her to address her fears in a supportive manner, because this results in reduced fear of pain in labour and shorter labour.”
I know of numerous women through my seven years of work and research who have been denied their cesarean birth choice on the grounds of tokophobia/ fear of childbirth, including two women who, despite obtaining second obstetrical opinions (and in one case counseling and cognitive therapy also), were still refused a planned caesarean and terminated their pregnancies.
In May 2011 (3 months before The One Show report), NICE published its first draft of the Guideline update and stated – for the first time – that for fear of childbirth at least, a woman’s “request for a CS should be supported within the health service” if following discussion “a vaginal birth is still not an acceptable option”.
Therefore, while Dr. Jarvis may personally see tokophobia as a legitimate reason to plan a cesarean, it's important that people understand that this is actually NOT current NICE guidance. The new guidance will be published later this year.
Re: cost and public funds
Please see my post on this:
The BIG problem here is the lack of awareness of tocophobia. The majority of people have no clue what it is, the reasons behind it and if you try and explain you very quickly get the comments like "everyone is afraid", a lack of sympathy and the too posh to push accusations. If you say you are considering an elective as an option the immediate reaction is generally a very negative one. Its very difficult to get beyond physical reasons as the only reasons for an elective.
It is not a conducive culture that helps women understand and realise they they have a NEED that may be medically recognised if they have tocophobia. Especially when you have the likes of Dr Jarvis fuelling the too posh to push thing and making it sound like it is much bigger than it actually is. If you see a doctor on tv saying that, are you going to ask your doctor for help? The answer is no as you think you will suffer the same judgment and will be refused anyway.
Which is why I found her opinion just so utterly unprofessional and further neglecting a huge number of women, who need help, don't feel supported and feel increasingly alienated by these policies. We need doctors to explain there are both physical AND mental reasons behind maternal requests. They need to acknowledge there is a problem with some women getting this recognised. The media's role in breaking apart the too posh to push thing is hugely important.
Do we actually have any properly studied surveys with real figures for the number of women having "lifestyle" maternal request c-sections? A study which actually asks the women involved about the reasons for their decision, rather than a medical definition? Something more than anecdotes and tabloid headlines? Until I see such a study, I really do maintain, that I'm convinced that the majority of these maternal requests are based on something more than just vanity and selfishness. No one is asking the really important questions here and are instead just jumping on a bigots bandwagon at the expensive vulnerable women. This is what angers and upsets me so deeply.
I just thought instead of giving an informative comment and explanation, it was judgmental, damaging, pandering to sensationalism and a step backwards to women who are already suffering in silence. We need support and understanding from doctors and we need the press to help by starting to ask the right questions.
Mary Dejevsky wrote a wonderful article for the independent last month questioning the actions of women who are using private maternity services. Its not about tocophobia, but its good to see someone seeing birth choices as more than simply middle class lifestyle choices. THIS is what journalists and the media in general should be doing.
Sorry to leave another message about this, but I think theres a really important message and gap in data that needs to be addressed and is being hidden by the "too posh to push" frenzy.
Select Committee on Health Fourth Report 2003
Point 86 states women who have maternal requests mainly do so for fear.
Points 81 & 82 (82 is highlighted in BOLD) Describe how there is wide ranging issues in how electives are recorded, and recommended that there be consistency in how they are done nationally and better categorisation.
This is where I see a MASSIVE problem. I've been trying to get information and support on forums, and came across the fact that three women saying that they had an elective on the grounds of tocophobia and yet it was recorded as "maternal request" or "social". The observations and recommendations of the 2003 report seem to have been completely ignored.
All three women were unhappy with this. One even described how this had a negative impact on how she was treated by midwives - the last thing a tocophobic needs. One wanted to change it, but had no idea how. And the third wasn't happy, but was just grateful she was having the c-section.
All three had explained they had been properly diganosed by a psychiatrist and signed off by a consultant.
This means when Trusts or anyone else is looking at the figures they are just seeing words that feed into the myth. What they aren't seeing are the words "mental health". Its having an affect on policy making and prevents research that might help women.
Anon, this is an absolutely excellent point regarding data collection and reporting. In fact, the separation of data (or rather lack of it) has been one of my main points from the very beginning of my campaign.
Thank you so much for adding your comment on tokophobia - it is a very important one.
It would help if you could spell the word caesarian seen as its being hotly debated, its a major operation, and women recover better having their babies normally. If they cant have them normally the medical intervention is necessary.
I use the American spelling of cesarean because my book is being published there and I was living there when I started blogging.
The British spelling of cesarean is caesarean.
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