|DO NOT INTERVENE
Just when are hospital staff and politicians going to understand that a normal outcome is NOT more important than a healthy outcome??
When are we going to see a shift in policy that focusses on birth outcomes and NOT the birth process??
The BBC reports today of a Warwick Hospital apology over death of newborn baby who was starved of oxygen during labour in May 2012. It says, "hospital staff did not monitor the baby's heart rate properly and failed to recognise he was in distress"; Lucas suffered brain damage and died a few days later.
According to the Daily Mail, Lucas' mother, Natasha Fermor, is 40 years old and now has advanced breast cancer). It says she was induced, and that while in labor she "was told that everything was fine." There is no mention of whether a planned cesarean was ever discussed as an option...
TARGETS IN PLACE
I have repeatedly expressed grave concerns about the push for 'normal births' at any cost, and when I did a little research this evening into South Warwickshire NHS Foundation Trust (SWFT), I discovered that it is one of the 19 Trusts in England where the NHS Institute for Innovation and Improvement's controversial Toolkit for reducing Caesarean section rates was first implemented.
The Institute stated in 2009 that "Normal birth is both cheaper and safer than Caesarean section" (note the complete lack of distinction between planned and emergency surgery here).
As such, in SWFT's Quality Accounts 2009/10, you can read how the Trust is seeking "to promote normal birth and reduce caesarean section rates... [with] an evidence based guideline for Care of Women in Labour, which empowers midwives to avoid unnecessary interventions which may lead to a cascade of further intervention, [as well as] updates for every midwife in the skills and art of facilitating normal birth".
It says, "In the coming year we have set a target of increasing our normal birth rate from a consistent 61% to 65%, and will focus on retraining midwives in skills that facilitate normal birth. We will also work... to ensure safe outcomes for both mothers and babies."
Interestingly, in February 2012 Minutes of the SWFT's Clinical Governance Committee Meeting, it says, "The high caesarean rate was noted and it was suspected that this might increase further due to the NICE guidance on elective caesarean sections."
No specific 'Action' is then noted, but in a July 2012 report to its Board of Directors (two months after baby Lucas' death), Promoting normal birth is listed as a High Impact Action - with "Continued emphasis on promoting normal birth". Cesarean rates for 2011/12 are highlighted as being at 26%, "slightly above standard of 25%... due to increased numbers of higher risk births", --- yet nowhere do I read any mention of what the hospital's perinatal mortality or stillbirth rates are, or what percentage of women are left with debilitating pelvic floor damage or psychological trauma following their births.
And this is despite SWFT's March 2011 report to its Board of Directors reporting that its instrumental deliveries are 14.4%, "the highest in the region (average 9.7%)" or that its stillbirth rate of 5.7 per 1000 births "is greater than previous years where traditionally SWFT had always one of the lowest rates in the region."
Finally, I read that the Trust's Maternity Forum 2011 Annual Report concludes, "Labour Ward staff are to be congratulated on real progress this year in reducing the caesarean section rate for first timers. This must continue to be a key focus of work."
No, no, no, no, no!!!!
Reduce unwanted cesareans where safely possible, YES.
Reduce emergency cesareans where possible, YES (but while including 'planned cesareans' as a viable alternative for women deemed at risk for an instrumental or surgical delivery).
Consider alternatives to induction as the default for late gestational age, YES.
Put individuals' best physical and psychological outcomes ahead of flawed cost-saving strategies, YES (NHS Litigation Authority data shows just how much delayed or absent cesareans cost).
Make 'reducing stillbirth and perinatal mortality' a key focus of work - not cesarean rates, YES.
Make 'positive psychological outcomes' another key focus, YES (an epidural isn't 'normal' according to these targets, but many women WANT one and are very UNHAPPY and even TRAUMATIZED when they don't get one).
* * * *
Lucas' parents, like countless parents before them, have said they want to "ensure the hospital has indeed learnt lessons from what happened to Lucas so that no other couple has to suffer the heartache we have endured."
But it is my belief that until we get away from arbitrary targets to reduce cesarean rates and increase 'normal birth' rates, I will be returning to this blog - all too soon - to write about the next reported case of death or injury following a trial of labor that went unforgivably wrong.