Tuesday, February 23, 2016

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:
"the NPEU evidence reports commissioned for this review show that midwifery care results in fewer interventions. If we can increase the proportion of births supported by midwifery care, we will be able to reduce the cost of medical interventions."

And pg.30: "planning a birth at home [for low risk women having a second or subsequent baby] or in a midwifery unit results in fewer interventions, the chances of transfer are low, and there is no evidence that outcomes are worse."

Unsurprisingly, the 'Maternity review bold plan for safer, more personal services' is not a bold one at all - just the same old, same old - IDEOLOGY continuing to trump balanced INFORMATION in NHS maternity care.

Though there may be one silver lining...
If the NHS Personal Maternity Care Budget mechanism is there to 'support women in their community to take control of their decisions and their maternity care', perhaps this means that, finally, ALL women whose choice it is to plan a prophylactic maternal request caesarean will be supported in their request, as per 2011 NICE guidance and 2013 NICE quality standards.

We'll see...


Anonymous said...

I suffered a horrendous natural birth. I tore so badly that I needed 2 hours of repair surgery, lost lots of blood, 35 internal stitches and 11 externally. I had intense pain and discomfort for months afterwards, had to see a specialist gynae physio to help with continence issues, and still have scar problems. Sex was painful for nearly 3 years. Why, after that, should I have to fight for a planned, elective c section, where I know the risks and what happens, with a scar I can manage (as opposed to having so many vaginal exams by random medical people to make sure it was healing) or be forced to deal with the emotional trauma of natural birth, and face it happening again? I had post partum depression badly after birth, partly attributed to this.
Women should have a choice, and if a cesearean section is going to help her mentally and physically, then she shouldn't have to fight for it, and be treated like she's abnormal.

Anonymous said...

I am from the U.S. - but I had what I consider to be a forced vaginal birth. I had a vaginal birth 13 months ago, which I am still struggling to recover from mentally and physically. It was a long and barbaric labor. I chose midwife care because I was mistaken in believing they would provide the same level of care as an obstetrician but offer the emotional support I thought I would need. My expectations were far from the reality of my experience. My delivering midwife was atrocious. I had already been pushing for five hours when the shifts changed and she came on duty. When she was around she treated me like a barn animal. I was demanding to know what my other options were. Her simple answer, "Well, there's the vacuum, the forceps, or c-section, and you DON'T want that." No reasons as to why I would choose one or the other, or why I shouldn't. I advised that I couldn't make a decision without understanding the risks. She spent thirty minutes hunting down a doctor to tell me about the vacuum (I think you call it a ventouse) and the forceps. I kept saying, I will not allow this without understanding the risks. Through my stomach turning contractions this doctor was explaining to me the risks of these procedures. Why had no one told me this was a possibility before? Why hadn't I been made to understand the risks of forceps or vacuum before I went into labor, rather than trying to understand these issues through contractions? All he had to say was "possibility of brain damage" for me to demand a c-section. The midwife took over an hour to find another doctor to perform a c-section (we were in a hospital, mind you, not Antarctica). By the time she showed up with a doctor, my baby was crowning. I believe my midwife purposefully and with intent lied to me about the size of my baby, my specific risk factors related to my GD, did not tell me the risks or reasons why one would need forceps or vacuum (which I thank God every day I did not use).

In the end, I had a nine pound baby, although I was guaranteed by 2 different midwifes he would be seven pounds. I suffered first and second degree tears. It has been 13 months, and I still suffer through sexual intercourse. I have doubts I will ever be able to enjoy sex with my husband again. I wish my choices had been honored. I wish I had been treated like a human being. I wish I had been given the right of informed consent.

Intervention rates will ALWAYS be lower with a midwife - because they will lie and risk you and your baby to get that vaginal delivery. My next birth will be maternal request c-section.