tag:blogger.com,1999:blog-41814726716486180712024-03-06T20:01:07.360+00:00cesarean debate (now caesareanbirth.org)The informed decision to choose a planned cesarean with no medical or obstetrical indication is perfectly legitimatecesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.comBlogger389125tag:blogger.com,1999:blog-4181472671648618071.post-64924587220241564312016-11-10T21:39:00.000+00:002016-11-10T21:40:51.193+00:00Written Evidence Submitted to UK Parliament Science Communication Inquiry <div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdSQvCrRgnsecBNcTB0qNSm8TufpC0LKx7RX0YCfa9wfh4iO48ztxDw1Rsmq7R0gsViM0L7ztcU5lbPPvLQ3sGxvxe9pVVhTWf-zgw29xKfrq2AHa4EOeuzmHsW9X4iKKnfg3fcf02cGU/s1600/11-Mar-14-16+rocking+chair+rushmoor+chilworth+gym+birdworld+002.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdSQvCrRgnsecBNcTB0qNSm8TufpC0LKx7RX0YCfa9wfh4iO48ztxDw1Rsmq7R0gsViM0L7ztcU5lbPPvLQ3sGxvxe9pVVhTWf-zgw29xKfrq2AHa4EOeuzmHsW9X4iKKnfg3fcf02cGU/s1600/11-Mar-14-16+rocking+chair+rushmoor+chilworth+gym+birdworld+002.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdSQvCrRgnsecBNcTB0qNSm8TufpC0LKx7RX0YCfa9wfh4iO48ztxDw1Rsmq7R0gsViM0L7ztcU5lbPPvLQ3sGxvxe9pVVhTWf-zgw29xKfrq2AHa4EOeuzmHsW9X4iKKnfg3fcf02cGU/s200/11-Mar-14-16+rocking+chair+rushmoor+chilworth+gym+birdworld+002.JPG" width="200" /></a></div>
In August 2016, my response to the Science and Technology Committee's invitation for written submissions was <a href="http://data.parliament.uk/writtenevidence/committeeevidence.svc/evidencedocument/science-and-technology-committee/science-communication/written/36576.html" target="_blank"><strong>published here</strong></a>.<br />
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Unfortunately, many advances in science are viewed as negative and unnecessary '<em>medical interventions</em>' in maternity care, and women are simply not informed about them.</div>
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<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-56973466902390855312016-11-10T19:56:00.002+00:002016-11-10T23:27:16.220+00:00Planned Birth Research that Does Not Compare Planned Birth Outcomes CANNOT INFORM BIRTH PLANS<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcxstQT9hS5fKyCZF0Ck7bdu1XTVwxaqh2V0vWkiTzm6OJ5XL8a1iNTr-j11Xa8NxpiEPjg1owh7hYQ5_WlG6lVM4vKV-VXo5W_orLCCGISyBFSTb9ES5IPcMPrPGH3-ZfUss8qYRoyJ0/s1600/IMG_5662.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcxstQT9hS5fKyCZF0Ck7bdu1XTVwxaqh2V0vWkiTzm6OJ5XL8a1iNTr-j11Xa8NxpiEPjg1owh7hYQ5_WlG6lVM4vKV-VXo5W_orLCCGISyBFSTb9ES5IPcMPrPGH3-ZfUss8qYRoyJ0/s200/IMG_5662.JPG" width="186" /></a></div>
<a href="http://pediatrics.aappublications.org/content/early/2016/11/03/peds.2016-2002" target="_blank">Researchers</a> this week warn women and doctors against planning births prior to 39 weeks because of an increased risk of poor child development at school.<br />
<br />
Predictably, the media has reproduced their conclusions almost unequivocally:<br />
<div>
- <em>American Council on Science and Health</em>: <a href="http://www.acsh.org/news/2016/11/08/planned-birth-non-medical-reasons-not-such-good-idea-10416" target="_blank"><strong><em>Planned Birth for Non-Medical Reasons not such a Good Idea</em></strong></a></div>
<div>
- <em>The Sydney Morning Herald</em>: <a href="http://www.smh.com.au/national/health/planning-an-early-caesarean-raises-the-risk-of-developmental-delays-sydney-researchers-find-20161108-gskq7s.html" target="_blank"><strong><em>Planning an early caesarean raises the risk of developmental delays, Sydney researchers</em></strong></a><br />
- <em>Medscape</em>: <a href="http://www.medscape.com/viewarticle/871484" target="_blank"><strong><em>Early Planned Birth Tied to Greater Risk for Poor Development</em></strong> </a></div>
<div>
</div>
What no one seems to have noticed is that the researchers don't factor in two very important risks of waiting until 39 or 40 weeks and/or spontaneous vaginal birth:<br />
<strong>stillbirth </strong>and <strong>intrapartum death or injury</strong>.<br />
<br />
The babies who died couldn't be assessed for their early child development, but by excluding their demise from the data, this research is unhelpful for the purpose claimed:<br />
<br />
Remember - the aim of <a href="http://pediatrics.aappublications.org/content/early/2016/11/03/peds.2016-2002" target="_blank"><em>Planned Birth Before 39 Weeks and Child Development: A Population-Based Study</em></a> (<em>Bentley JP et al, Pediatrics Dec. 2016</em>) is "'<em>to inform more judicious clinical decision-making</em>" as women approach the end of their pregnancy, by communicating the "<em>benefits of waiting</em>".<br />
<br />
<span style="color: #38761d;"><strong>In this context, listed below are 8 points that summarize important flaws in this research:</strong></span><br />
<a name='more'></a><br />
<br />
<div>
<strong>1)</strong> The study population only includes <strong>LIVE BIRTHS</strong>, and therefore hides all loss of life prior to 39 weeks' gestation. Babies who are stillborn or die during their intrapartum care cannot be assessed for early child development, but by excluding their deaths (at each gestational age) from the data, the research cannot fully inform birth plan decision-making. <br />
<strong><u>Note</u></strong>: Stillbirth data published by the <em>Australian Institute of Health and Welfare</em> in 2014 showed a spike of 179 deaths at 38 weeks' gestation (152 at 37 weeks' gestation) between 2000-2009 (which covers the birth years of the children included in this study); a further 440 babies were stillborn after 39 weeks' gestation; a further 440 babies were stillborn after 39 weeks' gestation, and none of these numbers include intrapartum deaths during a trial of labor.</div>
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</div>
<div>
<strong>2)</strong> The researchers base their comparison on how many children are 'developmentally high risk' (DHR) or developmentally vulnerable (DV) on an <strong>erroneous referent birth group</strong>, which is: '<em><strong>vaginal birth after spontaneous labor</strong></em>'. <br />
This is a birth OUTCOME, not a planned mode of delivery, and it is neither known nor guaranteed at the point of decision-making about delivery. The UK's 2011 NICE caesarean guidance demonstrated the importance of comparing different PLANNED modes of birth (PCD & PVD), with each set of corresponding outcomes, and it is entirely disingenuous for studies to continue comparing only the 'best' outcomes of PVD with 'all' PCD outcomes.</div>
<div>
</div>
<div>
<strong>3)</strong> For ALL outcomes, the number of children considered DHR or DV is actually higher for '<em>vaginal birth after spontaneous labor</em>', and while adjustment for confounders puts births with obstetric interventions in the higher DHR/DV risk group, '<em><strong>cesarean section after labor induction was consistently associated with the largest increase in risk</strong></em>'. This is important because if the data was recalculated to compare PVD and PCD (where emergency caesareans are outcomes of the PVD group), then PCD would compare more favorably.</div>
<div>
</div>
<div>
4) Children who scored in the bottom 10% of nation domains were considered DV, and children DV for ≥2 domains were considered DHR. We know that 91% of the children being assessed were younger than 6 years old, half of them were younger than 5/5 years old, and 8% were only 4 years old. Given the different pace of cognitive development that occurs in different children, and given that language and cognitive skills, social competence, emotional maturity, communications skills and general knowledge all formed part of their assessment in this study, it is likely that relative age effect (RAE) may have accounted for some of the children in the lowest 10%. Notably, 13.7% of 4 year-olds were labeled DHR compared with 9.6% of ≥ 6 year olds and 7.6% 5/6 to 5/11 year olds.</div>
<div>
</div>
<div>
5) The authors state that '<em>evidence is lacking or suggests little benefit</em>' for <strong>suspected fetal macrosomia</strong>. However, in the context of developmental delay in school, the impact of Erb's Palsy injuries (shoulder dystocia risk is higher with macrosomia), which can directly affect a child's ability to write and engage in other school activities, is a legitimate consideration for women when planning their birth mode, as is the increased risk of stillbirth with macrosomia, in terms of delivery timing. </div>
<div>
</div>
<div>
6) Advising women of the "<em>benefits of waiting</em>" needs to be done in conjunction with a <strong>late-term scan</strong> (to check for any cord complications, for example) and an honest discussion about the '<em>risks of waiting</em>', including late gestation stillbirth. Anything less is not providing balanced information. </div>
<div>
</div>
<div>
7) US term stillbirth rates and the 39-week rule: a cause for concern? (AJOG 2016) <br />
“<em>…the push to strictly enforce the 39-week rule should be reconsidered and guidelines concerning the use and timing of early-term labor induction should once again allow for both provider-level clinical judgment and individual patient input. <strong>Given the literal “life and death” importance of this issue, and given the need to fairly balance the ethical principles of Beneficence and Autonomy, there is reason to consider a moratorium on the enforcement of the 39-week rule </strong>until further research, including adequately powered randomized clinical trials, can better measure its benefits and risks.</em>”</div>
<div>
</div>
<div>
8) Neonatal outcomes after implementation of guidelines limiting elective delivery before 39 weeks of gestation (Obstet Gynecol, 2011) <br />
“<em>A policy limiting elective delivery before 39 weeks of gestation was followed by changes in the timing of term deliveries. This was associated with a small reduction in NICU admissions; however, <strong>macrosomia and stillbirth increased</strong>.</em>”</div>
<div>
</div>
<div>
<strong><span style="color: #38761d;">Summary</span></strong></div>
<div>
</div>
<div>
<div>
One of the greatest powers birth researchers have is the fact that their <a href="http://pediatrics.aappublications.org/content/early/2016/11/03/peds.2016-2002" target="_blank">Abstract</a> will be shared by journalists and members of the public without most ever reading the <a href="http://pediatrics.aappublications.org/content/early/2016/11/03/peds.2016-2002" target="_blank">Full Text</a> or challenging their caesarean criticisms.</div>
</div>
<div>
The fact that studies like this one go viral, and are published on multiple international medical news platforms with little or no challenge, is a serious concern given the issues raised above.</div>
<div>
</div>
<div>
I absolutely agree that we need to "<em>ensure optimal child health and development</em>", but it's important to recognize that this starts with doing all we can to make sure that these babies are born alive. </div>
<div>
</div>
<div>
</div>
<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com1tag:blogger.com,1999:blog-4181472671648618071.post-35805738779126139772016-11-10T19:56:00.000+00:002016-11-10T19:56:53.238+00:00Planned Birth Research that Does Not Compare Planned Birth Outcomes CANNOT INFORM BIRTH PLANS<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcxstQT9hS5fKyCZF0Ck7bdu1XTVwxaqh2V0vWkiTzm6OJ5XL8a1iNTr-j11Xa8NxpiEPjg1owh7hYQ5_WlG6lVM4vKV-VXo5W_orLCCGISyBFSTb9ES5IPcMPrPGH3-ZfUss8qYRoyJ0/s1600/IMG_5662.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjcxstQT9hS5fKyCZF0Ck7bdu1XTVwxaqh2V0vWkiTzm6OJ5XL8a1iNTr-j11Xa8NxpiEPjg1owh7hYQ5_WlG6lVM4vKV-VXo5W_orLCCGISyBFSTb9ES5IPcMPrPGH3-ZfUss8qYRoyJ0/s200/IMG_5662.JPG" width="186" /></a></div>
<a href="http://pediatrics.aappublications.org/content/early/2016/11/03/peds.2016-2002" target="_blank">Researchers</a> this week warn women and doctors against planning births prior to 39 weeks because of an increased risk of poor child development at school.<br />
<br />Predictably, the media has reproduced their conclusions almost unequivocally:<br />
<div>
- American Council on Science and Health: <a href="http://www.acsh.org/news/2016/11/08/planned-birth-non-medical-reasons-not-such-good-idea-10416" target="_blank"><strong><em>Planned Birth for Non-Medical Reasons not such a Good Idea</em></strong></a></div>
<div>
- The Sydney Morning Herald: <a href="http://www.smh.com.au/national/health/planning-an-early-caesarean-raises-the-risk-of-developmental-delays-sydney-researchers-find-20161108-gskq7s.html" target="_blank"><strong><em>Planning an early caesarean raises the risk of developmental delays, Sydney researchers</em></strong></a><br />- Medscape: <a href="http://www.medscape.com/viewarticle/871484" target="_blank"><strong><em>Early Planned Birth Tied to Greater Risk for Poor Development</em></strong> </a></div>
<div>
</div>
What no one seems to have noticed is that the researchers don't factor in two very important risks of waiting until 39 or 40 weeks and/or spontaneous vaginal birth:<br /><strong>stillbirth </strong>and <strong>intrapartum death or injury</strong>.<br />
<br />
The babies who died couldn't be assessed for their early child development, but by excluding their demise from the data, this research is unhelpful for the purpose claimed:<br />
<br />
Remember - the aim of <a href="http://pediatrics.aappublications.org/content/early/2016/11/03/peds.2016-2002" target="_blank"><em>Planned Birth Before 39 Weeks and Child Development: A Population-Based Study</em></a> (<em>Bentley JP et al, Pediatrics Dec. 2016</em>) is "'<em>to inform more judicious clinical decision-making</em>" as women approach the end of their pregnancy, by communicating the "<em>benefits of waiting</em>".<br />
<br />
<span style="color: #38761d;"><strong>In this context, listed below are 8 points that summarize important flaws in this research:</strong></span><a name='more'></a><br /><br />
<div>
<strong>1)</strong> The study population only includes <strong>LIVE BIRTHS</strong>, and therefore hides all loss of life prior to 39 weeks' gestation. Babies who are stillborn or die during their intrapartum care cannot be assessed for early child development, but by excluding their deaths, at each gestational age, from the data, the research cannot fully inform birth plan decision-making. <br /><strong><u>Note</u></strong>: Stillbirth data published by the <em>Australian Institute of Health and Welfare</em> in 2014 showed a spike of 179 deaths at 38 weeks' gestation (152 at 37 weeks' gestation) between 2000-2009 (which covers the birth years of the children included in this study); a further 440 babies were stillborn after 39 weeks' gestation. Also note, these numbers don't include intrapartum deaths.</div>
<div>
</div>
<div>
<strong>2)</strong> The researchers base their comparison on how many children are 'developmentally high risk' (DHR) or developmentally vulnerable (DV) on an <strong>erroneous referent birth group</strong>, which is: '<em><strong>vaginal birth after spontaneous labor</strong></em>'. <br />This is a birth OUTCOME, not a planned mode of delivery, and it is neither known nor guaranteed at the point of decision-making about delivery. The UK's 2011 NICE caesarean guidance demonstrated the importance of comparing different PLANNED modes of birth (PCD & PVD), with each set of corresponding outcomes, and it is entirely disingenuous for studies to continue comparing only the 'best' outcomes of PVD with 'all' PCD outcomes.</div>
<div>
</div>
<div>
<strong>3)</strong> For ALL outcomes, the number of children considered DHR or DV is actually higher for '<em>vaginal birth after spontaneous labor</em>', and while adjustment for confounders puts births with obstetric interventions in the higher DHR/DV risk group, '<em><strong>cesarean section after labor induction was consistently associated with the largest increase in risk</strong></em>'. This is important because if the data was recalculated to compare PVD and PCD (where emergency caesareans are outcomes of the PVD group), then PCD would compare more favorably.</div>
<div>
</div>
<div>
4) Children who scored in the bottom 10% of nation domains were considered DV, and children DV for ≥2 domains were considered DHR. We know that 91% of the children being assessed were <6 10="" 4="" 8="" accounted="" age="" all="" and="" assessment="" at="" children="" cognitive="" communications="" competence="" development="" different="" emotional="" for="" formed="" general="" given="" half="" have="" in="" is="" it="" knowledge="" language="" likely="" lowest="" maturity="" may="" nbsp="" notably="" occurs="" of="" old.="" old="" only="" pace="" part="" skills="" social="" some="" strong="" study="" that="" the="" their="" them="" this="" were="" years="">13.7% of 4 year-olds were labeled DHR</6></div>
<br />
compared with 9.6% of ≥6 year olds and 7.6% of 5/6 to 5/11 year olds.<div>
</div>
<div>
5) The authors state that '<em>evidence is lacking or suggests little benefit</em>' for <strong>suspected fetal macrosomia</strong>. However, in the context of developmental delay in school, the impact of Erb's Palsy injuries (shoulder dystocia risk is higher with macrosomia), which can directly affect a child's ability to write and engage in other school activities, is a legitimate consideration for women when planning their birth mode, as is the increased risk of stillbirth with macrosomia, in terms of delivery timing. </div>
<div>
</div>
<div>
6) Advising women of the "<em>benefits of waiting</em>" needs to be done in conjunction with a <strong>late-term scan</strong> (to check for any cord complications, for example) and an honest discussion about the risk of late gestation stillbirth. Anything less is not providing balanced information. </div>
<div>
</div>
<div>
7) US term stillbirth rates and the 39-week rule: a cause for concern? (AJOG 2016) <br />“<em>…the push to strictly enforce the 39-week rule should be reconsidered and guidelines concerning the use and timing of early-term labor induction should once again allow for both provider-level clinical judgment and individual patient input. <strong>Given the literal “life and death” importance of this issue, and given the need to fairly balance the ethical principles of Beneficence and Autonomy, there is reason to consider a moratorium on the enforcement of the 39-week rule </strong>until further research, including adequately powered randomized clinical trials, can better measure its benefits and risks.</em>”</div>
<div>
</div>
<div>
8) Neonatal outcomes after implementation of guidelines limiting elective delivery before 39 weeks of gestation (Obstet Gynecol, 2011) <br />“<em>A policy limiting elective delivery before 39 weeks of gestation was followed by changes in the timing of term deliveries. This was associated with a small reduction in NICU admissions; however, <strong>macrosomia and stillbirth increased</strong>.</em>”</div>
<div>
</div>
<div>
<strong><span style="color: #38761d;">Summary</span></strong></div>
<div>
</div>
<div>
<div>
One of the greatest powers birth researchers have is the fact that their <a href="http://pediatrics.aappublications.org/content/early/2016/11/03/peds.2016-2002" target="_blank">Abstract</a> will be shared by journalists and members of the public without most ever reading the <a href="http://pediatrics.aappublications.org/content/early/2016/11/03/peds.2016-2002" target="_blank">Full Text</a> or challenging their caesarean criticisms.</div>
</div>
<div>
The fact that studies like this one go viral, and are published on multiple international medical news platforms with little or no challenge, is a serious concern given the issues raised above.</div>
<div>
</div>
<div>
I absolutely agree that we need to "<em>ensure optimal child health and development</em>", but it's important to recognize that this starts with doing all we can to make sure that women's babies are born alive. </div>
<div>
</div>
<div>
</div>
<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-15582023753982917282016-08-16T19:30:00.001+01:002016-08-16T19:30:38.888+01:00Doctor's 2007 Interview Balanced and Measured <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2OReKTJ-K_bDlRkRsdMi568uGZ56KTEHnoq0psMqvdVcgqkNeehbr1a0TbtDW-EtxUsQ_Hvgyj1ec6ZYpsGVe1TfJb8EkgDR6gI0axdFlKl75OnEIXA9qZzV4pkly8mPUPfoopxc0lc0/s1600/IMG_3865.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg2OReKTJ-K_bDlRkRsdMi568uGZ56KTEHnoq0psMqvdVcgqkNeehbr1a0TbtDW-EtxUsQ_Hvgyj1ec6ZYpsGVe1TfJb8EkgDR6gI0axdFlKl75OnEIXA9qZzV4pkly8mPUPfoopxc0lc0/s200/IMG_3865.JPG" width="200" /></a></div>
I hadn't heard <a href="http://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMp068290&aid=NEJMp068290_attach_1&area=&viewType=Popup&viewClass=Audio" target="_blank">this interview</a> with Jeffrey Ecker MD before, though I had read the <a href="http://www.nejm.org/doi/full/10.1056/NEJMp068290" target="_blank">accompanying paper</a> in the New England Journal of Medicine (NEJM).<br />
<br />
What stands out for me in particular is his support of maternal request, and also his response to being asked whether he's concerned about rising caesarean rates; he says:<br />
<br />
"<em>I guess I'm more interested than concerned.</em><br />
<br />
"<em>I think a lot of this is decisions that patients and doctors make together, and <strong>when you make decisions about risks there's no one right answer, and really I think what's changed is that we've reset our threshold for what acceptable risk is.</strong></em>"<br />
<br />
You can listen to the full <a href="http://www.nejm.org/action/showMediaPlayer?doi=10.1056%2FNEJMp068290&aid=NEJMp068290_attach_1&area=&viewType=Popup&viewClass=Audio" target="_blank">(7 minute) interview here</a>, in which Jeffrey Ecker (an associate professor at Harvard Medical School and an obstetrician at Massachusetts General Hospital) talks to Rachel Gotbaum (an independent producer based in Boston) about the contributors to the increase in cesarean deliveries. <br />
<br />
<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-40341123287594142292016-08-15T03:11:00.002+01:002016-08-15T03:11:48.028+01:00Warning that Cost Cutting will Risk Babies' Lives <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPm-fWghYMiYFsWewzkaIulIax6y28r07qj1NPZQEfg6gGiovklT5oNQoBufaW1yliw5X3pkWvUsWdajbdh7dYCAZm2oChLiGPXfzA8qIWYxmaKlZkE-SQHECxVFEh36xdm7KrbMBb2U4/s1600/vide+4x3+j+after+birth.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="149" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiPm-fWghYMiYFsWewzkaIulIax6y28r07qj1NPZQEfg6gGiovklT5oNQoBufaW1yliw5X3pkWvUsWdajbdh7dYCAZm2oChLiGPXfzA8qIWYxmaKlZkE-SQHECxVFEh36xdm7KrbMBb2U4/s200/vide+4x3+j+after+birth.jpg" width="200" /></a></div>
'<a href="http://www.thetimes.co.uk/article/babies-at-risk-as-nhs-runs-short-of-paediatricians-cd225s05t?shareToken=d0cac74bf438e3a14954996333cfcdb3" target="_blank"><em>Babies ‘at risk’ as NHS runs short of paediatricians</em></a>', warns the president of the Royal College of Paediatrics and Child Health in <em>The Sunday Times</em> today.<br />
<br />
In <em>Martyn Halle</em> and <em>Robin Henry's </em>report, cuts to public services are criticized by interviewees, as are the NHS' efforts to save tens of millions of pounds.<br />
<br />
<strong>My thoughts on this</strong>:<br />
<br />
The juxtaposition of the NHS trying to save millions of pounds alongside accusations of risking babies' lives couldn't be more ironic to those of us who have watched as the NHSLA racked up billions of pounds in litigation paid (and still owed) to families whose babies (and/or mothers) were injured (or died) during their maternity care.<br />
<br />
The push for normal birth at any cost, and the desire to reduce caesarean rates to entirely arbitrary percentage rate targets, have endangered the lives of countless babies. <strong>Perhaps if </strong><a href="http://www.electivecesarean.com/images/12-aug-24%20rcog%20ccg%20press%20release%20final.pdf" target="_blank"><strong>warnings by charities and maternity care organisations</strong></a><strong> had been heeded years ago</strong>, <strong>the NHS could have made savings by reducing its litigation bill, instead of reducing neonatal care provision...?</strong><div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-61427236431237007512016-07-09T05:54:00.005+01:002016-07-10T04:31:09.377+01:00Inching Closer to Informed Choice...<div align="left" class="separator" style="clear: both; text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVmCpIbSAspVU5zKi5mez0K5IczoK954qlWFBiqJt7JsKmT3anL9Ww7xN-saBn55NmRLGiy0mN8H8GHAMZSocZQTvWl4QUMwz4UWIMU2KQtz8Jnin9yGUhQCW-WRqac5xfpdv3ZHlSWWo/s1600/IMG_2728+-+orange.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVmCpIbSAspVU5zKi5mez0K5IczoK954qlWFBiqJt7JsKmT3anL9Ww7xN-saBn55NmRLGiy0mN8H8GHAMZSocZQTvWl4QUMwz4UWIMU2KQtz8Jnin9yGUhQCW-WRqac5xfpdv3ZHlSWWo/s200/IMG_2728+-+orange.jpg" width="200" /></a></div>
I don't want to speak to soon, but momentum seems to be building once again, which might see a move towards greater balance in the way women are informed about different birth plan risks.<br />
<br />
Five years after NICE CG132 guidance said maternal request cesareans should be supported, you'd be forgiven for thinking it had never been published in many areas of the country.<br />
<br />
And though that in itself is bad enough (informed women who choose a caesarean still being denied this legitimate choice), it also impacts on women who have no particular birth preference and simply want to fully understand their (and their baby's) individual likelihood of risks and benefits with different birth plans.<br />
<br />
So it was very welcome news this week when the <em>New Scientist</em> published <a href="https://www.newscientist.com/article/mg23130812-000-a-womans-right-to-choose/" target="_blank"><strong><em>Doctors should warn women about the real risks of childbirth</em></strong></a>, and one of its reporters, Clare Wilson, wrote the accompanying article, <a href="https://www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks" target="_blank"><strong><em>UK doctors may officially warn women of vaginal birth risks</em></strong></a>.<br />
<br />
You see, Clare Wilson is one of a growing number of journalists who '<em>gets it</em>'.<br />
<br />
When I first contacted her in July last year, she'd just published <a href="https://www.newscientist.com/article/dn27929-stop-glossing-over-the-risks-of-natural-birth-to-cut-caesareans/" target="_blank"><strong><em>Stop glossing over the risks of natural birth to cut caesareans</em></strong></a>, and within months, I'd sent her a copy of our book, <em>Choosing Cesarean, A Natural Birth Plan</em>.<br />
<br />
Then just this week, another two journalists told me they're reading it too, and I can't emphasise enough what a shift this is even from as little as 4 years ago (when our book was published, not a single journalist reported on or reviewed the copy we sent to them).<br />
<br />
Somehow the world didn't seem quite as ready back then for what our book says; the 2011 NICE guidance on maternal request was being misrepresented and misinterpreted, and 'caesarean choice' (with its perceived elevated cost) didn't juxtapose at all well with austerity cuts in the NHS.<br />
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But the <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/408480/47487_MBI_Accessible_v0.1.pdf" target="_blank">Kirkup Report</a> on Morecambe Bay, the <a href="https://www.supremecourt.uk/cases/docs/uksc-2013-0136-judgment.pdf" target="_blank">Supreme Court Judgment</a> (Montgomery v Lanarkshire Health Board) on birth autonomy, and a plethora of other important developments (more new research and evidence on pelvic floor impact, more focus on late term stillbirths, more MPs noticing the associated ballooning costs of litigation cases with planned vaginal deliveries, and more parents - and even coroners - realising that cesarean rate targets and the 'push for normal birth at any cost' can lead to avoidable deaths and injuries - to name but a few) has changed all that. <br />
<a name='more'></a><span class="sewcaljel1nwer3"></span><span class="sewcaljel1nwer3"></span><br />
<br />
It even appears that RCOG might finally be forced into having to consider <span class="sewcaljel1nwer3">issuing patient information on the risks of vaginal births, something </span>RCOG's president David Richmond says is proving “<em><a href="https://www.newscientist.com/article/mg23130813-000-uk-doctors-may-starting-warning-women-of-childbirth-risks/" target="_blank">terribly sensitive and difficult</a></em>”.<br />
<div>
<span class="sewcaljel1nwer3"></span> </div>
<span class="sewcaljel1nwer3"></span><span class="sewcaljel1nwer3"></span>I'm sure it is...<br />
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After all, so many medical professionals have staked their entire careers, reputations and published research on the uncompromising premise that vaginal delivery is unequivocally superior to cesarean delivery.<br />
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* * * * *</div>
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When writing our '<em>Choosing Cesarean</em>' book, I included the following quote by the American poet and writer Ralph Waldo Emerson (1803-1882) on the subject of vaginal delivery risks, and it came to my mind again this week when reading these latest news articles:<br />
<br />
"<em><strong><span style="color: #990000;">Every violation of truth is not only a sort of suicide in the liar, but is a stab at the health of human society.</span></strong></em>" <br />
<br />
As the penny starts to drop, and once women finally learn that they have not been told the truth about the risks associated with vaginal delivery - long after the truth was known in medical circles, and long after organisations like my own had campaigned for this truth to be communicated - there will be very serious questions to be answered by the very professionals empowered to provide (or withhold) the full spectrum of maternity care.<br />
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The ramifications of <a href="http://symphysiotomyireland.com/the-story/" target="_blank">symphysiotomy in late 20th century Ireland</a> are still being felt today (and those poor women didn't have nearly the same record of care/ paper trail/ access to timely legal services that women today are more likely to have), and I foresee serious legal ramifications going forward (as I'm sure RCOG now does) if the lies don't stop soon.<br />
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But while the evidence mounts that '<strong><em>Information must come before Ideology</em></strong>', I am under no illusion that ideology is going to disappear from maternity care without a fight...<br />
<br />
and 12 years into my fight, it's still a case of 'e<em>very inch (towards informed choice) counts</em>'.<br />
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<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com3tag:blogger.com,1999:blog-4181472671648618071.post-20600659257046414462016-06-22T00:41:00.000+01:002016-06-22T00:41:56.871+01:00Cesarean Choice 'Abandoned By Feminists' <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdFGQTDwO4ojdlw8HWANmG02gGtHXLUqecU7jxwL29j7blVqPa2X9KsTArWG3ldDRYIkG0uWWxAk5iMZP-gH6KNYqw1ZY_sHE2I7LhCrf2fFUHOD2ArsdgrW_4v8kt114klWh0Pjfx5gM/s1600/11-Jun+Choosing+Cesarean+book+cover-1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdFGQTDwO4ojdlw8HWANmG02gGtHXLUqecU7jxwL29j7blVqPa2X9KsTArWG3ldDRYIkG0uWWxAk5iMZP-gH6KNYqw1ZY_sHE2I7LhCrf2fFUHOD2ArsdgrW_4v8kt114klWh0Pjfx5gM/s200/11-Jun+Choosing+Cesarean+book+cover-1.jpg" width="132" /></a></div>
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My co-author, <strong>Dr. Magnus Murphy</strong>, gave an excellent interview on CBC Radio this week (<a href="http://www.cbc.ca/radio/the180/the-positives-of-climate-change-the-ar-15-in-canada-and-elective-c-sections-are-a-feminist-issue-1.3638725/elective-c-sections-are-the-women-s-health-issue-abandoned-by-feminists-says-alberta-doctor-1.3639581" target="_blank"><strong><em>listen here</em></strong></a>), explaining how "<em>when it comes to caesarean sections, <strong>women don't have as much choice as they should.</strong></em>"<br />
<br />
"<em>There are a lot of women who do feel that the feminist movement has dropped the ball on this... pelvic floor outcomes are completely ignored and that is a huge impact on a woman's quality of life over time.</em>" <br />
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How right he is. <br />
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Beneath the CBC's accompanying article, <a href="http://www.cbc.ca/radio/the180/the-positives-of-climate-change-the-ar-15-in-canada-and-elective-c-sections-are-a-feminist-issue-1.3638725/elective-c-sections-are-the-women-s-health-issue-abandoned-by-feminists-says-alberta-doctor-1.3639581" target="_blank">Elective C-sections are the women's health issue abandoned by feminists, says Alberta doctor</a>, I posted the following comment:</div>
<br />
"<span style="color: #073763;">I am the co-author of one of the heavily referenced books cited in this article, and I am a woman and a journalist who chose a cesarean birth twice. I began working on a campaign to ensure greater balance in the information women receive in their antenatal care back in 2004, and my organisation, which is a Stakeholder for numerous NICE guidelines in the UK, was instrumental in bringing about an update to national guidance on maternal request cesareans in 2011. <br /><br /> I have worked closely with many other incredible women, including Maureen Treadwell (Birth Trauma Association), Penny Christensen (Birth Trauma Canada), Leigh East (c-sections.org), Janice Williams (Cesarean by Choice Awareness Network), and this is to name but a few. I've also worked or collaborated with organisations including the British Pregnancy Advisory Service, Advocacy for All (AFA), Erb’s Palsy Group, Perinatal Illness-UK, Pyramid Of Antenatal Change and AIM New Zealand, with all but one of my personal contacts at these organisations being women. Also worthy of note here is the incredible research and passion of Professor Hans P Dietz and midwife Elizabeth Skinner, at the University of Sydney, Australia, and their continued support for the (voluntary) work that I do, such as communicating with journalists and trying to help women whose cesarean requests are being refused. </span><br />
<a name='more'></a><span style="color: #073763;"><br /> Together, all of us are trying to redress the balance of information, and trying to expose the myths and untruths that are communicated about an informed planned cesarean birth choice - not to mention the lack of disclosure to women about the risks involved (for themselves and for their babies) with a planned VD.<br /><br />So while CBC must be congratulated for airing such an important topic, specifically on the question of why more women are not drawing attention to the issue, I would gently point out that we 'are' all trying; it's just that our voices are not always heard or are not always given the public platform to be heard... (I have contacted CBC at least twice asking for this subject to be covered, for example). <br /><br /> And certainly in general, the media needs to be more discerning in its reporting of planned cesarean risks versus planned VD (although inroads are fortunately being made... here's an article by one British journalist with whom I have been in contact and sent our book to, for example: </span><a href="https://www.newscientist.com/article/2078853-push-for-natural-birth-a-dangerous-flaw-in-uk-maternity-review/)" target="_blank"><span style="color: #073763;">https://www.newscientist.com/article/2078853-push-for-natural-birth-a-dangerous-flaw-in-uk-maternity-review/)</span></a><span style="color: #073763;">. <br /><br /> Lastly, on the subject of birth research, I think readers - and journalists at the CBC - might be interested to know what Australian doctors warned back in 2003 when debating whether or not a 'cesarean delivery on maternal request' clinical trial would be a good idea. They said: ‘What a disaster it would be if it was found elective caesarean was safer than vaginal birth’ (Robson S, Ellwood D. Should obstetricians support a ‘term cephalic trial’? Aust N Z J Obstet Gynaecol 2003;43:341–3.) <br /><br /> Indeed.<br /><br />And so we continue to see birth comparison research that ignores pelvic floor outcomes entirely (it doesn't matter if the woman is left incontinent; her VD remains a 'success' in the data compiled) and/or combines maternal request cesarean outcomes with other cesarean births that were carried out for existing or emergency medical and/or obstetrical reasons. And when the outcome data is skewed, so too are estimations of cost - remember NICE CG132 reported a mere £84 difference between PVD and PCD when (only) urinary incontinence downstream costs were accounted for. <br /><br /> Similarly, stillbirths prior to the onset of labour - especially those where the baby dies in the 38th, 39th, 40th or 41st week gestation - are very often not even counted in planned mode of delivery data. Don't these women deserve the choice of a planned cesarean delivery alongside the options of awaiting spontaneous labour or inducing labour at 40 weeks EGA? <br /> I think they do. <br /><br /> To conclude, death and injury during childbirth is wholly natural and normal, and while thankfully in the developed world the chance of serious adverse outcomes is much lower than in the developing world, when even a <1 100="" br="" happening="" is="" it="" risk="" s="" to="" you=""><br /> Women need to be more fully and fairly informed about the risks and benefits of both birth plans, and ultimately allowed to make their own choice, as per the 2015 Supreme Court ruling referred to in this, </1></span><a href="http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13424/full" target="_blank"><span style="color: #073763;">one of my letters published in BJOG</span></a><span style="color: #073763;">.</span>"<a class="vf-show-more" data-action="less" href="http://www.cbc.ca/radio/the180/the-positives-of-climate-change-the-ar-15-in-canada-and-elective-c-sections-are-a-feminist-issue-1.3638725/elective-c-sections-are-the-women-s-health-issue-abandoned-by-feminists-says-alberta-doctor-1.3639581#"></a><br />
<br /><div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com1tag:blogger.com,1999:blog-4181472671648618071.post-14562867382877744232016-02-23T06:57:00.002+00:002016-02-23T07:04:37.283+00:00National Maternity Review Silent on Life-Saving, Prophylactic Cesareans<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3kOeiaxVg5tSqNomVMYipnUfLRCxeuuKObPt9OJB7z9Rt-Mz0h24L-FTyHJ6GTFpTAHSD4jNRB2v9wUTPSXrTMDQ_UGCp56GgiQvMvMODvY8QXJzImyGCARwZ8aMU9m9J7QmK6ju8jLo/s1600/IMG_6732.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg3kOeiaxVg5tSqNomVMYipnUfLRCxeuuKObPt9OJB7z9Rt-Mz0h24L-FTyHJ6GTFpTAHSD4jNRB2v9wUTPSXrTMDQ_UGCp56GgiQvMvMODvY8QXJzImyGCARwZ8aMU9m9J7QmK6ju8jLo/s200/IMG_6732.JPG" width="150" /></a></div>
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Opening the pdf of '<a href="https://www.england.nhs.uk/wp-content/uploads/2016/02/national-maternity-review-report.pdf" target="_blank"><em><strong>BETTER BIRTHS</strong> - Improving outcomes of maternity services in England</em></a>' today, I was reminded of the faulty Shopkin packet my daughter opened recently - <strong>EMPTY</strong>, with <strong>No Surprises At All</strong>.<br />
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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.<br />
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'<strong>Safety</strong>' on pg.23 reads: "<em>There was evidence from the data of opportunities for improvement in the safety of maternity services. For example: <strong>stillbirth</strong> ... instrumental deliveries resulting in third and fourth degree <strong>perineal tears</strong>...[and] almost half of CQC inspections of maternity services result in safety assessments that are either ‘<strong>inadequate</strong>’ (7%) or ‘<strong>requires improvement'</strong> (41%)</em>" <br />
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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 <em>National Maternity Review</em> contains just three mentions of cesareans:<br />
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Pg.3 refers to an anecdote about watching a twin caesarean delivery.</div>
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Pg.27 refers to RCOG Clinical Indicators project data on emergency caesarean sections rates.</div>
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Pg.77 cites '<em>rates of caesarean section</em>' as a marker of quality in South West Trusts.</div>
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Compare this to pg.99:<br />
<a name='more'></a>"<em>the NPEU evidence reports commissioned for this review show that <strong>midwifery care results in fewer interventions</strong>. If we can increase the proportion of births supported by midwifery care, <strong>we will be able to reduce the cost of medical interventions</strong>.</em>" <br />
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And pg.30: "<em><strong>planning a birth at home</strong> [for low risk women having a second or subsequent baby] or in a midwifery unit <strong>results in fewer interventions</strong>, the chances of transfer are low, and <strong>there is no evidence that outcomes are worse</strong>.</em>"<br />
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Unsurprisingly, the '<a href="https://www.england.nhs.uk/2016/02/maternity-review-2/" target="_blank"><em>Maternity review bold plan for safer, more personal services</em></a>' is not a bold one at all - just the same old, same old - <a href="http://www.electivecesarean.com/images/12-aug-24%20rcog%20ccg%20press%20release%20final.pdf" target="_blank"><strong>IDEOLOGY</strong> continuing to trump balanced <strong>INFORMATION</strong></a> in NHS maternity care.<br />
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Though there may be one silver lining...<br />
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</div>
<div>
If the NHS Personal Maternity Care Budget mechanism is there to '<em>support women in their community to take control of their decisions and their maternity care</em>', 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.</div>
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We'll see...</div>
<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com2tag:blogger.com,1999:blog-4181472671648618071.post-5539915236925406642016-02-23T06:51:00.001+00:002016-02-23T15:54:29.218+00:00Feedback For Baroness Julia Cumberlege<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih9RtbdzliI48wVWBKAQZB-LIsUb32zxkhlLMyEIRirafzCorwXScDyVlW6kySvE6yltBOLtQvUgRmdu69hLLhZi0AmqimFoIYQVJyDfWTxoQ3lXJQ57Y-JgScWJEHTPkK0yTfoswVvT4/s1600/09-May-27+j+birth2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih9RtbdzliI48wVWBKAQZB-LIsUb32zxkhlLMyEIRirafzCorwXScDyVlW6kySvE6yltBOLtQvUgRmdu69hLLhZi0AmqimFoIYQVJyDfWTxoQ3lXJQ57Y-JgScWJEHTPkK0yTfoswVvT4/s1600/09-May-27+j+birth2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="125" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEih9RtbdzliI48wVWBKAQZB-LIsUb32zxkhlLMyEIRirafzCorwXScDyVlW6kySvE6yltBOLtQvUgRmdu69hLLhZi0AmqimFoIYQVJyDfWTxoQ3lXJQ57Y-JgScWJEHTPkK0yTfoswVvT4/s200/09-May-27+j+birth2.jpg" width="200" /></a><br />
On February 12, 2016, just ahead of the <em>National Maternity Review</em> being published, I commented on this post by <strong>Baroness Julia Cumberlege</strong>: "<a href="https://www.england.nhs.uk/2016/02/julia-cumberlege-9/" target="_blank"><strong><em>We are shaping services for years to come</em></strong></a>."<br />
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<br /></div>
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"The focus on natural or normal birth at any cost, and targets to reduce caesarean rates (as though a low percentage rate alone is a measure of good health outcomes - it is not) have endangered - and lost - the lives of countless mothers and babies giving birth in our maternity care system. </div>
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<br /></div>
<div style="text-align: left;">
Women and their partners are not always listened to - be that a request for a caesarean birth during pregnancy or a request for intervention of any kind after the onset of labour - and all too often there are adverse consequences as a result. </div>
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<br /></div>
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A fleeting glance at the cost and causes of obstetric litigation in the NHS will confirm this, and even this doesn't reflect all the families who decide not to pursue a legal route. </div>
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<br /></div>
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Women who are at full-term in their pregnancy are rarely advised of the risk of stillbirth, </div>
<a name='more'></a>and the option of a planned caesarean is not readily discussed in a balanced way alongside the other options available - i.e. to await spontaneous labour or to induce. For women planning a small family, and especially for women who have risk factors for complications during a planned (and/or overdue) v. delivery - for example, first-time pregnancy with advanced maternal age or suspected macrosomia - the information provided about planned mode of birth is all too often unbalanced and ideological. <br />
<br />
Also, the emphasis of maternity care research on 'place' of birth, instead of 'mode' of birth (both should be considered if balance of information is to be achieved) is unhelpful and biased. What matters to most women is their birth outcome rather than their birth process, and yet many people working in maternity care are so focused on women achieving the natural physiological process of birth that they ignore or miss vital warning signs. <br />
<br />
There are two important perceptions about pregnancy and birth - one, that it is inherently safe and medical intervention should only be used as a last resort, and two, that it is inherently risky and medical intervention is a welcome aid throughout. There must be room for both views in our maternity care system, and there must be respect and support for delivering the birth plan choices of women who have these differing perspectives. One is not superior to the other, and the cost difference is negligible (NICE 2011 reported an £84 cost difference between PVD and PCD when urinary incontinence was factored in, and this didn't include any other pelvic floor damage, injuries to babies or litigation). <br />
<br />
I sincerely hope that the National Maternity Review has incorporated the concerns and views of all contributors, including those of smaller organisations, particularly in light of continued calls from the NCT, RCM and RCOG to reduce the number of planned caesarean deliveries, and to communicate this as an important maternity care aim, strategy, policy or measure of good health outcomes. <br />
<br />
We need to measure good maternity health outcomes in terms of the numbers of mothers and babies who have positive physical and psychological birth experiences. This is the most important thing; it's time that the caesarean rate was viewed as a secondary, not primary, concern." </div>
<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-20812854072143809472016-02-23T06:42:00.005+00:002016-02-23T15:56:01.505+00:002015 Consultation Comments Submitted to National Maternity Review <div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglnwmxWTzQDBzbv57QxV63JYt3lFZx7PrSeohVXch50I8rzmR9odtz88Ef4CbsKSPNyJudoF-gEZRzfNVCPkkfN__7TiIeUcvrkon26FMquMqU1S8A85YecHFlkxC_NBUNhUIRsoRuR_M/s1600/09-May-27+eyes.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="125" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEglnwmxWTzQDBzbv57QxV63JYt3lFZx7PrSeohVXch50I8rzmR9odtz88Ef4CbsKSPNyJudoF-gEZRzfNVCPkkfN__7TiIeUcvrkon26FMquMqU1S8A85YecHFlkxC_NBUNhUIRsoRuR_M/s200/09-May-27+eyes.jpg" width="200" /></a></div>
On October 31, 2015 my organization <a href="http://electivecesarean.com/">electivecesarean.com</a> (also a Stakeholder for various NICE guidance), submitted the following comments during the <a href="https://www.engage.england.nhs.uk/survey/nhs-maternity-review" target="_blank">National Maternity Review consultation</a>:<br />
<br />
4.1 <strong> </strong><strong>Which users/groups/organisation do you represent?</strong><br />
The organisation <a href="http://electivecesarean.com/" target="_blank">electivecesarean.com</a> 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. <br />
<br />
4.2 <strong> What do you think are the barriers to providing high quality maternity services?</strong><br />
- 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).<br />
- There is an emphasis on process (i.e. achieving 'normal' birth) over outcome, positive experience and patient satisfaction.<br />
- 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). <br />
- 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).<br />
<br />
4.3 <strong> </strong><strong>What do we need to do to make maternity services better?</strong><br />
<a name='more'></a><br />
- Listen to women.<br />
- Listen to smaller organisations that represent women.<br />
- 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.<br />
- Learn from mistakes.<br />
<br />
- 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).<br />
- 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). <div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-53199176539351689682014-11-16T06:12:00.001+00:002015-11-10T03:51:33.242+00:00Unforeseen Complications of a Summer Cesarean Birth<div class="separator" style="clear: both; text-align: center;">
<br /></div>
My silence on this blog over the past year is no accident, and while my cesarean campaign work has continued (via NICE, public speaking, researching, writing and supporting women who are refused their maternal request), my main focus has been on a new campaign - with eerily familiar issues to those surrounding birth choice - related to our child's education.<br />
<br />
In short, when we decided that we wanted our son to begin school in England <b>at</b> compulsory school age and not before, our 'request' for this to happen opened <i>a huge can of worms</i>.... that ultimately led to <a href="http://summerbornchildren.org/"><strong>summerbornchildren.org</strong></a><br />
<a name='more'></a><br />
<br /><br />
Being 'summer born' in England (in legal terms, born between April 1st and August 31st) means, in theory at least, a child can start school in one of two different academic years, depending on whether the parent wants them to commence their education <em><strong>before</strong></em> or <strong><em>at</em></strong> the law's prescribed deadline.<br />
<br />
This is something readers from countries like Canada, America and even Scotland might be familiar with, but in England the '<strong>norm</strong>' or what's '<strong>normal</strong>' is for all children to start school at age 4 - despite professing to be a country with a compulsory school age of 'the term <i>following</i> a child's 5th birthday'.<br />
<br />
Most parents who dare to fight for a school start in the September when their child is age 5 often face insurmountable opposition from schools and/or local authorities, and even the 'lucky' ones who <em>do</em> succeed in securing a Reception (Kindergarten) class start at age 5 for their summer born child live in fear of their being forced to 'skip' a year later on in primary school or upon entry to secondary school. <br />
<br />
And yes, this really does happen to children in England - and also to children who move to England from overseas with a date of birth that falls within a different 'chronological age group' than the country they've moved from.<br />
<br />
In practice, it means these children lose a year of their education, and even children with English as a second language are shoehorned into strictly enforced 12-month teaching '<em>batches</em>' [September 1st - August 31st]. And should <em>Special Educational Needs</em> money need to be thrown at any subsequent problems these children may face, this approach is still considered preferable to 'opening the floodgates' and having too many children floating around in the 'wrong' year group.<br />
<br />
<strong>Déjà vu</strong><br />
<br />
The words unjust, illogical, inconsistent and ideological come to mind.... As do the need for greater flexibility, autonomy, freedom of choice and focus on an individual's best interests...<br />
<br />
But wait, in what context have I come across these terms before?<br />
<br />
Policy makers too afraid of changing the status quo, too afraid that if they allow a minority of people to do something, too many others might follow; a misconceived perception of what this 'different' choice might cost financially (despite evidence that this choice is more cost-effective in the long-term); and favoring what's '<strong>normal</strong>' regardless of the risks and/or outcome for the individual.<br />
<br />
Mmm....<br />
<br />
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<a href="http://www.summerbornchildren.org/" target="_blank">http://www.summerbornchildren.org</a></div>
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<br /><div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com2tag:blogger.com,1999:blog-4181472671648618071.post-10479381720123765662013-08-27T23:42:00.001+01:002015-11-10T03:51:46.208+00:00It's about knowledge and empowerment<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_ZLjfxGSvIW7-XGWourI9cVeLirHuUQ4hNpJBkDq0fc7criASrPk2J_rlsVYHPkk1ARsHkBiKImOc_iP8VzvefHOUG6qCr9lnBndAXt3m_cd8KRnq3zsT-H-a3lcwY2lyar_hqPhWhmU/s1600/piper+newton+-+and+then+my+uterus+fell+out.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj_ZLjfxGSvIW7-XGWourI9cVeLirHuUQ4hNpJBkDq0fc7criASrPk2J_rlsVYHPkk1ARsHkBiKImOc_iP8VzvefHOUG6qCr9lnBndAXt3m_cd8KRnq3zsT-H-a3lcwY2lyar_hqPhWhmU/s200/piper+newton+-+and+then+my+uterus+fell+out.jpg" width="133" /></a></div>
I plan to write about Piper Newton again - she's written a courageous book called, '<a href="http://prnewton.com/books/" target="_blank">And Then My Uterus Fell Out</a>', which is due out on October 1st - but for now I'd like to share the blog post she published a few days ago:<br />
<br />
"<a href="http://prnewton.com/blog/2013/8/12/its-about-knowledge-and-empowerment" target="_blank"><strong>It's about knowledge and empowerment</strong></a>"<br />
<br />
She describes how her vaginal delivery has left her "<em>with permanent disabilities, an inability to return to the workforce (at 30 years old) and... facing many high risk surgeries as [she tries to] cope with my disabilities.</em>"<a name='more'></a><br />
<br />
She is very honest, and says that she really isn't sure what decision she would have made if her doctor had done a risk assessment and said that she was high risk for prolapse and other birth complications, but now, given what she's lived through over the past eight years, she is sure: "<em>if I could go back in time with the knowledge I have now, I would have absolutely gone with an elective C-section. In my case, that procedure would have been the more sound and safe birth option... A planned C-section could have prevented most, if not all, of my current disability. And what I am facing is surprisingly common. </em>"<br />
<br />
Piper doesn't advocate caesareans as the best choice for all women; not at all. But she does have serious concerns about the information women are given about different birth plans:<br />
<br />
"<em>Where I have issue is when women are not being assessed for risk factors and not being informed of all risks factors, for all the options. Once assessed women should be educated and empowered to make an informed and knowledgeable choice based on what they want for their own body...</em><br />
<em></em><br />
"<em>Each woman is different, living a different lifestyle, with different desires and needs. For some women a large family is highly desirable, for others doing everything possible to preserve their pelvic floor due to work or athletics is desirable. </em><br />
<br />
"<em>What bothers me most about these arguments is that elective surgeries are done all the time. I can get my boobs inflated, my nose streamlined, my fat sucked out, <strong><span style="color: #38761d;">but if I want a C-section to help mitigate my risks of a lifetime of complications due to a damaged pelvic floor, the choice is attacked and in many cases denied by the medical community.</span></strong></em>"<br />
<br />
Piper also comments on Dr. Silvio's excellent <a href="http://cesareandebate.blogspot.co.uk/2013/08/obstetrician-changes-his-mind-about.html" target="_blank">blog post</a>.<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-33949206572414713812013-08-24T22:53:00.004+01:002015-11-10T03:52:22.863+00:00Obstetrician changes his mind about Maternal Request<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLv3rapmNbadT_Ne47kb2GoIUGugYxKx-khyphenhyphen6qHunQMFRvWxrslhTMb_X0TAgMqkUR5YlyNwnNor3gvGugu_QFo0UIIgbBssjDNr2O7Gb-0AXa_qStkEH1QPtGZwFsgcUz1NvHcxeCHqA/s1600/dr+silvio+aladjem.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjLv3rapmNbadT_Ne47kb2GoIUGugYxKx-khyphenhyphen6qHunQMFRvWxrslhTMb_X0TAgMqkUR5YlyNwnNor3gvGugu_QFo0UIIgbBssjDNr2O7Gb-0AXa_qStkEH1QPtGZwFsgcUz1NvHcxeCHqA/s1600/dr+silvio+aladjem.jpg" /></a></div>
Admiration and respect. These are the words I would use to describe my feelings towards Dr. <a href="http://www.drsilvio.com/" target="_blank">Silvio Aladje</a>, an OBGYN and maternal fetal medicine specialist at Michigan State University in the U.S. In his blog posted yesterday, '<a href="http://www.bloggernews.net/130290" target="_blank">Caesareans Section On Demand</a>', he describes how, after reading <a href="http://www.amazon.co.uk/Choosing-Cesarean-Natural-Birth-Plan/dp/1616145110" target="_blank">our book</a>, he has changed his position in the debate over maternal request caesareans. I don't admire and respect him because he has changed his mind, but rather because he is willing to say so publicly (which not everyone would be brave enough or gracious enough to do) and because his actions are one step closer towards wider recognition that maternal request caesarean is a legitimate birth plan. <a name='more'></a><br />
<br />
Dr. Silvio writes that his position used to be, "<em>there are two modes of delivery: 'vaginal' and 'cesarean section'. When needed, cesarean sections should be performed without hesitation, and, when not, they shouldn’t.</em>" He also says, "<em>until very recently I was in the group of physicians who would have been hard pressed to perform a cesarean section without a medical indication.</em>"<br />
<br />
But he concludes thus:<br />
<br />
"<em><strong><span style="color: #38761d;">I was once told that politicians change their positions because it may be convenient; we, physicians, change our ideas because our learning never stops. Yes, I have now changed my mind. The time has come for us to support women making an informed decision regarding how they want to be delivered. They have their choice for a vaginal delivery experience or a birth by cesarean section, without medical indications. It should be a decision between the pregnant woman and her physician, after a thorough evaluation of the patient’s intrinsic risks based on her medical history or circumstances, and not based on our own bias on the subject.</span></strong></em>"<br />
<br />
Thank you, Dr. Silvio. <div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-83641431333892034752013-08-21T23:26:00.002+01:002015-11-10T03:53:04.104+00:00Birthrights organisation highlights maternal request refusal<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTVRrE8vHUeSpIFW0SflSMlKE79fCtevaUWXCP-IHe7hEvaA2cL1wK_DTF373hOt3MO4G6004SSp1iD2_uXV337fu904uCf0cpucS7Uu1ysSzN6Z_aQc-l5HESd2oOdi_v1CGa9PDdn2k/s1600/birthrights+logo.bmp" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTVRrE8vHUeSpIFW0SflSMlKE79fCtevaUWXCP-IHe7hEvaA2cL1wK_DTF373hOt3MO4G6004SSp1iD2_uXV337fu904uCf0cpucS7Uu1ysSzN6Z_aQc-l5HESd2oOdi_v1CGa9PDdn2k/s200/birthrights+logo.bmp" width="200" /></a></div>
Birthrights website reads: "We believe that all women are entitled to respectful maternity care that protects their fundamental rights to dignity, autonomy, privacy and equality." And on August 9, 2013, in <a href="http://www.birthrights.org.uk/2013/08/cqc-consultation-making-human-rights-a-regulatory-standard/" target="_blank">its response</a> to the Care Quality Commission consultation on changes to the ways the CQC regulates, inspects and monitors care services, Birthrights included the issue of maternal request caesareans being misunderstood and refused, alongside the issues being faced by women with various other birth choices (e.g. epidural and home birth). <br />
<br />
The document is certainly well worth reading; and I can only hope that the CQC takes serious note of Birthrights' comments, and that its response leads us one step closer towards true autonomy and respect for the woefully misunderstood prophylactic caesarean.<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-6333598179857027062013-08-12T21:46:00.003+01:002015-11-10T03:53:17.853+00:00Why women often don't get the birth they want<div class="separator" style="clear: both; text-align: center;">
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The answer to why women often don't get the caesarean birth they want is this: <span style="color: #38761d;"><strong>Their requests are blatantly refused.</strong></span><br />
<br />
The answer to why women often don't get the vaginal birth is more complicated, but there was an <a href="http://www.bbc.co.uk/programmes/b0383jlm" target="_blank">interesting debate today on BBC Radio 4's Woman's Hour</a>, hosted by Kirstie Allsopp.<br />
<br />
I have much to write about it, but due to other more immediate commitments tonight, I will leave any comments for another day, and simply post <a href="http://www.bbc.co.uk/iplayer/episode/b0383jlm/Womans_Hour_Kirstie_Allsopp_Why_women_often_dont_get_the_birth_they_want/" target="_blank">the programme link</a> here and encourage you to have a listen. <br />
<br />
Feedback welcome! <div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-62402311955669823182013-08-07T21:37:00.002+01:002015-11-10T03:53:53.765+00:00NICE says a planned caesarean section SHOULD be offered to women who request it<div class="separator" style="clear: both; text-align: center;">
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<a href="http://www.bmj.com/content/347/bmj.f4649?tab=responses" target="_blank"><strong>My letter</strong></a> (title above) was published in the British Medical Journal today; I wrote it in response to another letter, <a href="http://www.bmj.com/content/347/bmj.f4649" target="_blank"><strong><em>NICE says caesarean section is not available on demand unless clinically indicated</em></strong></a>, sent in by Mandie Scamell, a lecturer in midwifery, Alison Macfarlane, a professor in women’s and child health, Christine McCourt, a professor in women’s and child health, Juliet Rayment, a research fellow, Judith Sunderland, a lecturer and programme lead in midwifery, and Mary Stewart, a research midwife.<br />
<br />
<span class="contrib-role"></span>It reads:<a name='more'></a><br />
<br />
"I am equally “alarmed" by Scamell et al’s letter (“NICE says caesarean section is not available on demand unless clinically indicated”).[1] Mainly because of the inaccuracies it reveals in maternity professionals’ knowledge and understanding of current NICE guidance (CG132) on caesareans, but also because of the potential dissemination to a wider body of student midwives and the subsequent effect on pregnant women.<br />
<br />
<br />
NICE guidance does not refer to “demand” but rather “maternal request”, and in Mascarenhas et al’s letter,[2] they refer to women who “choose” surgery. Semantics in the context of maternal autonomy is imperative here, not least because the language of birth has become increasingly political, derisive and divisive, but also because with “demand” correctly substituted here, it is erroneous to state that NICE guidance does not recommend scheduling surgery for informed women who request a caesarean “unless clinically indicated.” It does. <br />
<br />
Firstly, these ‘no exceptions’ criteria in the Clinical Audit Tool “Implementing NICE caesarean guidance”[3] are quoted directly from CG132:[4]<br />
<br />
- For women requesting a caesarean section, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, a planned caesarean section should be offered.<br />
- An obstetrician unwilling to perform a caesarean section should refer the woman to an obstetrician who will carry out the procedure.<br />
<br />
Notice the word “offer” in the first criterion. This is extremely important to stress because the only compulsory action is an individualised “discussion” to ensure that the woman is fully informed of both the risks and benefits of surgery. Even women with anxiety or fear are under no obligation to accept the offer of mental health support. So when Scamell et al write, “The recommendation is that a caesarean section should be offered only if this fails”, their assertion is incorrect. A woman is at liberty to decline the offer of additional support, but more importantly, the use of the word “fails” in this statement (which does not appear in the NICE guidance) betrays a belief that only by changing a woman’s birth plan to vaginal would the referral be considered a success. Indeed in practice, knowledge or expectation of what this type of “support” might entail is precisely why many women prefer to decline its offer. <br />
<br />
Secondly, and in addition to the above, in June 2013 NICE published its Quality Standard for Caesarean Section[5], which reinforces maternal request support[6] and emphasises the importance of maternal satisfaction. It recommends informing decisions based on “the planned mode of birth” and ensuring that women “can talk to the most relevant member of the maternity team*…at any point during [their] pregnancy”; this should be “promptly arranged following a request.” Other statements make it clear VBAC is an “option” but not compulsory; there should be “consultant involvement in decision-making”; and “dedicated” lists that provide “protected surgical and anaesthetic time and appropriate staffing” for planned caesareans. I believe it is these much improved standards of care for informed women choosing a caesarean that may be the “raised expectations” Mascarenhas et al are referring to… <br />
<br />
<strong>Maternal Request Cost</strong> <br />
<br />
I also think it’s likely that much of the confusion surrounding NICE’s updated recommendations, and how to make them workable in the current economic climate, has come about for a number of reasons, not least of which include:<br />
a) too many people have never actually read the guidance in full, and<br />
b) there is a widespread misunderstanding of the comparative cost of a maternal request caesarean. <br />
<br />
NICE has confirmed that the document attached to the 2011 press release distribution was the (much shorter, 57 page) NICE version of its updated caesarean guideline, and not the (282 page) FULL version. Yet it is this latter document that contains the Health Economics discussion in which a cost model including urinary incontinence (i.e. just ONE downstream adverse outcome of birth; and there are many others that need to be considered) reduced the cost difference between PVD and PCD to just £84. The guideline says, “On balance, this model does not provide strong evidence to refuse a woman's request for CS on cost effectiveness grounds.”<br />
<br />
Unfortunately, a traditional and persistent focus on intrapartum costs alone has underestimated the true cost of PVD, and obfuscated the potential cost-savings of maternal request support. NHS treatments of birth injuries and trauma, not to mention its colossal obstetrics litigation bills, have largely been ignored.<br />
<br />
<strong>Commissioners need ALL facts and evidence</strong><br />
<br />
In contrast with Scamell et al, what alarms ME most in Mascarenhas et al’s letter is confirmation of anecdotal evidence I’ve had for some time now: that “commissioners are unwilling to fund caesareans at maternal request” and “women with previous caesareans are being pushed down the road of a trial of vaginal birth because of targets for reducing these operations.” It alarms me because this stance doesn’t just result in “disappointment and anxiety” of women, but more importantly – mortality, morbidity, higher overall costs, maternal dissatisfaction and increased litigation. Adverse birth outcomes are costly - but potentially more so when evidence-based guidance is wilfully ignored.<br />
<br />
Until maternity care policy takes further steps away from widely criticised arbitrary targets[7] to reduce caesarean rates (which NICE does not recommend) and to increase “normal birth” rates (NICE does not use the terms “normal” or “normalising” birth), the ideology that every woman should at least attempt a vaginal birth will continue to leave promises on caesarean section “unmet”. An urgent and unbiased reconfiguration of maternity services is needed, with recognition that midwifery-led care is not the choice of every woman, and that a trial of labour should not be forced on anyone who understands the risks of prophylactic surgery, and who is in fact making the exact same choice as a very high percentage of doctors (for their own children’s births).<br />
REFERENCES<br />
[1] Scamell M, Macfarlane A, McCourt C, Rayment J, Sunderland J, Stewart M. NICE says caesarean section is not available on demand unless clinically indicated. BMJ 2013;347:f4649. (30 July).<br />
[2] Mascarenhas L, Nash Z, Nathan B. NICE promises on infertility and caesarean section are unmet. BMJ2013;346:f3814. (18 June.)<br />
[3] National Institute for Health and Care Excellence. Clinical Audit Tool. Implementing NICE caesarean guidance. 2013 <a href="http://guidance.nice.org.uk/CG132/ClinicalAudit/MaternalRequestForCaesareanSection/doc/English" title="http://guidance.nice.org.uk/CG132/ClinicalAudit/MaternalRequestForCaesareanSection/doc/English">http://guidance.nice.org.uk/CG132/ClinicalAudit/MaternalRequestForCaesar...</a> <br />
[4] National Institute for Health and Care Excellence. Caesarean section (update). CG132. 2011. <a href="http://guidance.nice.org.uk/CG132" title="http://guidance.nice.org.uk/CG132">http://guidance.nice.org.uk/CG132</a>. <br />
[5] National Institute for Health and Care Excellence. Caesarean section. QS32. 2013. <a href="http://guidance.nice.org.uk/QS32" title="http://guidance.nice.org.uk/QS32">http://guidance.nice.org.uk/QS32</a>. <br />
[6] New NICE Quality Standard Reinforces Support for Maternal Request. (11 June 2013) <a href="http://cesareandebate.blogspot.co.uk/2013/06/new-nice-quality-standard-reinforces.html" title="http://cesareandebate.blogspot.co.uk/2013/06/new-nice-quality-standard-reinforces.html">http://cesareandebate.blogspot.co.uk/2013/06/new-nice-quality-standard-r...</a><br />
[7] New RCOG guidance urges CCGs to increase births without epidurals and reduce caesarean rates to 20%. (24 August 2012) <a href="http://www.electivecesarean.com/images//12-aug-24%20rcog%20ccg%20press%20release%20final.pdf" title="http://www.electivecesarean.com/images//12-aug-24%20rcog%20ccg%20press%20release%20final.pdf">http://www.electivecesarean.com/images//12-aug-24%20rcog%20ccg%20press%2...</a> <br />
* The core membership of the maternity team should include a midwife, an obstetrician and an anaesthetist.<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com3tag:blogger.com,1999:blog-4181472671648618071.post-525164174330403472013-08-07T21:25:00.002+01:002015-11-10T03:55:17.302+00:00Refusal to follow NICE caesarean guidance is unjustified<div class="separator" style="clear: both; text-align: center;">
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<a href="http://www.bmj.com/content/346/bmj.f3814?tab=responses"><strong>My letter</strong></a> (with the title above) was published in the British Medical Journal today; I wrote it in response to another letter, <a href="http://www.bmj.com/content/346/bmj.f3814"><strong><em>NICE promises on infertility and caesarean section are unmet</em></strong></a>, sent in by Law<span class="name">rence Mascarenhas</span><span class="contrib-role">, a consultant obstetrician and gynaecologist, Za</span><span class="name">chary Nash</span><span class="contrib-role">, a medical student, and Ba</span><span class="name">ssem Nathan</span><span class="contrib-role">, a consultant surgeon.</span><br />
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It reads:<a name='more'></a><br />
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"Firstly, I’d like to commend Mascarenhas et al[1] for their efforts in highlighting the lack of implementation of NICE caesarean guidance in many hospitals.<br />
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Mascarenhas et al write that the “updated NICE guidelines will perpetuate the belief that these guidelines are only implementable for a select educated few who can successfully argue their case with professionals”, and unfortunately, in too many hospitals this is not simply a belief but precisely what happens. Even the most educated women can face blatant refusal to follow NICE guidelines, and are directed towards private maternity providers they can ill afford. <br />
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Furthermore, Mascarenhas et al confirm anecdotal evidence I have gathered from numerous women that “commissioners are unwilling to fund caesareans at maternal request [and] women with previous caesareans are being pushed down the road of a trial of vaginal birth because of targets for reducing these operations.” Except in my experience, this erroneous practice is not limited to the London area, and the effects are far greater reaching than “great disappointment and anxiety”. Through my voluntary work, I have known women terminate pregnancies, lose babies through stillbirth, see their babies injured during instrumental deliveries, suffer post-traumatic stress disorder and depression (needing counselling), require surgery for incontinence, prolapse and sexual health problems, lose careers (in cases of fecal and anal incontinence) and sue (or try to sue) the NHS. Over and over again they say, “I wanted a caesarean but it was refused.”<br />
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Yet the fact is NICE would not have recommended supporting maternal request unless there was sufficient evidence to demonstrate a justifiable balance of prophylactic benefits of a caesarean versus risks associated with a trial of labour. It could also not have made these recommendations without demonstrating cost-effectiveness. The problem arises because of ignorance and misunderstanding about how NICE arrived at these recommendations:<br />
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- For women requesting a caesarean section, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, a planned caesarean section should be offered.<br />
- An obstetrician unwilling to perform a caesarean section should refer the woman to an obstetrician who will carry out the procedure.[2]<br />
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It is important to stress the word “offer” above, since the only compulsory action for women is an individualised “discussion” to ensure that they are fully informed of both the risks and benefits of surgery. Even women with anxiety or fear are under no obligation to enrol in mental health support. <br />
Furthermore, NICE’s Quality Standard for Caesarean Section,[3] published in June 2013, reinforces support for maternal request[4] and emphasises the importance of maternal satisfaction. It recommends informing decisions based on “the planned mode of birth” and ensuring that women “can talk to the most relevant member of the maternity team*…at any point during [their] pregnancy”; this should be “promptly arranged following a request.” Other statements make it clear VBAC is an “option” but not compulsory; there should be “consultant involvement in decision-making”; and “dedicated” lists that provide “protected surgical and anaesthetic time and appropriate staffing” for planned caesareans. I believe it is these much improved standards of care for informed women choosing a caesarean that may be the “raised expectations” Mascarenhas et al are referring to.<br />
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However, compared with the costs associated with many of the outcomes women experience when their request for a caesarean is refused, it is not necessarily “current underfunding of the NHS” that makes these recommendations “unachievable”; but rather the false perception that pushing as many women as possible to have a vaginal birth is unquestionably the most cost efficient strategy. It is not.<br />
Unfortunately, a traditional and persistent focus on intrapartum costs alone has underestimated the true cost of PVD, and obfuscated the potential cost-savings of maternal request support. NHS treatments of birth injuries and trauma, not to mention its colossal obstetrics litigation bills, have largely been ignored. For example, in the NICE guideline’s Health Economics discussion, one of the cost models comparing PCD and PVD includes urinary incontinence (i.e. just ONE downstream adverse outcome of birth; and there are many others that need to be considered), which reduces the cost difference to just £84. NICE says, “On balance, this model does not provide strong evidence to refuse a woman's request for CS on cost effectiveness grounds.” The reality is that adverse birth outcomes are costly, and potentially more so when evidence-based guidance is wilfully ignored.<br />
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I fear that until maternity care policy takes further steps away from widely criticised arbitrary targets[5] to reduce caesarean rates (which NICE does not recommend) and to increase “normal birth” rates (NICE does not use the terms “normal” or “normalising” birth), the ideology that every woman should at least attempt a vaginal birth will continue to leave promises on caesarean section “unmet”. An urgent and unbiased reconfiguration of maternity services is needed, with recognition that midwifery-led care is not the choice of every woman, and that a trial of labour should not be forced on anyone who understands the risks of prophylactic surgery, and who is in fact making the exact same choice as a very high percentage of doctors (for their own children’s births)."<br />
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<strong><u>REFERENCES</u></strong><br />
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[1] Mascarenhas L, Nash Z, Nathan B. NICE promises on infertility and caesarean section are unmet. BMJ2013;346:f3814. (18 June.)<br />
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[2] National Institute for Health and Care Excellence. Caesarean section (update). CG132. 2011. <a href="http://guidance.nice.org.uk/CG132" title="http://guidance.nice.org.uk/CG132">http://guidance.nice.org.uk/CG132</a>. <br />
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[3] National Institute for Health and Care Excellence. Caesarean section. QS32. 2013. <a href="http://guidance.nice.org.uk/QS32" title="http://guidance.nice.org.uk/QS32">http://guidance.nice.org.uk/QS32</a>. <br />
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[4] New NICE Quality Standard Reinforces Support for Maternal Request. (11 June 2013) <a href="http://cesareandebate.blogspot.co.uk/2013/06/new-nice-quality-standard-r..." title="http://cesareandebate.blogspot.co.uk/2013/06/new-nice-quality-standard-reinforces.html">http://cesareandebate.blogspot.co.uk/2013/06/new-nice-quality-standard-r...</a><br />
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[5] New RCOG guidance urges CCGs to increase births without epidurals and reduce caesarean rates to 20%. (24 August 2012) <a href="http://www.blogger.com/null" title="http://www.electivecesarean.com/images//12-aug-24%20rcog%20ccg%20press%20release%20final.pdf">http://www.electivecesarean.com/images//12-aug-24%20rcog%20ccg%20press%2...</a><br />
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* The core membership of the maternity team should include a midwife, an obstetrician and an anaesthetist.<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-89592484118231199212013-07-31T22:17:00.002+01:002015-11-10T03:56:13.490+00:00Midwives worth their weight in gold<div class="separator" style="clear: both; text-align: center;">
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Every now and then, I meet or read comments by a midwife who is completely and utterly supportive of women who request cesareans, who understands and respects their motivations, and who is willing to speak up about the very real risks associated with a vaginal birth. This is what one midwife wrote on one <a href="http://www.ausmed.com.au/blog/entry/the-rise-of-caesarean-births-in-australia" target="_blank">Australian blog</a>: <a name='more'></a><br /></div>
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"<em>I have worked as a midwife, and now in general practice.</em></div>
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<em>I have been quietly more and more concerned as I near my retirement, at these discussions.</em></div>
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<em>I do Pap smears as part of my work now.</em></div>
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<em>I see increasingly women, young to old, who have such damage to their pelvic floor that they wear pads constantly because they are incontinent of urine and faeces.</em></div>
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<em>We push 'natural, when women are having bigger babies than ever before, and women are taller than ever before, both of which contribute to obstructed labour, and the heroics to deliver vaginally, which leaves huge, long acting damage.</em></div>
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<em>I am ashamed to be 'midwife' who focuses on the 6 days of the life continuum, and believe that we are right.</em></div>
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<em>I believe we have a duty to support women to have the birth of their choice.</em></div>
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<em>I also believe we are trained to also protect them and their babies from damage.</em></div>
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<em>The social pressure to have vaginal birth is immense. It is not CS vs vaginal birth, it is holistic care. If I encourage this woman to deliver this woman of her 4kg baby with intact peri, I am proud. Never mind that she has major surgery every 15 years to repair undetected prolapsed and anal sphincter damage.</em></div>
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<em>Please can we look at the whole?</em>"<br />
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Read more comments at: January 23, 2013 <a href="http://www.ausmed.com.au/blog/entry/the-rise-of-caesarean-births-in-australia" target="_blank">The rise of Caesarean births in Australia</a> by Sarah Vogel </div>
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<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com1tag:blogger.com,1999:blog-4181472671648618071.post-20219351431176939212013-07-28T00:56:00.000+01:002015-11-10T03:56:51.502+00:00 The wrong debate about cesarean sections<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpONQZh5N8oMsjHl7hEnHQrk6phjT4IjyE7X97OejGxx8kA1rDC8EB2WJolhz32a-pxJCbkE4BNM8APqE2tvHwI_kQj_R31vVv2tY4BS4rV-4aRZ_UwoYb0xCJ-1ChtFZhGvujUMTvC1Y/s1600/09-May-27+Jack+birth2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjpONQZh5N8oMsjHl7hEnHQrk6phjT4IjyE7X97OejGxx8kA1rDC8EB2WJolhz32a-pxJCbkE4BNM8APqE2tvHwI_kQj_R31vVv2tY4BS4rV-4aRZ_UwoYb0xCJ-1ChtFZhGvujUMTvC1Y/s200/09-May-27+Jack+birth2.jpg" width="143" /></a></div>
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Following a comment I left on his article this week, <a href="http://www.bloggernews.net/130026" target="_blank"><strong>What Is A Normal Pregnancy?</strong></a>, Dr. Silvio Aladjem invited me to comment on an article he'd written in May 2012, titled, <a href="http://www.drsilvio.com/blog/2012/05/21/the-wrong-debate-about-cesarean-sections/" target="_blank"><strong>The wrong debate about cesarean sections</strong></a>.</div>
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Here is what I wrote:<a name='more'></a><br /></div>
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I am always very pleased when I read criticism of the obsessive focus on caesarean rates, and of national and global efforts to reduce these rates to arbitrary levels. In 2009, the WHO admitted it had no empirical evidence (and still doesn't) for recommending a 15% threshold in 1985, and that there is no known optimum rate; yet countries and hospitals are still rated according to their overall number of caesarean surgeries as though this absolutely reflects the health outcomes of mothers and babies.</div>
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One example of the problem with these international 'league tables' can be read in my letter to the BMJ earlier this year: <a href="http://cesareandebate.blogspot.co.uk/2013/02/two-letters-to-bmj-editor-published.html" target="_blank"><em>Reducing mortality is not as simple as low cesarean rate good, high cesarean rate bad</em></a></div>
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Another problem is that focussing on the "overall CS rate" ignores the fact that it's emergency caesareans that are associated with the greatest risks, and planned caesareans have comparatively better outcomes (and costs). Yet instead of strategies to reduce the worse types of CS, very often planned CS are refused or avoided - only to end up as an emergency CS anyway.</div>
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My instinct is that we probably agree on the above, but I am not so sure about your views on maternal request caesareans. You write that "there is no good medicine where extraneous and non medical forces intervene", so it would be interesting to read what you think about a CS that is not medically indicated (though of course someone like myself would describe such surgery as prophylactic; i.e. there is no immediate medical indication, but there is knowledge of and desire to avoid known morbidities with a trial of labour).</div>
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In this context, if I may, I'd like to highlight concerns I have with some of the statements in your article, particularly in the context of what's happening in UK maternity care (as opposed to U.S.).</div>
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<strong>Extract</strong>: "a new trend is evolving: cesarean section on demand...In the USA this is not yet a serious problem. But in other countries, this is a problem. Cesarean sections rate has reached 90% levels, like in Brazil for example."</div>
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This is usually referred to as caesarean on maternal request, but whether demanded or requested, you refer to what I believe is a legitimate prophylactic request (given the known potential risks associated with a trial of labour - both in the intrapartum period and longer term) as "a problem". Yet there is evidence of very high maternal satisfaction following CDMR, and very good health outcomes too (for women planning small families and with delivery at 39+ weeks' gestation).</div>
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<strong>Extract</strong>: "The movement to reverse the trend is facing great obstacles."</div>
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Unfortunately, maternal request caesareans are viewed as an easy target in efforts to reduce CS rates, and I am frequently contacted by women whose legitimate request is being refused and denied. Forced trials of labour (that often end up as emergency CS or instrumental VD) for women who WANT a CS is, in my opinion, an unethical and ineffective method of 'reversing CS trends'.</div>
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<strong>Extract</strong>: "Third, there is a need for tort reform, so that medical decisions should not, even remotely, have to take into account the possibility of legal consequences of a medical decisions."</div>
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I agree that medical liability is a factor in driving up CS rates but I disagree that tort reform should go this far. Already in the UK, we have a HUGE litigation bill for obstetrics (both current and estimated future payments), and this is a country where there is a very strong drive to reduce CS rates and increase "normal" birth rates. In countries where maternity care is cost-driven, and litigation is taken out of the equation, there ends up being too many cases where efforts to get the baby out vaginally (and avoid a CS) leads to mortality and severe morbidity. The MODE of birth should never be the driving focus, but rather health outcomes and maternal satisfaction.</div>
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<strong>Extract</strong>: "Fourth, we need to educate the public that there are going to be complications and poor outcomes, no matter who cares for the patient. The occurrence of obstetrical complications is a reality we should stop denying."</div>
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I agree with your perspective that birth is inherently risky (while accepting others' views that it is inherently safe - with intervention only as a last resort). However, this is where maternal choice is vital. Women need to be informed of the risks and benefits of BOTH birth PLANS (PVD and PCD), and allowed to choose which they prefer (e.g. some may choose VBAC, others may choose repeat CS). Maternity policies dictating one birth plan or another is a real problem.</div>
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<strong>Extract</strong>: "Neonatal morbidity was high, much of it the result of obstetrical maneuvers and manipulations intended to deliver the infant vaginally at all costs, because of fear of performing a cesarean section. Those times are gone for ever. Thank God."</div>
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Unfortunately, this is simply not true in countries like the UK. A quick google search (or look on my blog) will provide you with numerous examples of cases where this exact scenario has resulted in the death or injury of mothers and babies.</div>
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<strong>Extract</strong>: "“Good medicine” will take care of itself and the rate of cesarean section will find its own level. But it will not be the rate of the 50s or 60s, nor should it be."</div>
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Good medicine in the context of obstetrics is extremely subjective, and this is one of the ongoing problems in the whole caesarean debate. There are some who hold very strong ideological beliefs that vaginal delivery should always be attempted in the absence of immediate medical indications, while there are others who believe that a caesarean delivery is advisable with even the slightest risk factor. Personally, I don't propose any appropriate caesarean level, so I am not going to say that a range of 50 or 60% is either right or wrong. However, I would repeat that in some countries/hospitals with high CS rates, the rates of perinatal mortality (incl. stillbirth) and maternal mortality are very low - and also the very opposite is true. So again, I would like to see discourse moving away from the criticism of caesarean rates alone - whatever the number - and only talk about CS alongside rates such as stillbirth, perinatal mortality, maternal mortality, infant birth injuries and maternal morbidity (short- and long-term). The CS rate alone actually tells us very little.</div>
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<strong>On maternal request:</strong></div>
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I genuinely believe that where women ARE allowed to choose CS freely, there are more women choosing it than some may be comfortable with... but this doesn't make it 'wrong', nor categorically 'unsafe'. Absolutely, surgery is not risk-free, but increasing numbers of women are realising that natural birth (or rather, a trial of labour) is not risk-free either, and the rates of CS that are seen in private hospitals - where women have greater CHOICE - demonstrate that maternal request CS is a reality; albeit one that some have chosen in turn to ignore, deny, criticise, discourage and (if all else fails) refuse.</div>
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<strong>One final comment.</strong></div>
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This month, ACOG published the article (written by W.Lawrence Warner, MD), "<a href="http://www.acog.org/About%20ACOG/ACOG%20Departments/District%20Newsletters/District%20VIII/July%202013/Cesarean%20delivery%20rate.aspx" target="_blank">Arriving at the appropriate cesarean delivery rate</a>". Again, I'm glad that Warner is not advocating simply "lowering" the CS rate, but I have concerns about some of his comments.</div>
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He writes about an increase in maternal mortality in the U.S., linking it with a rise in the caesarean rate, but of course there are numerous other factors at play. For example, obesity levels in the U.S. and socio-economic differences in quality of health care to name just two. Also, other countries with higher CS rates than the U.S. have lower maternal mortality rates, but American women are unlikely to hear about that.</div>
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I commend Warner for seeking to reach an "appropriate" CS rate "rather than just lowering [it]", but his conclusion, that doctors "educate our patients about the immediate and future consequences of a cesarean delivery" is concerning. Surely they should be educating patients about the consequences of BOTH birth plans, and then measuring HEALTH outcomes (physical and psychological)? Perhaps this is what he means, but it's not completely clear.</div>
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Something tells me we haven't moved far enough away from the focus on caesarean rates as we need to... It's as though it's finally been agreed that yes, a 15% CS rate is unrealistic and unachievable, but if we can get down to 'let's say the mid-20s%', then that would be about right.</div>
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I disagree with this view. There is no more evidence for rates of these suggested percentages than there ever was for 15%, and with more women having (bigger) babies later in life, with very high expectations of a good outcome, obstetric challenges have never been greater.</div>
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Dr. Murphy and myself talk about this, and much more, in our book, "Choosing Cesarean: A Natural Birth Plan" (Prometheus Books, New York), and if interested, readers can browse some of the chapter pages <a href="http://www.youtube.com/watch?v=ftag_hGZzlg&list=UUe0MAqhu-Met52AzmxzCy7A&index=2&feature=plcp" target="_blank"><strong>here</strong></a> for more information.</div>
<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com1tag:blogger.com,1999:blog-4181472671648618071.post-41247171509564834252013-07-22T23:51:00.001+01:002015-11-10T03:57:15.346+00:00Royal Congratulations to William and Kate!<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaqTSKL7K4ZZrGFg2Hv2JklGqSgsU6hDSDCOkLViCz3npKe4Yexx-Loe7FW0EWhHFkD-ZirYWWwIq92JtUwGMge9xADgAYZ2ClLzKrZM1M9n8T3Mf-3OIi3acMk6YN0WW04ZKOdXUn9AY/s1600/IMG_0072-1.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaqTSKL7K4ZZrGFg2Hv2JklGqSgsU6hDSDCOkLViCz3npKe4Yexx-Loe7FW0EWhHFkD-ZirYWWwIq92JtUwGMge9xADgAYZ2ClLzKrZM1M9n8T3Mf-3OIi3acMk6YN0WW04ZKOdXUn9AY/s200/IMG_0072-1.JPG" width="199" /></a></div>
It's great news today that the Duke and Duchess of Cambridge have become new parents to a baby boy. <br />
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No news on the name yet - only that he was born at 4.24pm at St Mary's Hospital in London, weighing 8lb 6oz.<br />
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Now, I haven't been particularly enamoured by many of the political and ideological debates about what Kate may or may not have wanted in her (private) birth plan, but I thought I'd share a very short anecdote from my experience of talking with other mums this morning.<a name='more'></a><br />
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Like most people, we were chatting about the media circus surrounding the impending Royal birth, and the cameramen who have been standing outside in this unbearable heat for days.<br />
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Then someone said, "I thought she might have chosen a cesarean", to which another mum replied, "No, I don't think she's the type to do that." There was nothing malicious in the way she said it; the mum in question is a truly lovely person, and I didn't pick up on what she said.<br />
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It's just that in a somewhat Carrie-esque manner, <em>I couldn't help but wonder.</em>.. what "type" of woman do others perceive as being the type to choose a cesarean?<br />
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I'm certainly one, and if you're reading this blog, you might be one too - so I wonder what it is that <em>typifies</em> us in the eyes of others?<br />
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My guess is - the perception of others and our personal reality are very likely two different things. <div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com1tag:blogger.com,1999:blog-4181472671648618071.post-60604961616627367162013-06-15T22:17:00.001+01:002015-11-10T03:57:40.072+00:00Australian Royal Birth debate this month<div align="left" class="separator" style="clear: both; text-align: center;">
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I'm not keen on the title of this debate (it's not for anyone to say how a woman "should" give birth), but in the context of talking about the risks and benefits of different birth plans, the debate below (<a href="http://www.acps.unsw.edu.au/news-and-events/acps-events" target="_blank">more information here</a>) may be of interest.</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB-IiQJxvmUDc3o5BiqmJxkYUVDyS2id8iFOF4uv1wUy0pGKTpmePP3KvypWco53jVivyYxHFz2osUfGZXo7Agn-FC67PMHcEHhWGaNhvIXQGGegJELtnQpfr7pq6F4K-HIIHjzjU9cO4/s1600/13-Jun-26+Why+the+Duchess+should+have+a+Caesarean+p1.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhB-IiQJxvmUDc3o5BiqmJxkYUVDyS2id8iFOF4uv1wUy0pGKTpmePP3KvypWco53jVivyYxHFz2osUfGZXo7Agn-FC67PMHcEHhWGaNhvIXQGGegJELtnQpfr7pq6F4K-HIIHjzjU9cO4/s400/13-Jun-26+Why+the+Duchess+should+have+a+Caesarean+p1.jpg" width="400" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWMoaUu2kWUEJ3odcAoiMuLJd1BHAoFaHXHidZOF_HuA83xCyU3WFszwmxN8ywq-u_A1JTQEtZO5WhupZL3EK00F5pJI-jt95jsONRSUva8ATx8gW-qawe9kFALeUrhoafdS3dT9hjbck/s1600/13-Jun-26+Why+the+Duchess+should+have+a+Caesarean+p2.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhWMoaUu2kWUEJ3odcAoiMuLJd1BHAoFaHXHidZOF_HuA83xCyU3WFszwmxN8ywq-u_A1JTQEtZO5WhupZL3EK00F5pJI-jt95jsONRSUva8ATx8gW-qawe9kFALeUrhoafdS3dT9hjbck/s400/13-Jun-26+Why+the+Duchess+should+have+a+Caesarean+p2.jpg" width="400" /></a></div>
<br /><div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com1tag:blogger.com,1999:blog-4181472671648618071.post-10307530549300197952013-06-11T02:26:00.001+01:002015-11-10T03:58:21.513+00:00New NICE Quality Standard Reinforces Support for Maternal Request <div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqmUGHjHZjcMd9MFYBwQBGTamx2Bs05Go89em7p0KoP9VcccK_9QYTObFZOlT5A1y-F6c0hPpPeV4OhQBnMmUPQqlspuWYwMpUN61fcMHeYCnceUzTawFV65rmxOPKEPHGWIDI15oZ3zQ/s1600/mini_logo.bmp" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiqmUGHjHZjcMd9MFYBwQBGTamx2Bs05Go89em7p0KoP9VcccK_9QYTObFZOlT5A1y-F6c0hPpPeV4OhQBnMmUPQqlspuWYwMpUN61fcMHeYCnceUzTawFV65rmxOPKEPHGWIDI15oZ3zQ/s1600/mini_logo.bmp" /></a><span lang="EN-GB" style="font-family: "times new roman" , "serif"; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><span style="font-family: inherit;"><strong>electivecesarean.com</strong> </span></span><span lang="EN-GB" style="font-family: "times new roman" , "serif"; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><span style="font-family: inherit;">2013 NICE Quality Standard Reinforces Support
for Maternal Request Caesareans and Mothers’ Satisfaction with Maternity Care </span></span><u><span lang="EN-GB">PRESS
RELEASE<o:p></o:p></span></u></div>
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<span lang="EN-GB">Embargoed
until 00:01 Tuesday 11<sup>th</sup> June 2013 (GMT)<o:p></o:p></span></div>
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<span lang="EN-GB">Published
by <b style="mso-bidi-font-weight: normal;">electivecesarean.com</b><i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
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<span lang="EN-GB">Following the
National Institute for Health and Care Excellence (NICE)’s publication of its <i style="mso-bidi-font-style: normal;">Caesarean Section Guideline</i> (update) in
November 2011, which recommended ultimate support for women who choose to plan
a caesarean birth without any clinical indication, and highlighted a cost
difference of just £84 with planned vaginal birth when the adverse outcome of
urinary incontinence was considered,[<sup>1</sup>] <b style="mso-bidi-font-weight: normal;">electivecesarean.com</b> welcomes NICE’s <i style="mso-bidi-font-style: normal;"><a href="http://guidance.nice.org.uk/QS32" target="_blank"><strong>Quality Standard for Caesarean Section</strong></a></i>, and hopes that it results
in greater adherence by hospitals and health professionals to its 2011
caesarean recommendations. </span><a name='more'></a><br /></div>
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<span lang="EN-GB"><o:p> </o:p></span></div>
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<span lang="EN-GB">It is this
organisation’s experience, through communication with parents, midwives,
doctors and hospital trusts, that arbitrary refusal of maternal request planned
(primary and repeat) caesareans continues to occur, and more widely, that women
without a personal preference for any particular birth plan are being encouraged
to focus on the <i style="mso-bidi-font-style: normal;">benefits</i> of planned
vaginal delivery and the <i style="mso-bidi-font-style: normal;">risks</i> of
planned caesarean – with the emphasis on reducing overall caesarean rates and
increasing rates of ‘normal birth’ – rather than being provided with balanced
information and an evidence-based assessment of their individual risk factors
associated with a trial of labour.<o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">WHAT
IS MOST WELCOME FROM THE QUALITY STATEMENTS </span></b><span lang="EN-GB">(with <u>emphasis</u>)<b style="mso-bidi-font-weight: normal;"><o:p></o:p></b></span></div>
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<span lang="EN-GB"><o:p> </o:p></span><span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">Overview</span></i><span lang="EN-GB">: “A <u>person-centred approach</u>
to provision of services is fundamental…”<o:p></o:p></span></div>
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<span lang="EN-GB"><o:p> </o:p></span><span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">QS 2 Maternal request for a caesarean section: maternity team
involvement: </span></i><span lang="EN-GB">“The purpose of this statement is to
inform decisions about the <u>planned</u> mode of birth. It is <u>important
that the woman can talk to the most relevant member</u> of the maternity team… It
is important that access to members of the maternity team is possible <u>at any
point during the woman’s pregnancy</u> and <u>promptly arranged following a
request</u>. <i style="mso-bidi-font-style: normal;">Outcome measure</i>: “<u>Women’s
satisfaction</u> with the process of discussing options with the maternity team.”
<i style="mso-bidi-font-style: normal;">Definitions</i>: “The core membership of
the maternity team should include a midwife, <u>an obstetrician</u> and an
anaesthetist.”<o:p></o:p></span></div>
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<span lang="EN-GB"><o:p> </o:p></span><span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">QS 1 VBAC: </span></i><span lang="EN-GB">“Pregnant women who have had
1 or more previous caesarean section have a documented discussion of the <u>option</u>
to plan a vaginal birth.” i.e. it is <b style="mso-bidi-font-weight: normal;">not
compulsory</b>.<i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
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<span lang="EN-GB"><o:p> </o:p></span><span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">Q 4 Definitions. Pregnant women who may require a planned caesarean
section have consultant involvement in decision-making: </span></i><span lang="EN-GB">“This includes both women who have clinical indications… and <u>women
who request a caesarean</u> section when there are no clinical indications.<o:p></o:p></span></div>
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<span lang="EN-GB"><o:p> </o:p></span><span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">QS 3 Pregnant women who request a caesarean section because of
anxiety about childbirth are <u>offered</u> a referral to a healthcare
professional with expertise in perinatal mental health support<o:p></o:p></span></i></div>
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<span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">QS 5 Timing of planned caesarean section</span></i><span lang="EN-GB">:
The <u>woman should be given a specific day and time at which the caesarean
section will be performed</u>. A model for delivering planned caesarean section
is for services to have dedicated planned caesarean section lists. The lists
should have <u>protected surgical and anaesthetic time and appropriate staffing</u>
to ensure that planned caesarean section are not delayed because of surgical
time being prioritised for emergency cases.</span></div>
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</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">NICE press release</span></i><span lang="EN-GB">: She should also be
able to talk to the most relevant member of the maternity team depending on her
question or concern <u>at any time</u> during her pregnancy. A <u>consultant
should be involved</u> in decisions surrounding caesarean sections because they
are best placed to advise about the potential benefits and risks. <i style="mso-bidi-font-style: normal;">Quote from Dr Malcolm Griffiths, Consultant
Obstetrician and Gynaecologist, Luton and Dunstable Hospital and chair of this
QS expert group</i>: “…Most women want to avoid the major surgery of a
caesarean section. However, <u>it is important that the NHS ensures all women
can give birth in the most appropriate way for them, and for some women, this
will mean having a caesarean section...</u>”<span style="mso-spacerun: yes;">
</span><o:p></o:p></span></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">WHAT
WOULD ALSO HAVE BEEN WELCOME IN THE QUALITY STANDARD<o:p></o:p></span></b></div>
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<span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">NICE press release:</span></i><span lang="EN-GB"> While the number of caesareans
“has gone up dramatically” in the last 30 years from 9% in 1980 to around 20-25%
in 2013, in 2011, NICE made clear that “Many of the factors contributing to CS
rates are often poorly understood. This guideline has <u>not sought to define
acceptable CS rates</u>.”[<sup>1</sup>] <o:p></o:p></span></div>
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<span lang="EN-GB"><o:p> </o:p></span></div>
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<span lang="EN-GB" style="mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt;">Over the same
period, rates of infant deaths have decreased significantly. The <i style="mso-bidi-font-style: normal;">neonatal mortality rate fell</i> by 62%,
from 7.7 deaths per 1,000 live births in 1980 to 2.9 in 2010, and <i style="mso-bidi-font-style: normal;">the perinatal mortality rate (which includes
stillbirths) fell</i> by 44% from 13.3 deaths per 1,000 total births in 1980 to
7.4 in 2010 (and in October 1992, the legal definition of a stillbirth was
changed to include deaths after 24 completed weeks of gestation or more,
instead of after 28 completed weeks of gestation or more; therefore <i style="mso-bidi-font-style: normal;">improvements in perinatal mortality</i>
outcomes may be even greater.)<o:p></o:p></span></div>
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<span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB" style="mso-bidi-font-size: 11.0pt;">QS 9 Outcome:</span></i><span lang="EN-GB" style="mso-bidi-font-size: 11.0pt;"> “Rates of complications in women
who have had a </span><span lang="EN-GB">caesarean section</span><span lang="EN-GB" style="mso-bidi-font-size: 11.0pt;">.” For this information to be
useful, it’s essential that <u>type</u> of caesarean is recorded here.</span><span lang="EN-GB"><o:p></o:p></span></div>
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<span lang="EN-GB" style="font-family: "symbol"; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font-size-adjust: none; font-stretch: normal; font: 7pt/normal "Times New Roman";">
</span></span></span><i style="mso-bidi-font-style: normal;"><span lang="EN-GB">QS 2 Outcome</span></i><span lang="EN-GB">: “Women’s satisfaction with
the process of discussing options with the maternity team.” Women’s <u>satisfaction
with actual birth outcome</u> is crucial to record here too (whether she has
her maternal request CS or is persuaded to plan a vaginal birth), as is the <u>actual
number of maternal request</u> births (so that we finally <i style="mso-bidi-font-style: normal;">know</i> this % rate).<o:p></o:p></span></div>
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<span lang="EN-GB">[<sup>1</sup>] CG
132 - <a href="http://www.nice.org.uk/nicemedia/live/13620/57162/57162.pdf"><span style="color: blue;">http://www.nice.org.uk/nicemedia/live/13620/57162/57162.pdf</span></a>
<o:p></o:p></span></div>
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<span lang="EN-GB">“For women
requesting a CS, if after discussion and offer of support (including perinatal
mental health support for women with anxiety about childbirth), a vaginal birth
is still not an acceptable option, offer a planned CS. <o:p></o:p></span></div>
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<span lang="EN-GB">“An obstetrician
unwilling to perform a CS should refer the woman to an obstetrician who will
carry out the CS.”<o:p></o:p></span></div>
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<span lang="EN-GB">“On balance,
this model does not provide strong evidence to refuse a woman's request for CS
on cost effectiveness grounds.” (<i style="mso-bidi-font-style: normal;">Health
Economics p.100-1 & see p.220 for £84 figure</i>)<o:p></o:p></span></div>
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<div align="center" style="margin: 0cm 0cm 0pt; text-align: center;">
<u><span lang="EN-GB">Contact for Further Information<o:p></o:p></span></u></div>
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<b style="mso-bidi-font-weight: normal;"><span lang="EN-GB">Pauline Hull<span style="mso-tab-count: 2;"> </span><o:p></o:p></span></b></div>
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<span lang="EN-GB">Co-author of ‘Choosing
Cesarean, A Natural Birth Plan’ (<i style="mso-bidi-font-style: normal;">Prometheus
Books, New York. 2012</i>), and founder of <b style="mso-bidi-font-weight: normal;">electivecesarean.com</b>
and <b style="mso-bidi-font-weight: normal;">cesareandebate.blogspot.com</b><o:p></o:p></span></div>
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<div style="margin: 0cm 0cm 0pt;">
<span lang="EN-GB">Telephone 07780
308 455<o:p></o:p></span></div>
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<span lang="EN-GB">Email <a href="mailto:info@electivecesarean.com"><span style="color: blue;">info@electivecesarean.com</span></a> <o:p></o:p></span></div>
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<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com2tag:blogger.com,1999:blog-4181472671648618071.post-71465765614958833122013-06-03T13:54:00.002+01:002015-11-10T03:59:17.997+00:00Guess which makes headlines - Birth Orgasm 0.3% or Perineal Tears 39.9%?<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr4A3sRnQBy1sqqRcP52KX_d1kdryIHwyL2i_QBe4O6WCKP9SXap1OT8xYjV_EPssGbwwvj-lg7Zs34iRb_iwmoFmRWtexjagwmB-NC0O2taUwxz6URr0VZp_4M_7TBSnmd65UtPuYlUo/s1600/pregnant+tummy.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr4A3sRnQBy1sqqRcP52KX_d1kdryIHwyL2i_QBe4O6WCKP9SXap1OT8xYjV_EPssGbwwvj-lg7Zs34iRb_iwmoFmRWtexjagwmB-NC0O2taUwxz6URr0VZp_4M_7TBSnmd65UtPuYlUo/s200/pregnant+tummy.jpg" width="200" /></a><span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">The fact that some </span><span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">women experience an orgasm during birth is not a new concept, as one midwife commented at the bottom of yesterday's <a href="http://www.dailymail.co.uk/news/article-2334789/Women-orgasms-giving-birth.html" target="_blank">Daily Mail article</a>: </span><span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">"<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><em>Can I please state in 1984 when I became a midwife this was well known so its not a new study, but in 30 years I have never seen it NOT ONCE.</em>" (<a class="js-usr" href="http://www.dailymail.co.uk/registration/769932/lizzy2511/profile.html" id="ext-gen55">lizzy2511</a> Swansea, United Kingdom, 2/6/2013 23:41)</span></span></div>
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">But a <a href="http://www.livescience.com/37039-orgasmic-birth-real.html" target="_blank">new study</a> by Thierry Postel has highlighted the possibility once again. </span><a name='more'></a><span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br />The French psychologist contacted 956 French midwives, of which 109 online responses were completed, and concluded that there was a 0.3% rate of women who experience an orgasm while giving birth. </span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><strong>Informing women</strong></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">I don't have a problem with Postel's survey per se, but I do have concerns about how its results might be used by some maternity health professionals, in the context of emphasising that birth need not be viewed as inherently painful or fearful, but rather an experience to be embraced and enjoyed - with the 'right' mental attitude.</span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">I also think it might pile on pressure for some new mothers, who may already feel like they've somehow 'failed' if their labor didn't go according to plan, and now they discover there are women who enjoyed their labor in more ways than they might ordinarily divulge.</span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Now I don't write this blog in order to scare women, but I do think it's important to inject a little balance to the 'orgasmic' headlines that I've seen over he last few days, and remind women that in England at least, maternity data includes the following percentage outcomes too:</span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Perineal laceration (39.9%)</span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Long labour (10.3%)
</span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Obstructed labour, fetal distress and umbilical cord-related complications
(30.5%)</span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Episiotomies (15.2%) </span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">Emergency cesareans (14.8%)</span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><strong>So if birth isn't orgasmic for you, you're really not alone.</strong></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;">I think it's a shame we don't see more news headlines and discussions about how to reduce some of the big numbers above - and have a little less focus on the titillating topic of orgasms in a context that most people are really not interested in at all. </span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"><br /></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br />
<span lang="EN-GB" style="font-family: "times new roman" , "serif"; font-size: 12pt; mso-ansi-language: EN-GB; mso-bidi-font-family: Arial; mso-bidi-font-size: 11.0pt; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-US;"></span><br /><div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-50679140076250872042013-05-23T22:13:00.003+01:002015-11-10T03:59:36.641+00:00Prolapse surgery unsuccessful for almost one third of women<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbmEq06moVmiH78QNObhRY6JXkU5_GCUxgUCCGjhv4YAoedPi-aQkqofY24zvoyuA87ModvCLzanacOVUYCNINWGh2sjX8hPt3PyBGufCczjaPHn7_fU7OOVf1AT26MWYNI7uMMLDV1Q4/s1600/vide+4x3+red+belly3.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbmEq06moVmiH78QNObhRY6JXkU5_GCUxgUCCGjhv4YAoedPi-aQkqofY24zvoyuA87ModvCLzanacOVUYCNINWGh2sjX8hPt3PyBGufCczjaPHn7_fU7OOVf1AT26MWYNI7uMMLDV1Q4/s1600/vide+4x3+red+belly3.jpg" /></a>A <a href="http://media.jamanetwork.com/news-item/study-evaluates-long-term-effectiveness-of-surgery-for-pelvic-organ-prolapse/" target="_blank"><strong>new study</strong></a> from the University of Utah School of Medicine (lead author Ingrid Nygaard, M.D), which followed the experiences of 215 women following reconstructive surgery for pelvic organ prolase, has concluded:</div>
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"<em>Results after seven years of follow-up suggest that women considering abdominal sacrocolpopexy (surgery for pelvic organ prolapse [POP]) should be counseled that this procedure effectively provides relief from POP symptoms; however, the anatomic support deteriorates over time; and that adding an anti-incontinence procedure decreases, but does not eliminate the risk of stress urinary incontinence, and mesh erosion can be a problem...</em>"<a name='more'></a><br />
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The May 14, 2013 press release also reminds readers that POP "<strong>occurs when the uterus or vaginal walls bulge into or beyond the vaginal introitus [vaginal opening]. It is a common occurrence and 7% to 19% of women receive surgical repair</strong>...<br />
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More than 225,000 surgeries are performed annually in the United States for POP."<br />
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<br /><div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0tag:blogger.com,1999:blog-4181472671648618071.post-59232392398705072962013-05-22T23:47:00.005+01:002013-05-22T23:47:58.959+01:00Hooray for the c-section vacation!<div class="separator" style="clear: both; text-align: left;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcXEII4M8BYGOFgx_o2Wo_HZOwzubhzeSF7EO_K_gQjMVH88RE1DL9V65dsLFRXlxIB0eE_jTvAlQ8KBT-ZX8YF_Mrmvd09Ovrf13HQ7s-0uQTuS-cC_QaglZEasbVKlTfSCnYXDaL8q8/s1600/c+artwork+for+cufflink+april+2011.jpg" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="147" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgcXEII4M8BYGOFgx_o2Wo_HZOwzubhzeSF7EO_K_gQjMVH88RE1DL9V65dsLFRXlxIB0eE_jTvAlQ8KBT-ZX8YF_Mrmvd09Ovrf13HQ7s-0uQTuS-cC_QaglZEasbVKlTfSCnYXDaL8q8/s200/c+artwork+for+cufflink+april+2011.jpg" width="200" /></a>Above is the title of a recently posted blog on the U.S. babycenter website by mum of two Kristina Sauerwein. </div>
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Kristina's post begins by asking, "<a href="http://blogs.babycenter.com/mom_stories/05162013-the-c-section-vacation/?utm_source=dlvr.it&utm_medium=tumblr" target="_blank">Dare I admit that I enjoyed my c-section birth experiences?</a>" and she goes on to describe with relish what she <em>enjoyed</em> about her hospital stay.<br />
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Some of what she writes will certainly be controversial for some tastes, but I really felt it was a blog post worth highlighting here as it's a perspective I haven't really seen anywhere else.<br />
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Of course, see what you think.<div class="blogger-post-footer">Read more at my main website, http://www.electivecesarean.com</div>cesarean debatehttp://www.blogger.com/profile/01711913972260724246noreply@blogger.com0