U.S. cesarean rate is down from 32.9% to 32.8%

According to this report by USA Today, the latest figures from the United States show that the country's overall cesarean rate fell from 32.9% in 2009 to 32.8% in 2010.

Why do some women prefer birth by caesarean? New research published

It's taken a few years to publish but it's finally here - my website survey results formally published in the British Journal of Midwifery:

Why do some women prefer birth by caesarean? An internet survey by Pauline Hull, Carol Bedwell, Tina Lavender

BJM, Vol. 19, Iss. 11, 02 Nov 2011, pp 708 - 716

Abstract: Caesarean section at maternal request remains a contentious issue, fuelled by reports of associated morbidity. To explore the motivations behind women's expression of preference for a planned caesarean birth, an internet survey was conducted using semi-structured questionnaires available via a UK-based international website, www.electivecesarean.com, over a 9-month period. A convenience sample of 359 pregnant women who stated that their preferred delivery method was 'elective caesarean section through my own choice' was included.

More NICE cesarean media coverage

Media coverage of the NICE draft guideline on caesarean section continues, and in the last few days, I have commented on the following:

Telegraph: Cruel cuts to midwives have made Caeasarean sections a cheaper option for NHS (3rd Nov)

Practical Ethics: The moral case for elective caesarean section (2nd Nov)

Marie Claire: All women will have the right to a caesarean, Hannah Thomas (31 Oct) 

Huffington Post: Midwives are Able to Help Women Make the Right Choice About Their Childbirth, Cathy Warwick, Chief Executive of the Royal College of Midwives (31 Oct)

Huffington Post: Why didn't I have the right to a Caesarean, Sue Hedges (31 Oct)

Interview on BBC Breakfast Television

I was interviewed this morning on BBC Breakfast television, and for a short while at least, a shortened version of the discussion can be viewed here.

Sian Williams and Bill Turnball interviewed me and made the whole experience a very enjoyable one.

I must also thank

RCOG's response to the NICE guideline media reports

This is what the Royal College of Obstetricians and Gynaecologists (RCOG) has to say about the past few day's media headlines and stories:

"The RCOG does not comment on draft consultation documents since the content and recommendations are subject to change. 

However,

Comment posted on media NICE guideline stories today

So many stories, so many views.

The news that the draft NICE caesarean guideline supports maternal request for all informed women who want one has undoubtedly caused a media storm.

Here are a selection of links where I have registered (variations of) my comment below:

Express: Folly of caesarean births for everyone, Vanessa Feltz
Guardian: Caesarean sections should be life-saving, not a lifestyle choice, Louise Foxcroft
Telegraph: Childbirth finally leaves the Stone Age, Cristina Odone
Daily Mail: Now all women have the right to NHS caesareans in hugely expensive move, Tamara Cohen
AOL: All women to get the right to a caesarean birth on the NHS, Ceri Roberts

My Comment

The most important things here are

Media reports on NICE guideline ahead of publication

The Sunday Times' front page today reads "All women get right to caesareans" - a story that's been followed up by many other newspapers, radio and television news* programmes.

And athough I was surprised to read the article ahead of the NICE final publication date, I have not been surprised by some of the negative reactions to the news.

Unfortunately, many of the comments being made highlight the desperate need for education about planned cesarean births, and particularly those on maternal request, but even so, it is absolutely incredible to think that as of November 2011, cesarean autonomy may finally be a reality for all women, and not just those who are lucky enough to meet with a supportive obstetrician or live in an area with a supportive hospital.

*I was interviewed live on Sky News at lunchtime today and am scheduled to talk on BBC Breakfast tomorrow morning.

Where have I been? I've been to London to visit the Queen

That's not actually true of course, but it rhymes a whole lot better than 'the MP Dr. Daniel Poulter'!

On Tuesday 25 October, I attended the APPG meeting on Maternity and Population, Development and Reproductive Health in Portcullis House, House of Commons, London.

Afterwards, I spoke briefly with Dr. Poulter, who is the APPG chair, and he agreed to present a letter containing my concerns about caesarean rate targets to the Department of Health.

Is an obsession with natural birth putting mothers and babies in danger?

This was the question posed yesterday, by reporter Jane Feinmann, in an article that is certainly worth reading.

I commented: "There is nothing wrong with supporting women to have a natural birth if this is their preference, but we should not put maternity policies in place that set out to encourage (and even force) natural birth for ALL women who have been labeled 'low risk'. It is impossible to be sure which pregnancies and births are low risk until the birth is over, and women should be fully informed of this. The fact is that no birth plan is inherently "safe" or risk-free, and it's about time we started measuring good practice based on the actual physical and psychological health outcomes of babies and women - and not a hospital or area's caesarean rate."

Fair Play FIGO

I'll be honest, I am not the biggest fan of FIGO's 1998 statement on the ethics of cesarean birth with no medical indication (a subject I will return to later).

However, just recently, the International Federation of Gynecology and Obstetrics handled a situation (regarding a news story on its website) so professionally and courteously that I felt compelled to write about it.

Should women get to choose c-sections?

Jezebel Birth Pains blog

I liked this blog quote so much that I just had to mention it.

Written by Anna North in her review of this BBC news story, she wrote:

"So basically, women and their doctors should discuss birth options and come up with a plan that takes into account both a patient's wishes and her medical needs. Sounds so crazy it just might work."

You just have to ask yourself - who can argue with that?

Can I choose to plan a cesarean birth in the NHS?

This is one of the most common questions I am asked by women who visit my websites.

And up until recently, the answer was very much, "Not officially, but there are supportive doctors out there, if you can also find a supportive midwife who's willing to refer you to one."

However, finally, there may now be better news for women - whether you have a fear of labor and birth, or you've been considering a cesarean for prophylactic reasons and want to discuss your individual risks and benefits further with an obstetrician, or you have another personal reason.

This month, NICE published its draft guideline on Caesarean section (update) and in it, recommends the following:

Women don’t have to push so much, says U.S. doctor

This is a very interesting article with advice for women who want to achieve a vaginal birth outcome, and is essentially a Q&A with Dr. Aaron Caughey on the subject of "delayed pushing" techniques.

But what caught my attention was the poorer outcomes for babies in the research group of women who did wait before finally pushing...

Pay (Not) To Push, says Northern Ireland's health minister Edwin Poots

I am not going to criticize the Northern Ireland's health minister Edwin Poots here just yet - despite the fact that yesterday he said that cesarean births should be paid for by women who choose them (see BBC and Belfast Telegraph reports).

This is because I am not convinced that he has heard all sides of this debate, and as such, have contacted his office and am awaiting his response.

Northern Ireland has the highest rate of cesarean births in the UK, at 29.8%, and this is one of the reasons why

The Biggest Change in Women's Rights since they got to Vote

One of the many supportive doctors I've worked with over the years sent me an email today that got me thinking.

He (yes - a male doctor) had written, "it's a major breakthrough. The biggest change in women's rights since they got to vote" (in response to the NICE Guideline news).

I realized that just because we take the vote for granted as a good thing now, this doesn't mean that the women who campaigned had much support at the time - and least of all from other women.

Which is precisely what I've been finding over the past few days.

NICE News - ALL Women to be Offered a Cesarean if they Request one

Fantastic News.

If women make the informed decision to choose a cesarean birth, following individualized discussion and support, the new NICE Caesarean Guideline (Update) Draft, says that this should be made available to them on the NHS.

More on this later!

NICE Admits "Extra £800 Cost" Doesn't Add Up

A great deal is being made of maternal request cesareans (principle of choice aside) being a waste of tax-payers money and an unaffordable luxury in the current economic climate. 

But, and it's a BIG BUT, the reported estimated £800 extra cost is flawed.

Even NICE admits this in its 2011 Guideline Update (Draft), as indeed it did in its 2004 Guideline too (even though it was dismissed).

When both PLANNED modes of delivery (cesarean and vaginal) plus their subsequent intrapartum AND longer term health consequences are assessed, a "different cost-effectiveness result" could be produced, says NICE.

Maternal Anarchy or Human Evolution?

Quite by chance this evening, I came across this fascinating bioethics blog on the history of anesthesia, and it really struck a chord with me regarding birth choices.

Religion and ideology have historically hampered women's access to pain relief during labor (from chloroform through to modern-day epidurals), but I had no idea that such obstacles stood in the way of the very first surgical pain relief relief too.

According to the blog (based on a Boston Globe report on 7 June 2009), Prior to October 16, 1846 (the date of the first operations conducted under anesthesia) our view of the person seemed inseparable from the concept of pain: “the vast majority of religious and medical opinion held that pain was inseparable from sensation in general, and thus from life itself”. Thus, while the technology was available, the doctors and the patients were not ready for medicine: less painful medical care “required not simply new science, but a radical change in how we saw ourselves”.

Pivotal Moment in Obstetrical History - the NICE Caesarean Update

The 2011 NICE Guideline Update will ALLOW maternal request cesareans in NHS hospitals.

There are those who fear its coming, and there are those who welcome it, but in a few months' time (barring a complete U-turn), the blanket refusal of maternal request cesareans will no longer be considered acceptable maternity care.

"If a vaginal birth is still not an acceptable option to the woman, her request for a CS should be supported within the health service." (quote from May 2011 Update Draft)

What's the Real Story Behind the Cesarean 'Ban' News?

I found last week's 'news' that a number of PCTs are banning maternal request cesareans very strange.

After all, the 2004 NICE Guideline already states that the request is not "on its own an indication" for surgery.

So why are PCTs suddenly re-iterating their long-established rule in such a public way?