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?

I've joined The Mom Pledge Community

I came across this rather intriguing website recently, and decided to sign up. Its founder, Elizabeth Flora Ross, has written a book called 'Cease Fire', which she describes as a "call to end the war between women", and The Mom Pledge aims to eradicate cyber bullying among moms. Here's what she writes:

A Rare but True Risk of Planned Cesareans

War, Hurricanes and any other Disruptive Force.

I read two things this week that made me decide to write about this risk.

That is - if you want or need to have a cesarean birth, you really are reliant on the availability of your obstetrician, other supporting medical staff, and a hospital with a functioning OR.

Obviously, as a statistical risk, this is likely a very small one

My Interview with My Baby Radio is Now Live

You can listen to this 30 minute 'Planned Caesarean' interview with MyBabyRadio.com here. 

This was a great opportunity to talk through the many issues surrounding planned cesarean birth, and I really appreciated the professionalism of the team who invited me on.

Thank you! 

Interview on BBC Tees - Maternal Request Cesarean 'Ban'

I was interviewed by Ali Brownlee on his Breakfast Show (at 2hr 10min), with a second guest, Dr Michael Dixon, Chairman of NHS Alliance.

In all honesty, I was shocked by some of the answers Dr Dixon provided, and was very concerned that someone

Complaint to BBC's The One Show re: its Cesarean Coverage

Last night, I contacted BBC Complaints, and also the programme itself, to ask why 'news' of NHS Trusts banning maternal request cesareans was presented in such an unbalanced and one-sided way.

The guest being interviewed on Monday's show was Dr. Sarah Jarvis, someone who clearly had her own personal views about maternal request, and whose views went completely unchallenged during the live chat.

The programme will only be available on BBC iPlayer (20 mins in) for a few more days, so I have typed up the transcript of what was said below:

The Labor Ward 'Care' I Chose to Avoid

I may have chosen to avoid the unpredictability of Mother Nature and a trial of labor when I planned my cesarean births, but I know that many women are choosing to avoid the unpredictability of care in NHS labor wards too.

These poor families lost their babies, quite unnecessarily, and all because the care they received was utterly atrocious.

(Much Needed) Call for More Maternity Doctors

On August 10, the BBC reported on a Call for more maternity doctors in order to prevent mothers dying due to "substandard care".

Six obstetricians have written an editorial in the British Medical Journal, pointing out that "most maternal deaths are now caused by treatable medical conditions."

NHS Controversial Cesarean Cost Clampdown

Yesterday, I commented on this, one of many reports following up on The Sunday Times story this week: NHS in clampdown on Too-Posh-To-Push mums.

I wrote: Firstly, there is actually evidence that a planned cesarean is no more costly than a planned vaginal birth - when comparisons include costs beyond the immediate intrapartum period (e.g. treating infant and maternal birth injuries, but also litigation).

In terms of choice however,

Read this GP's experience of "Brutal" NHS maternity wards

This is a fascinating comment by GP Partner Katharine Morrison, which I saw posted on the Pulse report, PCTs impose restrictions on caesarean sections.

Perhaps this will help some readers understand just one of the meanings of PROPHYLACTIC in the context of planned cesareans.

Morrison writes: I chose to have two caesarian sections after witnessing the brutality of "normal vaginal deliveries" that are the culture of the NHS.