Two letters to BMJ editor published today

In response to the publication of a new research paper on the Maternal and fetal risk factors for stillbirth, I wrote two Rapid Responses, and they were published today.

In the first, I ask the researchers whether there is any other data available (in addition to that published) on the gestational ages of the stillbirths that were analyzed in their study, as this information is very useful for women deciding on delivery mode:

Gestational ages at which stillbirths occur and maternal or fetal risk factors observed at term

And in the second, I talk about the caesareans, stillbirth and maternal mortality in Greece and the Netherlands, and question whether the push for 'normal' birth and minimal intervention is the best approach in maternity care:

Reducing mortality is not as simple as low cesarean rate good, high cesarean rate bad

This is  a very quick post to reassure readers who may have read the story making worldwide headlines yesterday: Caesarean deliveries and formula feeding linked to lifelong diseases: research

Incredibly, and despite the fact that it only involved 24 infants, 6 of whom were delivered by cesarean (and we don't know what type of cesarean), one Canadian paper (The Edmonton Sun) even went as far as to call it "the first large study of its kind in North America."

Thankfully, the NHS choices website has produced an excellent 'Behind the headlines' appraisal of the study: Caesarean birth link to asthma lacks proof.

It concludes, "The study does not provide any evidence that the mode of delivery or feeding pattern was the cause of the bacterial levels measured. Neither does the study provide any evidence that being born by caesarean delivery leads to developing asthma later on in life."

Busy blogger

I'm conscious that I haven't blogged for more than a month now, and I have a number of saved drafts that have accumulated here in recent weeks, but I'd like to assure readers that this is only because I have been inundated with birth research and other deadlines throughout January.

As just one example, NICE is currently writing Quality Standards on numerous areas of healthcare, and my organisation recently submitted feedback on the 'Caesarean' Quality Standard draft and there are two others ongoing this month. Each one requires vast amounts of reading and research, and together with other ongoing projects, my blog often ends up taking a temporary back seat.

Apologies for this, but rest assured that I am working hard to ensure that there is greater balance in both the delivery of maternity care, and the information that is provided to pregnant women.

Petition for Ultrasound Scan in Third Trimester

I'd like to highlight the work being done by Rachel Buckley (@rachelbuckley88), who (along with others, including Robbie Devine at POAC) is trying to raise awareness about the benefits of a late term scan in terms of assessing potential problems for your baby or for you.

 

I've just signed her petition below, and if you'd like to do the same, please click here.

 

"In the NHS, pregnant women will be scanned at 12 and 20 weeks gestation. ( First and second trimester). A simple ultrasound scan in a woman's third trimester could save their babies life. This scan should be done as a precaution to check the baby's amniotic fluid is not falling low. The scan can check the baby's growth and can check what position the baby is in! My baby's life could have been saved if I had had an ultrasound scan late on into my third trimester. Women need to be monitored more closely near the end of their pregnancies as this is where things can go wrong and stillbirth could be the devastating result."

Does the NCT tell women the truth about birth?

This is the question posed by New Scientist journalist Linda Geddes, author of the new book, Bumpology, in her new blog, and below is my response:

The impression I have of the NCT recently is that it has had to respond to the huge amount of criticism it's received (whether at the end of news articles, on sites such as Mumsnet or elsewhere), and ensure that its public message is one of support and choice for ALL women -- and not concentrated on the importance of natural or 'normal' birth (or breastfeeding for that matter) for as many women as possible. But while I welcome this change in attitude, my concern lies in how genuine the organisation's assurances really are.  Here's why:

Debate on TOKOPHOBIA broadcast Jan 2

On December 7, 2012 I was fortunate to be a guest at the Voice of Russia broadcast studios to pre-record a five-strong panel debate on the issue of tokophobia. An edited 28 minutes of this discussion aired on January 2, 2013 and can be listened to here, and here is a summary of who was on the panel and what we were asked about:


Too posh to push or too scared to give birth? Latest figures from the Health and Social Care Information Centre reveal that last year 25 per cent of mothers in England had a caesarean. Why so many? Are these mums-to-be squeamish, scared, or sensible? Listen in as VoR discusses the question with midwives and other birth experts. So, does pushing for normal birth always give the best psychological outcome for mothers and babies?

 

VoR's Juliet Spare is joined by Pauline Hull, co-author of ‘Choosing Caesarean: A Natural Birth Plan; Toni Harman, co-creator of the One World Birth film; Virginia Howes, an independent midwife; Zara Chamberlain, who is an NHS midwife counsellor in Kent; and Maureen Treadwell, co-founder of the Birth Trauma Association.

NEWS: Northern Ireland endorses NICE guidance

On December 31, I received this reply from the DHSSPS, in answer to my question about whether its new Maternity Strategy would include the evidence-based NICE recommendations on maternal request cesareans, as published in November 2011:

"Following a Departmental process, the guidance was endorsed for the HSC in November 2012. As set out in Circular HSC (SQSD) 04/11, the Health and Social Care Board are currently considering how best to commission services in line with this NICE guideline.

Is this the cutest cesarean pic ever?



(...our own babies' aside of course!). As reported by LifeNews.com, this "Photo of Baby Reaching Out From Womb During C-Section Goes Viral".
 

I just love this photo of a baby gripping a doctor’s finger during a cesarean, and it's reported that the parents of baby Nevaeh are delighted with it to.

Would you wear one of these t-shirts?

I've just been shown these t-shirts being sold by Asda - one with the slogan 'Too Posh to Push' written above a picture of Miss Piggy and the other with the words 'Keep Calm and Push'.

And mmmm... I must admit that I'm in two minds about how I feel about them.

On the one hand,

Baby dies in NHS Trust with 'normal birth' targets

DO NOT INTERVENE

Another day, another story of a baby dying because a supposedly 'low risk' pregnancy became high risk without appropriate action being taken - but this was at an NHS Trust that has been praised for its success in increasing normal births.

Just when are hospital staff and politicians going to understand that a normal outcome is NOT more important than a healthy outcome??

When are we going to see a shift in policy that focusses on birth outcomes and NOT the birth process??

The BBC reports today of a Warwick Hospital apology over death of newborn baby who was starved of oxygen during labour in May 2012. It says,

The unpredictable, understaffed and unofficial birth risk

In discussions about different birth plan risks - comparing the likelihood of maternal and perinatal mortality and morbidity outcomes - you won't often hear the risk that is 'your maternity ward care'. And yet this is a risk I've talked about in the past - because when you plan a vaginal birth in the UK, you don't know what the staffing levels will be like in the maternity ward you enter, how many other women will be there with you, or what level of experience your carers (midwives or doctors) will have. It's an unpredictable risk that is all too often unrecognized.

 

I raise it again tonight because, published anonymously in the Daily Mail this weekend, a London midwife has written, 'The secret midwife: Psychotic mothers, exhausted doctors and nurses asleep on the job: A whistleblower reveals the desperate truth behind those rose-tinted TV shows'.

Instrumental deliveries ↑ but c-sections headline

This week saw the annual publication of England's maternity data by the Health and Social Care Information Centre, and as always, the cesarean rate made headlines - for example, Caesarean sections now account for a QUARTER of all births - and older mothers are the reason why.

But for anyone interested in maternity care outcomes beyond the 'controversial c-section', there were far more concerning rate increases to be found in the HSCIC's NHS Maternity Statistics, 2011-12.

Filmmaker asks, 'Can anyone argue with this?'

This evening, I came across the article, Freedom for Birth - Can Anyone Argue Against Respecting Women's Rights in Childbirth?, written by "filmmaker turned birth warrior" Toni Harman.

 

This was my response:

Is the obsession with doctor-free births risking lives?

This is the question posed in the Daily Mail this morning, as Carol Sarler asks, Is the NHS’s obsession with doctor-free births putting babies at risk?

Here is the response I've just posted beneath it:

"Considering the DM has published some of the most vociferous criticisms of planned caesareans in the past (including reference to the outdated 1985 WHO recommendation), incl. articles like those of Jenni Murray (Sep.2012 Get real, girls! Pain is part of childbirth, and Nov.2011 The madness of Caesareans on demand), it's about time that the balance is being redressed.

A normal birth and a baby's death

Yesterday I posted the comment below in the Daily Mail article, 'Mother-to-be lost baby after staff at midwife-led birthing centre failed to spot rare pregnancy condition', and you can scroll down further to read a comment posted by another reader, who also lost her baby during labor in a midwife-led birth unit.

Please note that I am not against birth units as a birth choice, but I do not agree that they be encouraged as standard maternity care and policy for all women deemed 'low risk' in the UK.

 

My comment:

Support for tokophobic women

Following yesterday's blog on tokophobia, I came across another article today, this time by the BBC, with some positive news for women.

Dr. Malcolm Dickson, a consultant obstetrician at Rochdale Infirmary, is quoted as agreeing that cesareans "are often the best option for women who are terrified of delivering their baby for months beforehand.

Tokophobia support - am I right to be concerned?

"More needs to be done to help women who have a morbid dread of childbirth...", says expert.

I am trying very, very hard not to be cynical about this call for midwives to recognize tokophobia as a legitimate issue affecting as many as 10% of women. Firstly, why has it taken so long and why have so many educated health professionals never even heard of it? But secondly - and more importantly, - why the concern NOW?

Is it ethical to promote normal birth?

Dr. Amy Tuteur's blog yesterday is a must read. She reflects on an article published in the journal Birth the bioethicist Professor Anne Drapkin Lyerly, who writes about social and moral issues in women’s health and reproductive medicine.

Dr, Tuteur says, "[Lyerly] has dared to question the ethics of “normal birth” within the pages of the premier journal of the normal birth industry."

RCM annual conference starts tomorrow...

The 'Midwives Calling' conference and exhibition in Brighton, which will last two days, bills itself as an event for "everyone with an interest in maternity services today". Well, that includes me, but while I'd hoped to watch some of the presentations online, the £49 price tag means that unfortunately, I will likely miss out.

In fact, during ongoing email correspondence with the RCM over the summer, I volunteered to speak at the conference in person - especially since the publication of updated NICE guidance on maternal request cesareans is not fully understood (and is not being properly implemented) by all midwives - but unfortunately, I haven't receive a response to my offer. Maybe next year...

Maternal request cesarean a "societal and professional failure"? I don't think so

Readers of this blog may recall an earlier post in which I reported the reason given by Lamaze International's journal Birth for declining to review our book, Choosing Cesarean: A Natural Birth Plan. Reading no further than the book's summary, our publisher was told, "The content of this book does not match the philosophy of our journal."

It may come as little surprise therefore to read this article by Professor Michael C. Klein, which was published in Birth last week: