Tuesday, February 23, 2016

National Maternity Review Silent on Life-Saving, Prophylactic Cesareans

Opening the pdf of 'BETTER BIRTHS - Improving outcomes of maternity services in England' today, I was reminded of the faulty Shopkin packet my daughter opened recently - EMPTY, with No Surprises At All.

Not a single mention of how a timely, planned cesarean birth can save lives (especially full-term babies at risk of stillbirth), protect against pelvic floor damage, and result in high maternal satisfaction for women who choose it.

'Safety' on pg.23 reads: "There was evidence from the data of opportunities for improvement in the safety of maternity services. For example: stillbirth ... instrumental deliveries resulting in third and fourth degree perineal tears...[and] almost half of CQC inspections of maternity services result in safety assessments that are either ‘inadequate’ (7%) or ‘requires improvement' (41%)"

And despite the fact that a cursory glance at NHSLA obstetrics cases demonstrates significant (and costly) mortality and morbidity of mothers and babies when cesareans are carried out too late or not at all, England's new National Maternity Review contains just three mentions of cesareans:

Pg.3 refers to an anecdote about watching a twin caesarean delivery.
Pg.27 refers to RCOG Clinical Indicators project data on emergency caesarean sections rates.
Pg.77 cites 'rates of caesarean section' as a marker of quality in South West Trusts.

Compare this to pg.99:

Feedback For Baroness Julia Cumberlege


On February 12, 2016, just ahead of the National Maternity Review being published, I commented on this post by Baroness Julia Cumberlege: "We are shaping services for years to come."

"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.

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.

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.

Women who are at full-term in their pregnancy are rarely advised of the risk of stillbirth,

2015 Consultation Comments Submitted to National Maternity Review

On October 31, 2015 my organization electivecesarean.com (also a Stakeholder for various NICE guidance), submitted the following comments during the National Maternity Review consultation:

4.1 Which users/groups/organisation do you represent?
The organisation electivecesarean.com 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.

4.2 What do you think are the barriers to providing high quality maternity services?
- 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).
- There is an emphasis on process (i.e. achieving 'normal' birth) over outcome, positive experience and patient satisfaction.
- 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). 
- 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).

4.3 What do we need to do to make maternity services better?

Sunday, November 16, 2014

Unforeseen Complications of a Summer Cesarean Birth


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.

In short, when we decided that we wanted our son to begin school in England at compulsory school age and not before, our 'request' for this to happen opened a huge can of worms.... that ultimately led to summerbornchildren.org

Tuesday, August 27, 2013

It's about knowledge and empowerment

I plan to write about Piper Newton again - she's written a courageous book called, 'And Then My Uterus Fell Out', which is due out on October 1st - but for now I'd like to share the blog post she published a few days ago:

"It's about knowledge and empowerment"

She describes how her vaginal delivery has left her "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."

Saturday, August 24, 2013

Obstetrician changes his mind about Maternal Request

Admiration and respect. These are the words I would use to describe my feelings towards Dr. Silvio Aladje, an OBGYN and maternal fetal medicine specialist at Michigan State University in the U.S.  In his blog posted yesterday, 'Caesareans Section On Demand', he describes how, after reading our book, 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.

Wednesday, August 21, 2013

Birthrights organisation highlights maternal request refusal

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 its response 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).

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.

Monday, August 12, 2013

Why women often don't get the birth they want


The answer to why women often don't get the caesarean birth they want is this: Their requests are blatantly refused.

The answer to why women often don't get the vaginal birth is more complicated, but there was an interesting debate today on BBC Radio 4's Woman's Hour, hosted by Kirstie Allsopp.

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 the programme link here and encourage you to have a listen.

Feedback welcome!

Wednesday, August 7, 2013

NICE says a planned caesarean section SHOULD be offered to women who request it


My letter (title above) was published in the British Medical Journal today; I wrote it in response to another letter, NICE says caesarean section is not available on demand unless clinically indicated, 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.

It reads:

Refusal to follow NICE caesarean guidance is unjustified


My letter (with the title above) was published in the British Medical Journal today; I wrote it in response to another letter, NICE promises on infertility and caesarean section are unmet, sent in by Lawrence Mascarenhas, a consultant obstetrician and gynaecologist, Zachary Nash, a medical student, and Bassem Nathan, a consultant surgeon.

It reads:

Wednesday, July 31, 2013

Midwives worth their weight in gold


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 Australian blog

Sunday, July 28, 2013

The wrong debate about cesarean sections

Following a comment I left on his article this week, What Is A Normal Pregnancy?, Dr. Silvio Aladjem invited me to comment on an article he'd written in May 2012, titled, The wrong debate about cesarean sections.
 
Here is what I wrote:

Monday, July 22, 2013

Royal Congratulations to William and Kate!

It's great news today that the Duke and Duchess of Cambridge have become new parents to a baby boy.

No news on the name yet - only that he was born at 4.24pm at St Mary's Hospital in London, weighing 8lb 6oz.

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.

Saturday, June 15, 2013

Australian Royal Birth debate this month


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 (more information here) may be of interest.


Tuesday, June 11, 2013

New NICE Quality Standard Reinforces Support for Maternal Request

electivecesarean.com  2013 NICE Quality Standard Reinforces Support for Maternal Request Caesareans and Mothers’ Satisfaction with Maternity Care PRESS RELEASE
Embargoed until 00:01 Tuesday 11th June 2013 (GMT)
Published by electivecesarean.com

Following the National Institute for Health and Care Excellence (NICE)’s publication of its Caesarean Section Guideline (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,[1] electivecesarean.com welcomes NICE’s Quality Standard for Caesarean Section, and hopes that it results in greater adherence by hospitals and health professionals to its 2011 caesarean recommendations.

Monday, June 3, 2013

Guess which makes headlines - Birth Orgasm 0.3% or Perineal Tears 39.9%?

The fact that some women experience an orgasm during birth is not a new concept, as one midwife commented at the bottom of yesterday's Daily Mail article: "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." (lizzy2511 Swansea, United Kingdom, 2/6/2013 23:41)

But a new study by Thierry Postel has highlighted the possibility once again.

Thursday, May 23, 2013

Prolapse surgery unsuccessful for almost one third of women

A new study 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:

"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..."

Wednesday, May 22, 2013

Hooray for the c-section vacation!

Above is the title of a recently posted blog on the U.S. babycenter website by mum of two Kristina Sauerwein.

Kristina's post begins by asking, "Dare I admit that I enjoyed my c-section birth experiences?" and she goes on to describe with relish what she enjoyed about her hospital stay.

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.

Of course, see what you think.

Tuesday, May 21, 2013

Midwives in Switzerland want greater influence over women's birth choices



Julie Hunt, swissinfo.ch May 13, 2013

Pregnant women are faced with a whole range of birthing options, which can make choosing how to have their babies pretty difficult. An increasing number of Swiss women are opting for caesarians, mostly on the advice of their doctors.
 
The Federal Office of Public Health recently published a report that neither criticised nor supported C-sections. But health care professionals in Stans, canton Nidwalden, are clearly against them. At the cantonal hospital, 29% of births are C-sections, around the national average. Birthing staff want to reduce that number. And at the nearby privately run birthing house, ‘caesarian’ is almost a dirty word. 

Saturday, May 18, 2013

Cesarean Cachet or Status Symbol for Brazil Women?

An NPR report this past week, C-Sections Deliver Cachet For Wealthy Brazilian Women, by Lourdes Garcia-Navarro, is available to listen to here, and a few days later, this report by Nicole Stevens was published: Elective Cesarean Sections Seen as a Status Symbol [in Brazil]. I posted the following comment on the NPR news article:

I'd firstly like to agree with the OBGYN below, that it is very important that women are advised of planned cesarean risks, and in particular, the risks of repeat surgeries. This is precisely why CDMR (cesarean on maternal request) is only advised for women planning small families. Additionally,

Friday, May 10, 2013

Intervention in childbirth: What’s wrong with letting women choose?

On Tuesday 11th June, Bournemouth University is hosting a DEBATE with free entry, which promises to be interesting.

Intervention in childbirth: What’s wrong with letting women choose? is scheduled to take place between 10am and 12.30pm, and the organisers have told me that a summary will be published afterwards.
Details are as follows:

Hospitals 'are ignoring advice on caesarean sections

This was the headline in last week's Guardian article in which the Royal College of Obstetricians and Gynaecologists (RCOG) and the NCT criticised hospitals for not following NICE guidance on elective cesareans.

Absolutely! I agreed with them.

Just this past week I have been trying to help the latest of many women who have contacted me over the years to say their maternal request cesarean is being blatantly refused.

Friday, March 22, 2013

New ACOG Committee Opinion on Maternal Request

ACOG has just published a new Committee Opinion on Cesarean Delivery on Maternal Request (Number 559, April 2013), and says, "In the absence of maternal or fetal indications for cesarean delivery, a plan for vaginal delivery is safe and appropriate and should be recommended."