Tuesday, February 23, 2016

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,
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.

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.

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).

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.

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."

No comments: