Guest post: “We must support women’s decisions in birth and make respectful care a reality for all”
For a small percentage of women electing a caesarean is an important decision in a positive journey to motherhood. Rebecca Schiller, CEO of Birthrights writes of her concerns about NHS Trusts’ policies on elective caesareans
Posted on: Tue 21-Aug-18 10:00:48
(105 comments )
Women’s rights in childbirth have occupied a dusty corner of the feminist movement for too long. As CEO of the human rights in childbirth charity, Birthrights, I’m working with a small team of staff and an expert board of midwives, obstetricians, lawyers and maternity service users to change that.
We believe that all women matter in childbirth and that we need to be treated as the same, reasonably rational human adults we were before pregnancy at this transformational time in our lives. We’re using the human rights framework (with its focus on dignity, respect, choice and autonomy) to push for a system, services and practice that protects women during birth, offers them safe, equal and compassionate care and listens to their feedback. To do that we provide advice, training for NHS staff, conduct research and feed the resulting knowledge in to maternity policy - always with a focus on vulnerable groups.
Women contact us for free advice on a range of issues. From accessing their chosen place of birth and help with making a complaint about care to dealing with issues around informed consent or entitlement to maternity care in the UK.
Over the past two years a worrying third of our advice service enquiries have come from women trying to access a maternal request caesarean and finding themselves battling, jumping through endless hoops and waiting for months for answers. Some women whose reasons are not deemed compelling enough have even had their care withdrawn completely in the last weeks of their pregnancy. These enquiries have been some of the most distressing we have handled and we’re determined to do something about it.
Whether they are choosing a caesarean, a homebirth or any other birth option women have very compelling, thoughtful and sometimes private reasons for making their decision. From the 83 women hoping to have elective caesareans we advised in an 18 month period 33% had experienced a previously traumatic birth. 28% wanted a caesarean birth because of an underlying medical condition such as symphysis pubis dysfunction (SPD), vaginismus or fibroids. 16% of women simply believed it was the right option for them (often after extensive research into the evidence), 8% cited primary tokophobia as their motivation while 6% explained their request was based on other trauma in their lives such as sexual assault (6%). 10% did not give their reason for making this request. Nor should they have to given our growing realisation that many more women have experienced trauma and violation in their pasts than we’ve previously assumed.
A worrying third of our advice service enquiries have come from women trying to access a maternal request caesarean and finding themselves battling, jumping through endless hoops and waiting for months for answers.
Through a series of Freedom of Information request we have created this map of Trusts showing the 26% who offer a respectful pathway for women to request a caesarean (in line with best practice guidance) Trusts whose policy effectively bans maternal request caesareans (15%) and the many in the messy middle ground that women are expected to muddle through. We’re now working closely with national policy makers, the Royal College of Obstetricians and Gynaecologist and the Royal College of Midwives to push for clear national recommendations on this issue and to encourage Trusts to abide by them. And we are considering legal action if Trusts’ policies are shown to be unlawful.
Women make decisions on what kind of birth is right for them based on a range of medical, social, cultural and experiential factors. For me a safe birth meant being at home, for others it requires access to an epidural or the presence of a trusted midwife. And for a small percentage of women electing a caesarean is an important decision in a positive journey to motherhood. We must come together to support women’s decisions and insist on a system that makes safe, respectful care a reality for all.
If you need information on anything concerning your rights in pregnancy and birth head to our website and this series of Mumsnetters FAQs, such as “Can I be refused admission to a midwife-led unit” and “Do I have the right to access my maternity notes?”
I’ve used this radical idea that pregnant women are human beings as the basis for my new book, Your No Guilt Pregnancy Plan: a revolutionary guide to pregnancy, birth and the weeks that follow. I’ve focused less on the ‘you shoulds’ and ‘you shouldn’ts’ and more on the concerns that came up for me when I was first pregnant a decade ago and asked for support on a Mumsnet due date thread. So there aren’t endless comparisons of your baby to the size of a vegetable but I do cover the huge shifts happening in our relationships, bodies, work, sex and emotional lives as we become mothers. And of course a firm focus on rights and mental health.
By Rebecca Schiller
Great post. I experienced this and ended up with a traumatic elcs. If I ever have another pregnancy ill push for elcs from the start. We are conditioned not to argue with doctors and women's choices are not respected.
This is great, thank you. I started a thread in AIBU last week about just this. I am that person currently jumping through endless hoops to obtain an ELCS after previous traumatic births. It’s just causing me unnecessary stress.
I'm thrilled someone is taking up the the baton for this.
I had elc granted very easily inspite of no physical issues from my 1st labour.
In fact I was told I had an amazing first Labour.
My consultant however was a member of the the birth trauma association so she understood the other events around dc1 birth that led me ask for elc this time round.
My reasons were no less than anyone else's. It's about time we started to respect all women who ask for one. It's a brilliant way to give birth but it's not the easier option. Both ways have pros and cons. It was absolutely the right descion for me.
It makes me so cross when women present to consultants with years of physical trauma behind them due to birth injuries and mental trauma and they are to ld they can still give birth vaginally.
It's a national disgrace in fact I did say on a recent thread it's the last huge area where little progressive light has been shone.
Also birth trauma, injuries from vaginally birth are hidden.
Great Post let's hope in a decades time the clear path and option for elc is there.
I would like to add... When I gave birth first time however my hospital regularly closed its doors to labouring women due to unprecedented influx of immigrants in our area.
The other hospital they would be sent too has had horrific reputation, the stories that came out of it. I think at one point it was named the worst hospital in the UK. So that was the choice.
Now... One still closes its doors but there has been catch up and work done. But with a fear of birth, that was my 1st experience.. The warning... You may not even get on the the ward. It was barbaric butchery. That was just after the mw crisis too (Labour gov).
Great post! I had an ELCS partly for anxiety and partly because I decided it was the right choice after weighing up the options. My consultant was completely fine with it and it makes me sad this option isn’t available to women everywhere
I can honestly say that having had my 1st baby over 17 yrs ago (traumatic, undignified induction - terrible midwives, emcs) and my 8th baby 22months ago. That women’s choice and control over their birth has been awful and still is!! I would love to pay for a private birth (pregnant again now) but it’s not a financially viable option - in fact it really bothers me that there isn’t a financially viable alternative option to the nhs for women who are pregnant. I paid for private scans in my last pregnancy - the whole experience was better & the private anomaly scan was head and shoulder better than the nhs one I had two weeks later.
I saw the OP on Victoria this morning, along with a consultant (typical consultant). “We can decide together what’s best” - Actually this should have been “...I can advice and then the woman can make her decision” but it doesn’t work like this at all...in any part of the nhs and it needs to change! NICE guidelines are there and it’s about time the guidelines were agreed to...to the letter!!!
I know full well that provides this pregnancy progresses well, even though I know exactly how I want my birth to be...it’ll be my 9th delivery...I think I know what’s best for me now....I’ll have to fight for it.
in fact it really bothers me that there isn’t a financially viable alternative option to the nhs for women who are pregnant.
Sorry @WeShouldBeFriends...where is this viable alternative? The only private hospitals are in London and have a price tag of ~£12,000 per birth
2.5 years ago I was rather dismayed to find the midwives all pressuring me to give birth in the midwife-led unit. In fact it was the default option on the birth notes and only high risk women were allowed to put down the labour ward. They weren't interested in having a conversation about it either, and any concerns were pooh poohed.
I was confident that I wanted access to all the pain relief options and didn't want the possibility of transferring whilst in labour. It was actually a relief when I became high risk at 32 weeks and so had to go to the labour ward as it meant I didn't have to argue about it.
It's the only contact I've had with the NHS where my choices weren't respected and medical staff tried to push their views on me.
I was told I had to have a natural birth dispite the fact that I have hypermobility syndrome and PGP. I was told that of course they would take into account my range of movements. In the end I was ignored for the whole time I was in labour. Then I tore badly so I had to have stirrups for my stitches.
I feel so upset whenever I think about the birth even though I have a lovely baby.
I have DTs, and had mixed views depending upon consultants I saw regarding getting an elcs. One pushed it at me, one patronisingly told me I’ll change my mind, we’ll talk about it later, asked me to justify why I wanted one complete with evidence and said that the only reason he was considering allowing me a section was because I was pregnant with twins and the last one said it’s my choice which way I go, she’d arrange for either way of delivery, and gave me actual proper statistics on my choices (DT2 was breech).
I think it’s fantastic you’re fighting for this, thank you. It’s ridiculous that women have to justify and often be denied the right to choose how they have their baby.
@Lumpy76 I had my baby at home without any assistance from the NHS. Didn't cost anybody a penny. I realise this is not appropriate for everybody but I've had as much distain for my birth choice as women have had for their choice for elcs.
There’s no “alternative” for people who want cesareans though.
and I support your right to a fine birth, no matter how much I wouldn’t like that option, because as women we deserve to make our own choices!
I feel like women are conditioned into thinking that they have somehow failed if they don't have a natural labour and that the natural labour is always the better option in terms of health wise for mum and baby as well as financially for the nhs. However, having been one of so many women who have experienced the absolute horror that a forceps delivery can cause, both short and long term, having given the choice I am sure people would think differently. I'm not saying people shouldn't have natural births because of the risk of forceps but I do feel that ELCS are always painted as the most dangerous option and if you request one you have to really be strong willed to get it due to the push back from doctors, when you are never warned about three possible outcomes if your natural labour becomes problematic and forceps or emergency section becomes the only way forward. It's always brushed over. I suffered for years after a forceps delivery both mentally and physically. I will mostly likely be incontenant to some degree for the rest of my life. Planned section for my second and third babies and it couldn't have been any better - I just wish i had been given the option of a planned section with my first and the positives discussed as it would have saved the nhs money in the long run with the physio I've needed over the years, medication and counselling that followed my forceps delivery
I am part of the tokophobia statistic and have been incredibly well supported.
I've never understood this issue ...... surely it's a no brainer especially at one of the most emotional and painful times of a women who is ready to give birth........women should be able to choose 100% whether it be there first , second , third or what ever number child to have natural or c- section.
Two things I noticed while fighting for an ELCS over a VBAC were that:
1. Everyone was so concerned that I might feel I'd missed out on a vaginal delivery. I hate this assumption that a VB is something all women desire - pregnant women aren't some homogenous lump with a hive mind. Some of us prefer to look at the stats and choose our risks according to our own priorities (which is just as well, because getting my consultant to even acknowledge the extent of risks with a VB in my situation was hard going - high faecal incontinence risk apparently isn't enough of a reason to forego a VB experience).
2. The story of my first delivery - and those of so many other women's whose deliveries don't fit the 'it stung a bit so I had a little gas air right at the end and I took the baby out shopping six hours later' narrative - are dismissed as horror stories which should never ever be mentioned in case a first timer hear them and be afraid. That needs to change too. Women need to know the risks of both delivery methods and active consent needs to be gained for VB in the same way as for CS. If I'd known I could refuse an induction my first delivery would have been very different indeed.
active consent needs to be gained for VB in the same way as for CS
😂😂😂 tell the baby that!
I meant in terms of risk at the start of pregnancy - obviously leaving it until the day of wouldn't work
@DuggeeHugs Exactly this! Informed consent-not "we don't talk about the bad stuff because it might put you off"
"Women need to know the risks of both delivery methods and active consent needs to be gained for VB in the same way as for CS. If I'd known I could refuse an induction my first delivery would have been very different indeed."
I completely agree. I can remember pointing out when I had to sign my consent form for my ELCS with all the potential risks how odd I found it no one would’ve asked me to sign a consent form with shoulder dystocia, tearing, and PND on it, all risks of traumatic natural births.
Women should be given all the info to choose.
I had a planned homebirth with an ELC signed off at 40+12 as I refused to be induced. In the end I didn’t need it, but felt so much happier knowing if I went beyond the advised dates for a home delivery, that I wouldn’t have to be induced.
The reasons sited were on the grounds of severe vaginismus (had no V.E’s at all) and the increased risk of an assisted delivery (statistically high in my local trust) when undergoing induction of labour.
I would however say that, 1. I know of several instances whereby woman cannot access a midwife led unit without an examination. 2. Women who have been told, not asked, that an episiotomy was about to take place and 3. Like myself, pain relief won’t be offered unless you consent to a V.E. I therefore laboured for 26 hours at home and delivered my son without any pain relief because I would not consent to the midwife attempting an examination that my consultant gynecologist had confirmed was incredibly difficult, very distressing and excruciatingly painful. Not because I fancied being an awkward prude!
I don’t understand particularly why women going overdue aren’t given a discussion about the risks of induction vs having an ELCS instead. An induction is also an intervention a woman must agree to so why isn’t an ELCS seen as a valid alternative? The statistics for induced births are appalling at the my local hospital for emergency sections/instrumental births/complications, yet this information isn’t forced on women in the same way even smaller risks of elcs are