Green Party pledge to reduce c section rates

My issue with rocketing caesarean rates among healthy women is that this is happening in a context where we don't have enough obstetricians, anaesthetists or midwives, and where postnatal wards are heaving and inadequately staffed. I wonder if it leaves women with complex health issues who are trying for a vaginal birth with less access to surgical input when they need it.

"Actually, when post-birth complications like incontinence and tear repair are taken into account, CS are not necessarily more expensive than vaginal births. "

Well - if your comparison group is women giving birth in obstetric settings who have high rates of induction, unplanned caesarean and assisted birth.

Actually, when post-birth complications like incontinence and tear repair are taken into account, CS are not necessarily more expensive than vaginal births.

Politicians should not be forming medical policy ever.

ALL the evidence points to a mental health related issue.

To the point that I actually say that a request for an ELCS alone with no other information is probably an indicator for underlying mental health concerns and that midwives should treat accordingly.

I was put under the perinatal mental health team and had additional appointments during my pregnancy. This alone I would argue had long term benefits to me personally.

There was a report by a maternal mental health charity which looked at the cost of poor mental health due to pregnancy and childbirth birth related issues - the figures were mind-blowing in terms of cost to the economy. It has a huge impact on women long term. It was from a few years back and have to look it up on MN but it was shocking. As in if we invested much more in staffing the impact would be huge and the cost to the tax payer would be massively covered by improvements to women's lives and economic output. It's financially crazy to be proposing such regressive shit.

Frankly it's the type of ignorant bullshit I expect from the hard Right. To see it coming from the greens says a hell of a lot. It's anti-woman as far I am concerned.

Suffice to say, if I didn't have other reasons not to vote green, this would firmly lose my vote as it's something I particularly care about and have spent a huge amount of time trying to support women with.

"It's not as advisable for a first birth (the statistics aren't so favourable) though."

Depends what you're looking at. Lancet series on place of birth looked at a good number of studies involving vast number of births and didn't find a significant different in outcomes for babies of first time mums. Birth Place 2011 did. Interestingly though Birth Place 2011 found excellent fetal outcomes for first time mums choosing freestanding midwifery units - birth centres where obstetric input would require transfer by road to hospital, so suggests out of hospital birth per se isn't necessarily less safe for low risk first time mums.

It infuriates me that even after the NICE guidelines were changed - in response to mental health concerns that the NHS failed to change the way it recorded mental health related ELCS. This means that there's no data for it and there was not real official acknowledgement that it was valid to do so for mental health reasons. It's led to the stigma and ignorance continuing.

Absolutely. As you say shocking that it isn’t acknowledged as being related to mental health.

I had my daughter nearly 14 years ago so this wouldn’t have helped me at all.

If you have had an uncomplicated previous VB and a low risk pregnancy a homebirth is statistically much less risky than a birth in a consultant led ward. It's still less risky than being in a midwife lead unit too. Which surprises a lot of people. It's not the preferred option for all women (partly for anxiety reasons) but that's what the data says.

Women getting access to this has been greatly reduced due to staffing issues too though. You know cost and all that... (Funny how NICE also support homebirths isn't it?)

This doesn't make logical sense unless you factor in that anxiety has a role to place in childbirth as well as other factors. This isn't total woo woo - it's about hormones release during birth. Anxiety interferes with this process but it's not particularly well researched especially not to high standards without a predetermined ideological agenda. Mainly because it's an area of medicine that isn't regarded as a high enough priority and there's too many politicians trying to score points with their core red meat voters over childbirth.

It's not as advisable for a first birth (the statistics aren't so favourable) though.

And this comes with a caveat that a planned homebirth is a birth with a trained midwife present.

A free birth is highly risky and different again. That's a birth with no medical assistant present. It should not be confused with a planned homebirth.

@Thepeopleversuswork "I hate it too. I can’t hide my contempt for this nonsense. And the fact it has dictated attitudes to childbirth for so long is a disgrace."

And yet back in the real world of maternity services (rather than deep in the culture war chat around birth on the talk boards, and clickbaity articles in mainstream media) decisions around how labour and birth is managed are actually ever more shaped by defensive and highly medicalised approaches for managing labour that are resulting in rocketing rates of complicated & traumatic births including among low risk women.

I spent years researching this before getting pregnant.

I was so bad I wouldn't even get pregnant before I knew I could get a CS. I was exceptionally lucky because my GP agreed to refer me to the specialist I had tracked down at a nearby hospital.

I had looked into every conceivable alternative option.

Tokophobia is really poorly understood - there are very common features about women in each group. There is a definite pattern. And there is massive social stigma.

I've posted extensively on MN about it in the past - particularly in the run up to and after the NICE guidance was changed.

The NIcE guidance was a response to a lot of very distressed women raising the issue over the course of a number of years. There are cases where women were so distressed about the prospect of giving birth vaginally that they terminated pregnancies despite desperately wanting children.

It infuriates me that even after the NICE guidelines were changed - in response to mental health concerns that the NHS failed to change the way it recorded mental health related ELCS. This means that there's no data for it and there was not real official acknowledgement that it was valid to do so for mental health reasons. It's led to the stigma and ignorance continuing.

There are some awful stories about women not being allowed a CS. Women were travelling across the country to hospitals far away because their local one prevented them. Others were denied and were traumatised by the experience.

And here are the greens who were happy to roll back on all that because they couldn't be arsed to look into the reasons why the change happened in the first place.

It's all effectively documented on MN so it's not like it was hard to research if you could be bothered. Everything I posted years ago was referenced and linked to reputable sources.

As I say I'm pro ELCS and pro homebirth - there's no 'right way' to birth. Both options definitely have benefits to particular type of women and in a number of cases would be less risky for that particular woman than some other options. There is a most appropriate for your circumstances that's the crux of it (I don't think it's a good idea for every woman to be encouraged to have an ELCS and there are women who need additional information particularly if they want more than one child or are particularly young).

@MooseBreath

I hate the increasing belief that childbirth is a non-medical event. There is a very good reason most births take place in a hospital in the presence of a healthcare professional (and often with an entire team of midwives, doctors, and nurses).

I hate it too. I can’t hide my contempt for this nonsense. And the fact it has dictated attitudes to childbirth for so long is a disgrace.

“We will work to reduce the number of interventions in childbirth, and change the culture of the NHS so that birth is treated as a normal and non-medical event, in which mothers are empowered and able to be in control.”

I hate the increasing belief that childbirth is a non-medical event. There is a very good reason most births take place in a hospital in the presence of a healthcare professional (and often with an entire team of midwives, doctors, and nurses).

Yes, women's bodies are capable of childbirth. But childbirth is incredibly risky. Women lose excess amounts of blood, tear, go into shock, and babies suffocate, and go into distress. These are not uncommon occurrences. I would have died both times I gave birth had I not been in a hospital.

In society, childbirth is a normal, everyday occurrence. To a woman? It is something that happens a couple times in a lifetime, if at all.

Childbirth is medical. The government needs to keep its nose out.

@RedToothBrush

Your post about Tokophobia is very enlightening. I also was completely unaware of this and it makes me angry looking back that I was treated as a precious timewaster when I said I was terrified of a vaginal birth.

Literally no one, even my counsellor, mentioned this!

This is an absolutely brilliant post that nails the issue down. Thank you for this, personally i feel a little more seen and that someone else out there gets it.

I was scared of childbirth when i was pregnant and spent the whole time in a state of high anxiety and fear. My pregnancy was complicated for a number of reasons - any one of those reasons should have been enough to get me a c section. Turns out i am asd/adhd too, so it makes sense why i was so badly affected by the doctors and midwives completely ignoring my mental health in the drive to push me into a vaginal birth. Had they agreed to an ELCS early on, all the things that followed wouldn't have happened. I wouldn't have ended up with ptsd, and i might have enjoyed my pregnancy instead of dreading the birth.

And yet I'm told that I should be nice to the green party if they knock on my door.

There is no ideal number.

Risk profiles vary massively based on maternal age, health and other demographic differences.

Trying to apply an ideal rate across the country is nuts if you consider massive differences in inequality of health in this country.

What might be appropriate in a leafy suburb with healthy older women might not be appropriate in a deprived provincial town with high rates of obesity or in an area with greater ethnic diversity with younger demographic who have more children.

This is important stuff. The greens are trying to over simplify to cs = bad v VB = good.

It should be want is appropriate for each individual woman. And each individual woman is the best placed person to do that with accurate information and decent support and care.

Educated women are most likely to get this because of privilege and being taken more seriously than someone who is less educated simply because educated women are better able to challenge and question where appropriate.

The point is that women across the board are able to make good decisions about their health if well informed.

The fact that even educated women are dismissed as not being capable of doing this and are instead labelled as posh rather than educated is the issue.

It's worth noting that educated women also tend to have children later (higher risk factor) and have less children (less risk from multiple CS). If you are in your 40s having your first child and your chances of intervention are much higher and your chances of having multiple future pregnancies are much lower. On balance this makes a much stronger clinical argument for an ELCS overall based on risk factors versus a woman in her early twenties who is hoping to have a large family.

If women who work in healthcare and research aren't able to make informed decisions about their maternity care then why are they able to get good outcomes in all other areas of medicine? Why are they suddenly making bad or posh decisions when it comes to maternity?

Are we seeing a massive upsurge in complications in birth as the result of ELCS? I've never seen evidence for that. We should be looking for it, but surely if we are saying it's a really bad thing we should be backing up these type of claims with substance especially in the context of scandals involving lack of access to intervention.

Because does that only apply to ‘educated’ women? You hear posters wanging on about improving the breastfeeding rate and how sad it is it’s ’so low’. If you believe in choice then there is no ideal number

Why are women still not trusted to know what is in their own best interests?

As I say above, educated women have the best health outcomes in every other area of medicine. They are the best placed to understand and make informed decisions.

Yet for maternity care this is often dismissed as too posh to push.

What gets me is I had a 'maternal choice' CS. My notes had Maternal Health written all over them. I had deliberately sought out a hospital with staff who had experience and understanding of birth fear and took it seriously. The person who wrote all over my notes in caps is regarded as one of the leading experts on the subject in the UK.

And yet.

My cs could not be recorded as being for mental health reasons. It had to be recorded as maternal choice because there was no NHS tick box to reflect mental health.

It's interesting in terms of birth fear and presentation too.

Tokophobia is either primary or secondary. There are similarities but also differences.

Primary Tokophobia is women who have never had a child. They tend to be older, often have a history of infertility issues, sexual abuse or trauma is over represented and they generally have higher rates of anxiety. These feelings have often developed from early childhood and have persisted. They are often highly educated and very capable of making informed decisions (educated women have better health outcomes in every other area of medicine - in maternity this isn't deemed relevant though) If they are reassured they can have a CS early on, it removes huge amounts of anxiety from women. These women tend to go on to have an ELCS. Counselling only was useful to a small number of women.

Interestingly, rates of intervention and poor physical and mental outcomes amongst women with the highest rates of anxiety prior to birth are much worse than those who have normal levels of fear. If we understand that birthing is a natural process - we also can understand that anxiety can disrupt that natural process and that some women with especially high levels levels of anxiety and other risk factors may be better off just having an ELCS as that's less risky than an instrumental intervention or an EMCS. This is where individualised risk profiles are relevant. Equally this actually supports arguments for 'woo woo births' and home births rather than being contrary and at odds with it.

Secondary Tokophobia is women who have developed birth fear following a traumatic birth. This ranges from a physically traumatic birth to an emotionally traumatic birth where a woman feels she has not been listened to. The Birth Trauma Association are particularly concerned about the rise in cases - this has been dismissed by a lot of people as women becoming less resilient and more demanding - but this is again a series of maternity scandals that have taken years to be taken seriously and increasingly shocking poor rates of staffing.

It's hard to not draw a link between the two.

More interestingly if these women are given approval of a CS early in pregnancy they relax. With support and extra attention from midwives it's been found that a large percentage of this group of women tend to change their minds and have a VB with a robust birth plan which has clear points about when intervention is to happen (as in earlier pain relief / intervention rather than the woman being left to it). And often their experiences with this extra level of support are much more positive.

So more time with a midwife really seems to be a key factor her. And part of that listening process is not to ban or limit access to a CS. It doesn't necessarily led to a CS.

Hospitals which have sought to restrict access to an ELCS effectively were found by NICE to be part of the problem because it broke trust and were felt to dehumanise women. NICE recognised the importance of building a relationship with HCP. If women felt listened to and granted an ELCS it improved their relationship and trust levels so much that they felt able to have another go at a VB. Some have described this as massively healing. Counselling and going through previous birth exp

So yeah huge amounts of this is about respect for women and their lived experience, clinical research, mental health and yes poor staffing levels.

Why are women still not trusted to know what is in their own best interests?

That is what is under pinning this - wouldn't it be weird if they were pushing a policy that sought to control a procedure/pain medication men needed/wanted? We are so used to having our healthcare rationed and pontificated and decided on by men (often with very little actual underpinning research).

Still if they are reviewing and listening that is at least something for the party that used to claim they were the party of science.

@izimbra

Official NICE guidelines state: 'For women requesting a caesarean section, if after discussion and offer of support… a vaginal birth is still not an acceptable option (Trusts should) offer a planned cesarean section."

Yes. But the default is still that women are steered heavily away from elective caesarean section. In my case I was point blank refused. (I didn’t know at the time that it was in my gift to push back against this which is another story but there was no one other than my counsellor advocating for my right to have a caesarean). It was very much communicated to me that I was being a bit of a Princess and needed to just crack on.

It may technically be possible to insist on an elective CS but there is still a culture of disdain from healthcare professionals and particularly midwives when women choose this route outside of strict medical necessity.

Arguments are invariably trotted out about the risks associated with a CS and someone will pop up to make the startling observation that it’s a serious medical procedure (well no shit, Sherlock). And of course the “too posh to push” canard.

When in fact a serious cost/benefit analysis makes it clear that “natural” birth is not automatically either the safest or the cheapest option if you look at long term population health.

Of course there are arguments against CS. But I don’t see people piling on to tell people seeking gender reassignment surgery that it’s a “serious medical procedure”. It’s a given that they have considered this and weighed up the pros and cons.

My point is that these sorts of arguments are rarely made in the case of people opting for other elective procedures. They just don’t come into play. Why are women still not trusted to know what is in their own best interests?

The lack of dignity referred to is in the process of trying to get the procedure, rather than the medical procedure itself.

Who is referring to maternal choice caesarean as 'an indulgence'?

🙄

Maybe you're not aware of NICE guidance on maternal choice caesarean:

"Official NICE guidelines state: 'For women requesting a caesarean section, if after discussion and offer of support… a vaginal birth is still not an acceptable option (Trusts should) offer a planned cesarean section."

I don't think the Green party has set out that they want the NHS to stop offering maternal choice caesareans have they?

"Or just basic dignity?"

You're aware that a planned caesarean involves you lying on an operating table naked from the waist down, with a crowd of maybe 8 people standing around you that you've never met before, as someone inserts a catheter into your urethra? Then cleans your vagina out with swabs afterwards to remove blood clots, and inserts a pain relief pessary into your anus?

I'm not suggesting that any of this is intrinsically traumatising, but just to make the point that getting a baby out of your body isn't usually described by anyone as a 'dignified' experience regardless of mode of birth.

Quite.

Why is one concept ok despite the cost whilst the other must be cracked down on because of the cost when both are apparently connected to mental health?

Why is the protection of mental health of that group important but the mental health of another deemed too expensive? And it's not even mental health if we are talking about C-sections particularly with reference to black women or women who do not speak English as a first language. It's literally about life and death.

That's what is really gauling. If you are preaching about inclusivity and the importance of mental health why on earth do women particularly black women, somehow STILL seem to be deemed lower priority than every other person!?

It's striking.

And what's more, NICE have even done a cost analysis on the basis of long term complications and felt that on balance ELCS were cost effective and should not be denied on that basis alone!

Training isn't a free thing. It costs to have a member of staff off a ward for a day to go to training. Someone else has to be paid to be on the ward instead. And the training session itself isn't free. There will be a trainer and probably a company who are paid to do it. Has NICE done a cost analysis of whether the benefit to all patients is worthwhile from doing this training?

The idea it costs nothing when we are making financial arguments to stop ELCS when NICE say it's ok and there's no research into the cost benefits of training staff to 'be inclusive' is beyond appalling. It is fundamentally anti-women.

It seems to be constantly that even where women have evidence this is still not good enough but if someone says you can change sex and everyone has to sign up to this belief no matter what the cost then we should all go he'll yeah.

The sexism is atrocious.

We can argue the toss about this: I don’t automatically disagree and I don’t want to turn this into yet another trans row. It’s about the principle of parity in access to these procedures between the sexes.

If you accept the premise that people need expensive reassignment of their gender for the sake of their mental health why can’t this principle be applied to women who want to give birth with a minimum of distress and trauma? Or just basic dignity?

It just doesn’t feel consistent that these very expensive and highly intrusive procedures are deemed necessary for people transitioning but apparently not essential for women giving birth (for whom the relevant procedure is far cheaper and less complicated).

Why is one valid and the other an indulgence? Because birth is “natural”?

"Do you understand how gender neutral medical terms harm women? And are far from inclusive. They are elitist."

So if a midwife is at a meeting with her colleagues and refers to 'women and birthing people' in a discussion about, say discharge organisation from the postnatal ward - this hurts women? How? Please explain the mechanism by which these words materially 'hurts women'.

"Im not a transphobe"

Of course you are. You want to erase all references to trans people from our language. You don't want them to receive the care and communication in pregnancy and birth that they would feel most comfortable with, despite the fact that it costs nothing to provide this type of care and communication.

"I'm sick of the invisibility and lack of thought to how making simple language with broad understanding levels compliance, excludes and marginalises groups which are already the single most at risk group in maternity services."

How does referring to 'women and birthing people' 'erase or exclude women'.?