New guidance to reduce epidurals and a target rate of 20% for C-Sections

Margery "A lot of women are ill informed though." You could do with a good hard look in the mirror.

Wants You'll only get The Rage arguing with people like Margery. Just saying.... Anyway, extremists like her are the best anti-NCB argument ever.

Margerykemp said "A lot of women are ill informed though."

Margery, a lot of women who undergo vaginal birth are woefully uninformed too, and are shocked by the brutality of it all. But presumably that's OK with you, because it's "natural".

What about the many babies who are deprived of oxygen during birth, and end up with conditions such as cerebral palsy because natural birth zealots midwives fail to call in the consultants before the damage is done, in an effort to avoid c-section?

P.S. I should clarify that my natural birth zealots strikethrough does not refer to all midwives!

Margerykemp

1. Most hospitals will go over all the risks of a c section and make the woman sign a consent form before performing a planned c section (there may not be enough time in emergencies). So women who have planned c sections are not ill informed. Even if an individual woman's reasons to have a c section seem uneducated to you, who are you to say that she can't decide what to do with her body? Her body, her choice- there can be no exceptions and clauses to that. You either believe in it fully or don't bother.

1. C sections are a mass mutilation of women? Seriously?

And would you care to clarify what men could possibly be getting out of the high c section rates? (since you mentioned in your earlier post that they are done for mens' benefit)

A lot of women are ill informed though.

Not everyone is like a typical MNer have you seen the 'other site'?

re: mass mutilation I was referring to c sections rather than epidurals

I was very anti epidural and am a keen advocate of natural birth with as few interventions as possible. However I am disgusted by the attempt to force women to give birth in an "approved" manner.

£200 ? Well, that's a drop in the ocean compared with the weekly cost to the NHS of drug and alcohol-related incidents, sporting accidents and all manner of self-inflicted injuries. But obviously the needs of a woman in labour comes way down the batting order compared to a habitual drunk being admitted for the 3rd time in a day. Fucking great.

Patron Yes their classes seem to leave a lot of initiative to the individual instructor. But on an organisational level they consistently advocate for guidelines like these.

White Well yes but that's not what the target actually is about. Apart from which this 20% business is only one element of the guidelines. Making midwife led birth units the default for low risk women means restricting their access to CLU's.

LaVolcan I agree about the odd priorities. But continuity of care and one to one support aren't actually valued or wanted by all women either! Woman-centered care should include those who, for example, just want an epidural or a caesarean and aren't particularly bothered about whether they're getting one to one support or continuity of care or not. So why should targets focus only on that?

And surely the reason why none of this happens is that it costs money and women don't kick up any stink about birth. Those with bad experiences usually just want to put it behind them. Ironically enough the ideology of natural birth feeds into the ignoring of the issues too. If birth is so natural and normal then why should women need pain relief, caesareans or one to one care and support etc.? It's rife as is clear from the comments on any article about this in the press.

Hmm, I doubt it. More likely that they will get closed down, and more women will be shunted into the CLU to be left unattended. But perhaps I am too cynical.

Moreover, the same can be said about epidurals and c sections. Theoretically they are an option for all women now, but despite the recent NICE guidelines update, women are still being denied that choice. The provision for c sections and epidurals varies as well.

The question is is any woman getting the birth she wants?

LaVolcan I thought MLUs were being encouraged now based on all that I've read and heard and I highly doubt that they will shut them down in the future.
If anything, there seems to be a push to encourage home births and MLUs and discourage epidurals and c sections.

WantsToBeFee I am a bit puzzled as to how you have read all that into my posts. I referred to most women being sent to CLUs - but referred to it as being some sort of idealised CLU - which doesn't exist in real life.

You said I could argue that most women in the UK end up with midwife led care, whether they want it or not. What about women who prefer consultant led care? What indeed? How does my reply saying that in practice women are often not attended by anyone go against that?

I said (Or at least an idealised version of the CLU where they are all well staffed and can immediately spot a problem and attend to it. Not the CLU where you never see the same person twice and go unattended for long stretches in labour, never mind get to actually see a Consultant.)

How do you make an inference from that this is saying that women should be denied the chance to see a Consultant? When I had my first child I naively expected that a CLU booking meant just that. I didn't expect it to be a two hour wait to see - well who? I wouldn't have bothered if had known that the nearest I would get to him would be having his name on my notes. As far as I can tell that's the reality for most women and it might be more honest to tell them so.

It would also be more honest instead of telling women that they can have an epidural and they shouldn't have to wait more than 40 minutes that the key thing is that they have got to get across the threshold first - not be sent home because the hospital is too busy and you are not in established labour dear (even though you need support.)

Homebirths are a theoretical option for all women but provision varies. Some places are geared up to them; others have probably hardly seen a home birth in 50 odd years unless it's an accident.

MLUs? Well, it depends where you live, but there will be a good chance that if your nearest one hasn't already closed down it will soon be, so I can't see many women having births in them in future.

My grouse against these self proclaimed feminists is that they keep repeating the mantra "My body, my choice" to passionately support home birth and VBAC(which aren't exactly risk free), but when it comes to a woman's right to choose an epidural or a c section they get outraged and automatically assume that such a woman is "uneducated" or "ill informed". In fact, they end up supporting the idea of her being denied that choice.

So "My body, my choice" comes with limiting clauses then does it? It's your body and your choice as long as you choose a home birth at Ina May Gaskin's farm or a drug free labour. But if you dare to choose a more medicalised approach, then you must be misinformed and it is no longer your choice.

Makes ZERO sense and is sickeningly hypocritical.

If it's her body and her choice then it can be ANY choice irrespective of whether you agree with that choice or not. That's feminism.

"But I still dont think it's very feminist to endorse what could be argued is mass mulitation of women which is done for men's benefit often on ill informed women."

What are you talking about?!?!

Are you seriously saying that epidurals are a "mass mutilation of women"? And what kind of benefit do men get from them?

It isn't very feminist to assume that all women who ask for epidurals or c sections are automatically "ill informed". It's downright patronising to think like that.

PMHull

Thank you so much for all your hard work. It means a lot to women like me:)

LaVolcan

You said that for most women the default place of birth is a CLU. Perhaps that may be true, but from my understanding MLUs and home births are both legitimate and available options on the NHS. They are not just recommended for high risk pregnancies, which isn't all that unreasonable. Sort of like how c sections are not recommended prior to 39 weeks of gestation or for women who want 6 kids. Every choice has to be available with some sort of safety protocol in place.
I could argue that most women in the UK end up with midwife led care, whether they want it or not. What about women who prefer consultant led care?
The new guidelines seem to suggest that most women will be "advised" (read:forced) to give birth in MLUs and that epidurals and c sections will be discouraged. How is that fair?!

Your posts reminded me a bit of what Cathy Warwick said in response to women being denied epidurals and c sections-"Well, many women are being forced into c sections and epidurals even when they don't want them". So is the solution to one set of women being denied their rights that we move onto another set and take away those choices with a tit for tat mentality?

The solution is to get rid of the paternalistic attitude that exists among BOTH obstetricians and midwives. They think they get to decide what is best for a woman and her body, whereas she should be the one to make that choice. Women who don't want interventions should be supported to have a natural birth, and women who want epidurals and c sections should have every right to get them.

The way to reduce c section rates isn't to deny that choice to the small group of women who ask for the procedure, but to ensure that women who want a vaginal birth don't end up with unnecessary c sections.

By the emphasis being on the support as pregnant women should be seen as individuals each with valid opinions rather than a one size fits all homogenous group. To some women an elcs might be the most important option - to others a home birth. Both are equally valid. And yet it all boils down to money and resources. So highlighting that if you do this ( one to one care) results in saving money ( less epidurals, less emcs) should be the way forward? And not focussing straight on the cost-cutting bit?

no I didn'r read the earlier post.

But I still dont think it's very feminist to endorse what could be argued is mass mulitation of women which is done for men's benefit often on ill informed women.

Maybe the targets should be about achieving continuation of care, one to one support?

Yes, yes, yes to this. But people have been saying this for about 20 odd years now e.g. Changing childbirth called for continuity of care and woman centred care. Both lead to lower rates of intervention and satisfaction for the woman concerned, but it hasn't happened. Why not? How can it be made to happen?

sioda - I don't think feminism has been all that strong on motherhood though, has it? It was all about empowerment which seemed to mean education (good), better jobs ( also good) but in the process the importance of childbirth and child rearing was downplayed - or at least it's was seen as being synonymous with being a housewife. Not surprisingly IMO the issues around childbirth weren't fully addressed. They were to some extent back in the 60s with campaigns to admit fathers into the labour suites and not taking babies off to nursery, and the 70s with campaigns against routine enemas, shaving and episiotomies. Now while they are important things they perhaps weren't where the major emphasis should have been? Or perhaps they were right for the time but we have sat back and thought that now it's all OK?

(It sounds as though I am not a feminist but I definitely am, but we need to pick our battles, I think. The dire state of maternity care now is one battle worth fighting about.)

Thanks CH!

I take your point Sioda - however the 'targets' are more likely there as the juicy carrot to encourage better antenatal care and support - resulting in potential savings further down the line. The NHS has always been a little short-sighted over spending money up front to make savings long term.

Everyone has expectations of labour and birth. We now are information rich yet actual experience knowledge poor for first time labour and birth. We have more choice than ever - surely? Yet we also have been given a certain amount of responsibility too for what happens in labour and birth - it can be difficult for a women to consider what is the best option when she's been in labour for a number of hours, in pain and unsure what to do next? It can be difficult for a MW to suggest what options are available? Pain is subjective. It may be that good care and support before this point and an open mind by all will provide the best outcome, physically and emotionally.

Maybe the targets should be about achieving continuation of care, one to one support? Even providing information about options for birth, pain relief, other interventions can be difficult because of people's own prior knowledge, beliefs and expectations - which all have to be acknowledged.

WhitegoldWeilder has it spot on.

Can I say something in defense of NCT? The contents of their classes must really vary between branches. One thing I remember from my NCT classes was actually what I would call a rather "normalised" attitude to pain management, including epidurals, and c-sections. I went into the classes having a vague notions that interventions such as epidurals were scary negative things. However, the NCT classes made me feel much more confident about these options, definitely de-mystified them for me and made them appear more "normal." I remember the general mantra in my branch being "what matters most is a healthy baby."

I am still pissed off at them for not telling us how excruciatingly difficult breastfeeding could be though!

Frilly* That's awful and unfortunately not such an uncommon experience. One of the problems is that women are understandably so busy with their newborns, and sometimes so traumatized, that they don't complain to the hospital afterwards. Would you consider it? It shouldn't be the responsibility of individual patients to try to address these kinds of systemic problems but it can have an effect if enough women do it.

LaVolcan It's just that binary that's the problem. The focus should always have been on respecting women's autonomy, not on swinging the pendulum this way and that between hospitals vs. home/MLU. That that wasn't and isn't the case is an indictment of feminism.

White Renaming things as targets, guidelines or expected outcomes doesn't change their effect. It might if the context of this wasn't both cost-cutting and ideological. But in that context any guideline like this can and will influence care negatively.

Basically There's some good sociological and feminist research out there on it - on the ideology of Total Motherhood and things like that. Seems to me it boils down to the warm glow of superiority one gets for being on top of a hierarchy.

StarBall Your reading laziness shows. No one is suggesting that women should not be provided with accurate information about the risks and benefits of any intervention (or lack of intervention). That's not quite the same thing as their being 'made to consider' them. This is a feminist forum you know?
BTW, many women find that epidurals and CS were an easier option for them. Do their experiences not count?

Margery Is this the same WHO that PMHull mentioned above? Did you read that post? And you still think their nonsense about rates of CS is trustworthy?

100% natural labour, no drugs, squeeze baby out ... 'Well done YOU!'
EMCS after epidural - 'Oh. Well... At least you tried sad'
ELCS - 'But you're not really a Mother until you've Given Birth'

Women can't win though,can they? Someone who has a home birth will be criticised for being selfish, woo, lentil-weaving, more concerned about her own experience than the baby etc., etc.. Even though these statements don't stand up to examination and all women care about their baby, far more than anyone else, and want what's best for both of them.

I guess for me it's as simple as 'my body, my choice' - I can't make ab informed decision without information - if that information is biased (either way) then my choice is biased, rather than right for me.

I'm on the fence in terms of the medicalisation of childbirth and find I get very stuck - it's life saving, and potentially totally disempowering.

I weighed up the evidence too - as a diabetic with x8 previous abdominal surgeries - and opted for an induction at 38 weeks. Which after 39 hours was declared failed, so I had an epidural and an EMCS. I knew the likelihood of a c-sec was high, and the risks of induction - they far outweighed the risks of leaving DS until he was ready to come out and risking shoulder dycotia, major pelvic injury and / or serious complications from the unstable BM's for us.

I agree that all women should be informed in an unbiased manner about the benefits and risks of possible interventions.

I had a FAB consultant who gave me reams of studies - from both sides - to read, and told me her view, and let me choose. I was VeRY lucky to have this. ALL women should have the option of such info and choice.

But the NCT class and the one 2 hour NHS class we had didn't discuss induction, c-sec, epidurals, types of intervention etc at all. All I had from those classes was a rosy (and unrealistic for me) view of active, natural labour, which left me feeling shit and like I was somehow failing by not even TRYING the natural option. Which was as equally unbalanced and biased as if my consultant had said 'We're inducing, you are too high risk, end of'.

But I've had much grief since then from NB advocTe friends who say, sad faced, that I'll 'just never know the joy of pushing the Baby out' ... I got a healthy baby, I was healthy and recovered - all that mattered to me :)

I remember a WHO stat that the c section rate for a developed country should be 10%. With the implication that the excess is due to poor management eg unnecessary inductions, 'once a section, always a c section' mentality of some OBs, hospitals' opposition to home birth, lack of one to one midwife care throughout pg& birth etc.

If more resources were put into good midwifery then the c section rate would come down naturally.