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

Sorry I can't wade through 16 phs. On my iPod.

However, I think women should be made to consider the short and long term effects of interventions during labour.

Weighing up the evidence I wanted neither a epidural or a CS, unless absolutely necessary.

They are far from easy options.

Interesting discussion about the role of feminism in this. I think there are historical reasons why feminism = NCB. It wasn't so long ago that midwives refused to take responsibility for a woman in labour because she wanted to position herself on all fours rather than lie on her back with her legs in stirrups in the 'accepted' manner*. It was the NCT that effectively campaigned for women to be able to have more choice in labour. Previously you did what the doctor told you and that was that. So - back in the day - feminists were on the side of the NCT because they were the ones who wanted to empower women.

The NCT has ALWAYS been about NCB, so it's not really fair to criticise it for being a major advocate of this approach. What's changed is that the orthodoxy has now swung right round - mostly because the NCT has been so successful, and that's not a wholly bad thing - and the drive to give everyone a natural birth is now over-riding the needs of individual women. It is, to say the least, ironic.

*This happened in the Royal Free in London in the early 80s. I can't remember if I read this in the Naomi Woolf book or 'Birth - A history' by Tina Cassidy.

I would like to know if there is any other medical procedure for which patients are routinely denied adequate pain relief, or brainwashed into thinking that using pain relief is 'failing'.

Seriously, are there any? is it just a coincidence that this only happens in a circumstance that only affects women? pfft.

Bit late to this and maybe off topic a bit tho related...

Why is there such a heirarchy of what women can / can't and choose to do / not do with their bodies? I don't get it.

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

All things I've heard recently, in relation to my super medical EMCS and a friend's attempted hypnobirth VBSC which didn't work as planned.

Ditto BF - I read a mate's comment recently that it's 'incredibly selfish' to 'not even try to BF'...

As though you're 'more' of a mother if you have a natural birth, BF etc etc.

Does what I'm trying to say make sense?

I think it depends on how you read and interpret the document. I may be wrong but if antenatal care was improved and labour was well supported then intervention and emcs would probably fall to the targets suggested. So if the care and support was provided as the document intends the targets would be achieved. The problem is if the targets become the focus rather than the methods to achieve them then it would not help individual women IYSWIM? Most women would probably like a straight-forward birth with little or no pain in surroundings providing the most support so that they recover well - as well as the birth that gives the best outcome for their baby. For some that may mean an elcs, others a home birth?

The emcs rate is considered higher than necessary because women are not supported and cared for - because of a lack of one to one care, because of the threat of negligence, because of the over medicalisation. It is this that affects whether women get to choose an elcs - if the emcs rate was reduced then there probably wouldn't be as many elcs requested, but then women who did request an elcs would find less resistance to obtaining one.

Maybe the document should be reworded do that the targets are more like outcomes expected rather than used as targets to be achieved?

Yes there's not a whimper out of feminist organisations, or many feminists for that matter, about things like access to consultant-led care, epidurals and c sections. Where you'll find them, en masse, is in homebirth advocacy, the natural birth industry (selling independent midwifery, doula services, hypnobirthing courses etc.) and campaigns for more midwives and more midwife-led birth centres.

Yes, but I think that until very recently at least the CLU has been the default option for at least 90% of women. (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.)

In most places you have had to be very determined to organise a homebirth, and MLUs aren't an option because they have been closed down. If the pendulum really swings towards either of these, as it was in the 1950s when it was difficult to get a hospital birth, then I think feminist organisations would swing into action.

Sioda "Yes there's not a whimper out of feminist organisations, or many feminists for that matter, about things like access to consultant-led care, epidurals and c sections. Where you'll find them, en masse, is in homebirth advocacy, the natural birth industry (selling independent midwifery, doula services, hypnobirthing courses etc.) and campaigns for more midwives and more midwife-led birth centres. Many of them pay lip service to choice for all women but you won't find them actually advocating for it. It's very messed up"

Very true - and all under the guise that they don't have a product to sell, but just try to shield women from the knifewielders who only want to do it for profit.

FWIW - I chose ELCS and when I did my research it was hard to find unbiased figures and facts. In the same way that it's near impossible to find sober unbiased info on breastfeeding/formula.

NCB etc to me doesn't seem to me to be about empowering women but to put them in their place.

The stores has been picked up my the Daily mail, the comments on there are awful. Why are we still our own worst enemy? Lost of comment along the line of 'I did it 3 times and if I can anyone can', 'all my friend who had epidurals tore really badly'. Only the individual woman can decide her pain threshold and as we are so often told every labour is different. It doesn't surprise me that the NCT support this.

It still bothers me that 7 months after my DC2 that the midwife tried to discourage me from having an epidural, it also bother me that when the epidural didn't work properly she refused to get the anesthetist back in. She still made me lie on the bed even though the epidural had failed just in case and when I said it was uncomfortable her reply was 'well you did choose an epidural'. It was patronizing and humiliating. As if wanting to not be in pain is unusual.

PMHull,

I just wanted to say "thanks" for doing all your work. I really appreciate that there is somebody out there advocating on my behalf. Thank you.

Foot I do my bit. Unfortunately there are many women who consider themselves feminists who effectively oppose choice under the guise of liberating other women from their patriarchy-induced choices of caesareans or epidurals (or formula - but that's a whole other story...). There are lots of them out there, I personally know quite a few. It's depressing.

Yes I should have said that there are honourable exceptions to the lack of advocacy for birth choices - not least Pauline's website. The overwhelming influence of NCB ideology among women who would in most other circumstances value women's autonomy means that such groups and individuals have nowhere near the clout that groups like the NCT do unfortunately.

Where are the feminists? They are you. Where are you?

I hope there comes a time very soon where women get the information they need, in the manner they need it, to make the decisions that enable the best birth for them that the situation allows. And if it all goes against hopes, that they get the support necessary, both before the birth and after.

WantsToBeFree There are a number of people out there working very hard to challenge the 'normal birth' guidance proposed in this document (and many others like it), of which I am only one.

My website carries the slogan 'Your baby, Your body, Your choice' and I have protested the legitimacy of a prophylactic caesarean, on a voluntary basis, for the last eight years. In 2010, together with other organisations, I submitted evidence to NICE that would ultimately lead to its November 2011 maternal request caesarean recommendations. This was a huge step forward.

Similarly, in 2008, together with the Birth Trauma Association, csections.org and Birth Trauma Canada, we publicly called on the WHO to provide evidence for its 1985 15% caesarean threshold recommendation. One year later, the WHO admitted there is no empirical evidence for a 15% threshold and indeed an optimum rate is unknown. Most recently, earlier this year, the book I wrote with Dr. Magnus Murphy, a urogynecologist in Canada, was published.

The voices of larger organisations can financially afford to make themselves heard; it is more difficult for smaller organisations with little or no funding to have the same impact, and the fact that you needed to ask your question demonstrates this perfectly.

I just wanted to assure you that we are here, we do exist, and on an almost daily basis, we are working hard to ensure that women have access to a full spectrum of birth choices, and also that they receive more balanced and evidence-based information about the risks and benefits of different birth plans in order to help them make that choice (if they want to).

Wants Yes there's not a whimper out of feminist organisations, or many feminists for that matter, about things like access to consultant-led care, epidurals and c sections. Where you'll find them, en masse, is in homebirth advocacy, the natural birth industry (selling independent midwifery, doula services, hypnobirthing courses etc.) and campaigns for more midwives and more midwife-led birth centres. Many of them pay lip service to choice for all women but you won't find them actually advocating for it. It's very messed up.

Pauline That's good news!

Buggy Yes but this guidance is about the medical profession bullying women out of procedures that they need or want.

sorry i should clarify- I am angry about the fact that giving birth has to be one of the most important physical things one can do. it is also something only women can do yet the inteserests of women are ignored. also the fear of birth seems to be working very conveniently for the medical profession in enabling them to bully a lot of women into proceedures they are not comfortable with.

Here's my question- where are the feminists? Where are the pro choice organisations and WHY aren't they protesting this nonsense?

They're quick to come up with slogans such as "My body, my choice" and "Stay out of my uterus", but is that limited to abortion and birth control? Why can't we extend it to childbirth options?

Feminists have sadly bought into the NCT bullshit and seem to be blissfully unaware of the misogyny at the heart of NCB movement.

Update for everyone:

RCOG removes controversial guidance from website
cesareandebate.blogspot.co.uk/2012/08/rcog-removes-controversial-guidance.html

Last night I wrote (not for the first time) to my MP, and I'd just like to thank everyone who has done/is doing the same.

I don't think BOF meant that she didn't want doctors involved with birth because they're mostly men - I think the 'mostly men' observation was an aside.

BOF, it's a strange, inverted sort of feminism which says "doctors are mostly men, therefore I don't want doctors to get involved in birth". Wouldn't feminism be better directed in helping all women to get access to the sort of birth they would like, whether they crave a water birth, a home birth, an epidural, or an elective c-sec?

BOF as I understood it from Woolf's account, part of the problem in the US is that the whole process is profit driven because birth services are funded by health insurance, so a highly medicalised birth is more profitable, giving HCPs a conflict of interest. With the NHS you have the opposite problem, with targets fixed for cost saving.

If you do legislate to advocate patient choice, you then need to address the problem of those with particular vested interests seeking to influence choice. One of the big frustrations is that, as the patient, you don't feel that you can trust anybody.

"It seems the proposal is putting the cart before the horse, and if, instead, we started implementing changes in the ideology of birth, looking at hospital processes, women's choices, education, etc., a reduction in C-sections would simply follow. "

I agree with this PatronSaintofDucks

And also that it's rational to be scared of birth. Telling women that they shouldn't be scared of birth is not the right way to go. Giving them what they need to feel confident would be more effective. And - for some - nothing less than a c-section will do that.

"If I can face it I may start a thread about the night to let you know what you have to look forward to in your new shiny hospitalised births. " - BoF, can't you see how patronising and downright rude you are being? I do not want people to preach at me. I want a conversation.

BoF, as others, I find your birth experiences horrific. BUT, I do feel that you are seriously contradicting yourself and is doing to other women what was done to you, only from a different ideological position. Yes, we can speak about self-delusion, self-discipline and lap dancers who think that they are liberated feminists but really are not. Only you seem to think that the right way to enlighten the lap dancers is to preach to them. I, however, would argue we should listen to them instead, understand their stories, positions and fears and rather look at the social systems and ideologies as a whole as opposed to blaming the individual women for being silly little uneducated scared sell-outs to patriarchy.

Same with birthing women. Yes, I agree with you that birth is overly medicalised and that much could be done to improve the experience of women, babies and to reduce the rates of drastic medical intervention. However, is imposing tariffs on C-sections really a good starting point? It seems the proposal is putting the cart before the horse, and if, instead, we started implementing changes in the ideology of birth, looking at hospital processes, women's choices, education, etc., a reduction in C-sections would simply follow.

Using the cut in C-section tariffs as a starting point seems to put the blame for the present situation right back onto the individual women. We are not talking about broad changes, we are talking about somebody (who??? doctors and bureaucrats, obviously) assessing whether individual women "need" C-sections. This does not sound very feminist to me. It looks like just another expression of patriarchy, telling silly little women what they should be doing.

As for being scared shittless of birth - Historically, the chances of women and babies dying in childbirth have always been high until the rather recent times. They are still very high in many parts of the world. We are scared of birth for a very good reason.

Women who are informed are being denied the C sections that they want/need.

Women who are informed are being denied the opportunity to have the natural births that they want/need.

Both, imo, are due to at best paternalistic and at worst misogynistic attitudes in society at large and the medical and midwifery professions specifically. It shows a lack of understanding of the diversity of women's desires and experiences that is belittling to us as a gender group.

Women should be given free choices with regards to birth, this might mean paying for my sister's hypnobirthing classes or my C section with no "medical" indications. Neither is wrong, neither is right except for the individual who wants them.