Green Party pledge to reduce c section rates

[TTCaxristi]

Is this something a political party should even get involved in?

I had understood that a focus on keeping c sections below an arbitrary threshold was at least partially responsible for the Shrewsbury maternity scandal.

https://news.sky.com/story/shrewsbury-maternity-scandal-the-babies-who-died-in-the-uks-worst-hospital-childbirth-scandal-12576727

It looks as though the greens are reviewing the policy now but am I alone in finding this chilling? What does it say about their attitude to women? I really strongly believe that it’s up to the individual woman how she gives birth, and the focus on arbitrary targets is misguided at best and dangerous at worst.

YABU - this is something a political party should have a policy on
YANBU - this is not something a non medical entity should have policy on

https://www.standard.co.uk/news/politics/green-party-nhs-lbc-b1162105.html#

When will politicians get their hands off what happens with women's bodies????????

It's actually unnatural how many restrictions are placed on women's bodies and the laws around their medical health. It's really disturbing. There isn't a fraction of these rules and regulations on what happens with men's bodies.

This isn't true. This was the old outdated who position. At least get It bloody right.

I find their righteousness about being kind both hypocritical and frightening.

Their "kindness" is only for the benefit of misogynistic men. Delusional women may just squeak in when they deny they're women, but that's it. Actual women are unpeople.

As for the comments that 'oh it's ok they are now reviewing the policy' after it's been pointed out how dangerous and regressive it is - that's really not ok.

We are in an election. They've had five fucking years to develop a manifesto and decide on policies.

Yet no fucker decided to question this one until it hit the public? What does that say about their internal policy development and review process?

It's really showing how they have not down due diligence or checking on the basic background to problems in maternity services. Which are all centred really on a lack of adequate staffing.

Meanwhile staff are unavailable for patient facing time for significant chunks of paid employment because they are busy being re-educated about what a woman is and how important it is not to refer to mothers or use gendered language for a female only fucking service. I'm not even going to comment on the cost analysis 'benefits' to this cos maternity should be all about listening to patients and having time with patients.

Anyone would think that NICE and the Green top guidelines didn't exist. I suppose the Green Party think they know better.

I'm so angry about this.

I've ranted about maternity issues on MN for years and how political parties choose to weaponise C-sections.

This is so so regressive and show a deep level of not understanding a major problem with in the NHS.

There is no other healthcare issue that has been more scandal ridden than maternity care over the last 20 years. None.

The Greens clearly have not been paying attention to healthcare politics AT ALL. This stinks of small party riddled with nutjobs with pet ideological pursuits and not a fucking clue about the real world.

I mean there is evidence that better care generally equals less intervention and lower c-sections rates. Of course a certain level of intervention and cesareans are NECESSARY but this isn’t always the case and it’s important to look into why numbers are getting higher.

But will measures to ‘lower c-section rates’ actually mean investing a lot more money in maternity care to ensure a higher standard? Or will it just mean dangerous decisions being made when intervention is needed, more women being butchered and injured by forceps, more hospitals point-blank refusing anybody who wants to request a c-section despite very valid reasoning, more traumatised women, more poor outcomes. Just having an aim to do ‘less c-sections’ with numbers and figures in mind will do so much damage!

Those who talk about the figures on CS never stop to think about the figures for assisted birth. The data for that is hard to find. The data on long-term outcomes is even harder.

If we looked at the elective rate, the staffing rate, the obesity rate, the maternal age rate, the underlying medical condition rate, the birth injuries by method of birth rate, the unassisted birth rate, the patient satisfaction rate and then finally the emergency CS rate (amongst others) I MIGHT give this the time of day.

But we don't. We just have this fuck witted mentality driven by zealots of all kinds that 'cs = bad, VB = good'.

Words can not express my contempt for people who seek to do this. It's just so appallingly ignorant.

"Meanwhile staff are unavailable for patient facing time for significant chunks of paid employment because they are busy being re-educated about what a woman is and how important it is not to refer to mothers or use gendered language for a female only fucking service."

I was waiting for a transphobe to join the thread and shoehorn a comment about transgender people into the discussion. 😂

'they are unavailable for 'significant chunks of paid employment because they're busy being re-educated about what a woman is'

Significant chunks of time? Really? How much? If midwives have clients who are LGBTQ - and they do - they're expected to attend training so they can sensitively meet the needs of these people. Why does it make you angry that a midwife might have additional training to be able to support the needs of their patients? Or is it just one particular group of patients you want midwives not to be able to access training for?

Midwives refer to 'birthing people' IN ADDITION to 'women' and 'mothers' because they care for pregnant people who want to be referred to in that way, and it costs midwives nothing to be inclusive.

"I'm not even going to comment on the cost analysis 'benefits' to this cos maternity should be all about listening to patients and having time with patients."

Not trans people though presumably? Their wishes about how health professionals communicate with them should be ignored for ideological reasons, yes? 🙄

@RedToothBrush

"Those who talk about the figures on CS never stop to think about the figures for assisted birth. The data for that is hard to find"

That data is not hard to find.

Hospitals publish monthly figures showing their birth outcomes in accessible formats (usually a cute infographic) on their facebook pages, and then you can access NHS statistics easily online.

There will be no investing in maternity care. It will all be more butchering and damaging women. In some cases it will frankly endanger lives. My own daughter would be dead without a C-section she was stuck and in distress. The greens wanting this are probably expecting Women to all have magical woo free births in fields surrounded by farm animals and only an old wise woman to assist. Infant and mother mortality means nothing to birth idealists. Women don't matter at all to any of the politicians in charge.

Perhaps we should start denying men proper health care. We can tell them that all their health concerns are hormonal or weight related and they should drink more water. Force them to have minor procedures without pain relief (looking at you coil insertions). Force men to have 3 yearly undignified procedures that at best are uncomfortable for women and have not been changed since they were invented and done on slave women who the physician decided wasn't human at the time so ignored any pain or discomfort she may feel (looking at you cervical smears). Then gaslight the men undergoing these procedures. I'm pretty sure the tide would change then.

Well, you certainly are consistent in your whataboutery.

Why is it absolutely disgusting to label people who want an extension of access of maternal choice caesarean as promoting 'too posh to push' but completely reasonable to point to those advocating changes in maternity care that increase the likelihood of a straightforward experience for those who would prefer not to have a surgical birth and label them as reckless idealists?

It's good to promote women's access to maternal choice caeasaren.

It's good to promote women's access to care supportive of physiology if they want the best chance of a safe vaginal birth.

Can we stop the culture wars around this issue - it's all bs and toxic to women and to people working in maternity.

'costs nothing'

Tilts head.

Do you understand what a cost analysis is?

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

Poor maternal outcomes are most associated with black women and women who do not have English as a first language. Using word salad terms has greater negative consequences for this group than benefits for another who have the backing of loud and powerful lobby groups.

If we spent more time talking about this instead of the resources used to focus on the teeny tiny number of women (yes they are women) who use maternity services but are in denial that they are women, then I'd have time for your concept of 'inclusivity'. But we don't.

So no. Im not a transphobe. I'm just sick of the greens reducing women to unimportant 'non-men' (their language not mine) who are second class to default human aka men. 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.

So yeah. Nice to see how we dont centre on the real biggest needs in maternity or women centred care and we must put ideology before maternal outcomes.

Slow hand clap for illustrating the point.

So they publish their rates of third and fourth degree tears then do they?

The data just shows VB, ELCS, EMCS and assisted delivery.

It doesn't show the demographics of the women using the service.

It's really not helpful at all.

If someone wants to knock on my door and tell me about their politics, which involve restricting women's right to make choices about safe healthcare on the basis of cost, i don't owe them shit.

If this sweet little 20 year old is old enough to knock on my door and tell me all about the green party with wide eyed naivete, they're old enough to have a discussion with me about it.

If they are upset by me getting upset, then maybe they'll have a think about the kind of politics they're representing. I really couldn't care less if i upset a canvasser who is intruding into my personal space. I wouldn't dream of doing it if i approached them on the street, because i wouldn't.

I don't have the emotional energy to contact green party hq to tell them about why pregnant women aren't the enemy, or why a policy around improving maternity care would have been a better idea than just targeting c section numbers. If they can't work it out themselves, why do i have to tell them?

Don't worry, the tory and reform candidates will get hell too.

"So they publish their rates of third and fourth degree tears then do they?"

Yes - they do. https://maternityaudit.org.uk/pages/home These are included as part of their audit of maternity outcomes every year and they get a great deal of attention among midwifery staff.

But agree - it's often very hard to make sense of statistics at an individual level.

So for example, we might say 'this percentage of people who have a vaginal birth will experience a severe perineal laceration' - but if we don't then stratify that by parity, maternal age, mode of onset of birth and possibly by birth setting, then it's very hard for individuals to make sense of what that risk means for them. We also need to look at long term outcomes and what impacts on these. The quality of the initial repair and follow up will make a difference to long term outcomes.

"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'.?

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”?

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.

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.

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

@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?

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.

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.