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#

"Really? That’s the bit of my post you want to discuss?"

You sound angry. Have I said something that's offensive to you?

Obviously as far as your second birth goes you're more likely to experience complications in a labour following a first caesarean. I think that's the point I was making. You had complications as a higher risk mum trying for a vaginal birth & required a significant input from obstetricians. This is one of the ways an increase in surgical births might create challenges for maternity units.

"OK so just for starters: this is nothing to do with “culture wars”. The dog I have in this fight is my anger at having my terror of vaginal birth dismissed by HCPs and midwives."

I'm sorry your care was shit. Nothing I said is commentary directed at your personal experience of birth.

"After literally decades of being told that birth is “natural” and I should be able to manage it alone at home without pain relief if I am a real woman "

Who says this?

I had a home birth and ran a home birth support group for a decade so I'm at the crunchier end of the spectrum and I've never heard this type of disrespectful rhetoric about women.

Silly me. I should’ve let the first one die instead of take the emergency c section that left me with complications in the second.

Don’t be daft.

You asked about the pressure - it’s everywhere. The term ‘natural’ used to mean ‘vaginal’, the competitive ‘no drugs’ nonsense. Even the consultant who did my CS - one of the top ones in the country - told me as she checked in the next day ‘it went well, so don’t worry, there’s no reason you can’t try for a vaginal birth next time,’ as if that’s the holy grail of birth.

I don’t think I’m angry - just exasperated at what seems to be a position born (forgive the pun) of belief not science. I might be being unfair though - it would be great to hear some proper evidence to support your position.

The entire premise of “midwife led care” essentially rests on the idea that birth is a non medical event. No disrespect to midwives by the way. Many of them are outstanding and essential.

But I take issue with the whole approach that birth ought to be treated as a non medical event. I think the idea that you make birth safer and more comfortable by putting it in some parallel track whereby it is led by people who only focus on vaginal delivery is lunacy

It more or less guarantees that if and when medical interventions are needed (and they are needed quite often) they will be last minute, stressful and poorly prepared for. Women are push to avoid “interventions” until they get to the point where they are in pain, distressed and traumatised.

The entire infrastructure of birth in this country is built on the idea that because a “non interventional” vaginal birth is the gold standard, there is no point having a Plan B.

Its a bit like planning your career on the basis that you will definitely win the lottery at age 30. It’s pure fantasy.

"The entire premise of “midwife led care” essentially rests on the idea that birth is a non medical event."

It doesnt really. Midwives who attend home births and who work in birth centres medically monitor both women and babies throughout birth - they measure women's blood pressure, and fetal heart rate. They monitor the strength and frequency of contractions and the descent of the baby through the pelvis. Sometimes they perform episiotomies and they suture perineal injuries if needed. Sometimes they need to perform medical manoeuvres to birth the baby, and they administer drugs to deliver the placenta and reduce the risk of bleeding after birth. All of them are trained to deal with a range of emergencies such as postpartum bleeding and a baby that's not breathing. This medical monitoring enables them to identify when there are problems in the labour and to bring in obstetric help when needed.

Midwifery care acknowledges that labour and birth is a physiological function, and it also acknowledges that sometimes serious problems arise with this physiological process.

"But I take issue with the whole approach that birth ought to be treated as a non medical event. I think the idea that you make birth safer and more comfortable by putting it in some parallel track whereby it is led by people who only focus on vaginal delivery is lunacy"

Midwives care for women across the risk spectrum. They care for women who have epidurals, who are having an assisted or surgical birth. Who do you think is better placed to manage straightforward births? Doctors? Like in the USA where almost all babies are delivered by doctors and where maternal outcomes are worse than in the UK? It's not a good use of the incredible surgical and medical skills, or the time of obstetricians to do the work of midwives, which is primarily monitoring women and babies in labour and providing support in birth.

And there isn't evidence that women are increasingly being encouraged to avoid interventions - in fact the opposite is true. Intervention rates are rocketing. Interventions now happen more, and they happen sooner. And there's no evidence that women who give birth in settings where interventions in birth are more common are happier with their experiences of birth.

BTW - the vast majority of women in the UK give birth in obstetric settings.

"The entire infrastructure of birth in this country is built on the idea that because a “non interventional” vaginal birth is the gold standard, there is no point having a Plan B."

That's a really weird spin. Our health infrastructure provides choice for women on the strength that women have different wants and needs in labour and birth.

All women should have access to a surgical birth if they want or need one.

All women should have access to midwifery led settings and the services of a homebirth team if this their preference for birth - and it is for some women.

All women should have access 24 hours to the services of an obstetric anaesthetist should they want or need an epidural.

I can't see why anyone would object to this except people who don't wish women to have choices around their care in labour and birth.

@Opleez "Silly me. I should’ve let the first one die instead of take the emergency c section that left me with complications in the second."

You're very defensive about your births. Nothing I've said suggests I think you shouldn't have had a caesarean with your first baby.

Also - who is saying you shouldn't have drugs? Everyone I know says 'take all the drugs'. It's a very fringe choice not to have pain relief in labour - only about 2% of people have nothing.

Some women feel disappointed about not having a vaginal birth, and they're entitled to feel that way, just like other people are entitled to feel delighted to have had a caesarean. People feel how they feel. I know a few women who hated their experience of a caesarean birth and were really keen not to have another one. Presumably the consultant has met women who feel that way and their comment was a reflection of that, not a judgement of you.

"I don’t think I’m angry - just exasperated at what seems to be a position born (forgive the pun) of belief not science. I might be being unfair though - it would be great to hear some proper evidence to support your position"

This is helpful:

www.thelancet.com/journals/eclinm/article/PIIS2589-5370(20)30063-8/fulltext

www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext

www.npeu.ox.ac.uk/birthplace

Evidence Based Birth is an American organisation but it discusses the evidence around midwifery care in a way that's very accessible. This is a transcript of a talk by the organisation's founder:

evidencebasedbirth.com/evidence-on-midwives/

I had an elective. I was out in two days. They would have discharged me sooner but they couldn't find someone to do the paperwork.

Honestly this was reasonable.

Also the problem with obstretricians tends to be outside standard hours rather than 9-5 (which are prefered working hours). Scheduled ELCS are cheaper than having to get the oncall in...

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.

28.5 per cent of births occur within between 9.00am and 4.59pm on weekdays while 71.5 per cent of births occurred outside these hours at weekends, on public holidays or between 5.00pm and 8:59am on non-holiday week days.

It stands to reason that issues are much more likely outside 'office hours' when staffing is lower anyway and its harder to get cover by obstreticians not when there are scheduled section already in theatre. Arguably (and NICE do reflect on this in the context of China which I mentioned about), scheduling births between 9 and 5 which are quicker and easier if they are planned takes pressure off oncall services and out of hours staffing if there is an issue with low staffing.

Low staffing levels means the out of hours service jobs are the hardest to fill. Yet thats when demand on services is likely to be highest...

So needing more obstetric cover from 9 - 5 because you - let's say - double the number of elective surgeries, will have no impact on finding obstetric cover inside or outside of those hours for emergencies?

It gets complicated.

You have to assume that a significant proportion of ELCS would have otherwise resulted in difficult births out of hours anyway. So you probably are reducing the number of EMCS but increasing the number of ELCS. And making them less risky and more plannable in terms of staffing and theatre staff.

To follow this, you have to understand NICE argue that you ultimately hit a tipping point where ELCS births become cheaper than planned vbs if you have a high enough ELCS rate. This isn't something they are in favour of.

It's cheaper to fund per birth during the daytime. It is harder to recruit out of hours staff. But cost wise the more ELCS you do, the lower it becomes per birth because more babies are born at more convenient times and theatres are more efficient in terms of time. This does mean you can in theory reduce our of hours staffing because there then becomes excessive staffing because demand during these hours becomes lower.

You could argue that even if previously you had two overnight Obs to deal with more patients you'd still have the same risk of there being a third patient who needs one at the same time. Because great demand is at certain times and this policy effectively flattens demand across the night into a more manageable pattern for managers and front line staff..

The same applies during the day if you have lots of patients lined up for theatre and an unbooked EMCS come up even if you now have higher staffing levels. Previously you probably wouldn't have staff during the day. It's a question of using ELCS to make staffing rotas more plannable and predictable and therefore make the budget stretch further. (And more efficient).

Given the current climate my concern wouldn't be about this pattern meaning more women are vulnerable to low staffing rates, the opposite is more probable.

The worry is perhaps now that individual hospitals might be getting around really low staffing rates by increasing ELCS to suit their budgets and recruiting crisis. Tqhe hours are better and staff retention improves.... It's a temptation.

... and this isn't in the best interests of individual women. The biggest issue probably isn't for the current pregnancy. The risks are more about subsequent pregnancies and how an ELCS possibly wasn't the best option for certain lower risk groups (such as those who want a large family)

As I say my concerns revolve around appropriate care. That means women get an ELCS if appropriate not because it suits strained budgets.

@izimbra

Of course women should have choice. That is paramount. But until very recently, certainly when I had my daughter, it was very difficult to get a elective caesarean. Vaginal delivery was very much the default and the rhetoric was that a CS was an inferior approach. I was denied a CS. So choice cannot have been the guiding principle at the time I had my daughter.

I’m not sure why you’re making a case for home birth to me. The fact that low risk home births have slightly less intervention than low risk hospital births and equal rates of mortality amongst those ‘intending’ to give birth at home seems besides the point.

Even sharing this study shows that you place a value judgment on medical interventions in birth. Why do you believe ‘fewer’ is better? That aligns with the narrative that a vaginal birth with no interventions is ‘better’ than anything else.

This discussion is about a policy (now retracted, I believe) to limit women’s freedom of choice regarding elective CS to save money.

What would be relevant, should it exist, is a study that shows poorer outcomes for mothers / babies from medicalised births.

You say I’m defensive about my birth, and you’d be right. I am defensive about any attempt to restrict women’s choices to life-saving healthcare. My labours went extremely well until suddenly they didn’t. I was extremely lucky that I live in London and was under the care of world class hospitals who saved both me and my baby. Mistakes were made and my wishes were not honoured in my second birth, but my child was delivered alive. That would not have happened if I was outside the medical arena.

My friends whose babies had to be blue lighted to hospital from home are extremely lucky to also live in London where they were able to get the specialist care they needed within moments.

Reducing women’s choice to save money is abhorrent - and there is no clear evidence that it even does this, when looking at outcomes for post-birth injuries. Reducing choice under some sort of value-judgement where less intervention = a better, more natural birth is just vile.

On this basis, amongst others, I won't be voting Green. I certainly won't be voting Conservative either. It will come down to a choice between Labour and the Lib Dems for me.

Politicians are not obstetricians or gynaecologists. Nor are most of them medically trained in any way so they should not be making these decisions.

Yes this really sums up their outrageous inconsistencies 😂