New guidance to reduce epidurals and to achieve a CS target rate of 20%

[HmmThinkingAboutIt]

New guidance to reduce epidurals and to achieve a CS target rate of 20% is apparently being issued by the RCM, RCOG and the NCT.

I'm try to find the original source to be able to read exactly what is proposed, but this is my source at the moment (its a pdf) www.electivecesarean.com/images//12-aug-24%20rcog%20ccg%20press%20release%20final.pdf

On the face of it, I'm utterly appalled by this. It seems to be in direct opposition to what NICE, NHSLA and others are saying. And the trouble with targets is they completely neglect individual care, and create a conflict of interests for doctors & midwifes - and ultimately put woman last.

Has anyone else heard about this/got a better source to confirm EXACTLY whats been said before I get too upset about it?

I'm damn sure this is going to upset a few people here...

[seoladair]

The RCOG statement is a great improvement on what went before. This Doula statement was posted on the feminism board thread about Csecs and epidurals - I was encouraged that they acknowledge that maternal choice is important.
Well done everyone, for raising awareness of this issue!

doula.org.uk/content/doula-uk-responds-new-guidance-normal-birth

[Panzee]

Nice clarifications. That's not what they said at all!

[CouvelaireHair]

The RCM have issued this statement in repsonse to the negative attention.
www.rcog.org.uk/what-we-do/campaigning-and-opinions/statement/rcog-statement-response-joint-commissioning-document

[Want2bSupermum]

Couvelaire I agree it is unsustainable and given the funding through taxation there isn't an excuse for the trusts not to pay for the extra staff. There is a problem with recent immigrants having children in the UK. I was shocked that the NHS was happy to cover me coming to the UK from the US five months into a pregnancy.

In addition, when we were looking at moving back DH was advised that he would be non-dom for the first 3 years so would be able to deduct rent from his income and would not pay national insurance. This should not be allowed as the taxes pay for services such as the NHS and education.

[CouvelaireHair]

'Maternity wards should not be running at crisis management levels on a regular basis'
But thats it, they are. In realityou can't pull extra staff in all the time. The trusts don't want to pay for the extra staff. And if they do, whos going to replace them on the next 12 hour shift? Its unsustainable.

[CouvelaireHair]

Shag, the use of epidurals is restricted already in CLU's because of high activity and insufficient staffing.
There is no 'target' in hospitals to reduce this number.

[LaVolcan]

Reducing routine anything would be good - so that care is tailored to the woman in question.

[Shagmundfreud]

If it reduces the EMERGENCY c/s rates while improving maternal and neonatal outcomes then I'm all for it.

As long as they achieve this reduction in the following way:

• by increasing access to waterbirth
  
• by increasing access to one to one care in labour
  
• by increasing access to out of hospital birth
  
• by reducing rates of routine induction for post dates pregnancy
  

All these things result in fewer REQUESTS for epidural pain relief.

Please god they don't just take the easy and cheap route to reducing epidural use by restricting availability in CLU's.

Sadly government penny pinching makes the latter more likely than the former.

[HmmThinkingAboutIt]

Eliza I read a similar article yesterday from another paper.

My feeling with regard to immigration is that we NEED it and I do take issue with foreigners being blamed. If they are contributing to the economy I don't have a problem with it at all, and the majority of immigrants DO - what you are doing is making the assumption that they don't. With respect, I find comments about immigrants being to blame in hard times, particularly distasteful and ignorant when you look back to the history of the 1930s.

The problem isn't necessarily with immigration - its with PLANNING for immigration and planning for an increase in the birth rate - which hasn't just been restricted to immigrants. There is no flexibility in the system, which is worrying. If we had some sort of epidemic or emergency it makes you wonder how we would cope if we can't manage it on a longer term basis when it was obvious this was going to happen. The baby boom didn't just happen overnight. There was enough time to make provision for it.

The UK has always relied on new blood. Its what makes us strong, not weak. And given how low the birth rate was for British born women a few years ago, and the problems that could have caused, we certain shouldn't necessarily see 20% of the female fertile population being foreign as being bad. Japan is the classic example of how an aging population is a real problem.

No only that, but the problem of immigrants giving birth here, is very very regionalised - in some areas it accounts over 50% but in others its less than 5%. And yet the same restrictions are being talked about in areas which are able to cope. Don't forget, that the fertile population is the working population so the group most able to pay tax rather than tax from the system.

I think its a totally different debate and one for another thread as it rather detracts from this one.

[elizaregina]

www.thesun.co.uk/sol/homepage/news/politics/4513147/Foreign-motherland-1-in-4-new-mums-were-born-overseas.html


So...playing devils advocate reading this article also - can I ask where womens rights - choices come into play when our services are swamped - no measures in place to reduce the numbers of people coming here...

Personally I think women who are denied c sectoins for valid reasons including fear etc should kick up a huge stink - chain themselves to railings if neccasry - its a disgrace, BUT as I said before, its a simple question of numbers.,

Its very easy to say - it should not be about cost.

Of course it shouldnt but with the combined effects not only of health tourism, chaos within the NHS meaning that people dont pay us for their treatment - trusts owed thousands....AND open doors to the EU....

You have shortage anyway of MW's, of resources, you have a hospital that can cater to say 20 labouring women but your turning away many more than that and you will get slated for that....

where on earth CAN womens choices and rights fit in!

They are in crisis, they have too many " service users" with no end in sight..what can they do.

You can talk about womens choices and rights and feelings but there are number crunchers out there trying to come up with ways to reduce cost of a mass population boom.

You do two things, you start to get vocal about immigration and you start to get vocal about not being the easily picked on group with which to cut costs with.

[HmmThinkingAboutIt]

OH MY GOODNESS. Its the SECOND story on their homepage! Only Kate and Wills second honeymoon comes first.

Its a fairly decent write up (by DailyFail standards ahem). I bet the comments will be interesting though. Its already got 300 - so I guess that says the story is generating interest.

Warning DailyFail Link

[MyNeighbourIsStrange]

Mail reporting today.

[HmmThinkingAboutIt]

At least the story made the press. Don't care if its the Sun. There will be people who read it who aren't that stupid and even if its only a few thats good enough for me.

[grimbletart]

Indeed MamaMary. The ones who go to back to work the same day are presumably not among the 270,000 women a year in Africa who die in childbirth. But hey, Sun readers are not going to have the highest IQ in the world in general so maybe we shouldn't be surprised at such stupidity.

[MamaMary]

And the old gem of: 'In Africa women are working in the fields, go and have a baby in the afternoon and then return to the field the same day if not the day after.'

Yes, and life expectancy in 'Africa' is??

[seoladair]

There's a particularly charming Sun comment which says that if women can't face the pain, they shouldn't have a child. Because obviously one's pain threshhold is directly linked with mothering skills....

[HmmThinkingAboutIt]

Reading through the comments on The Sun article, there needs to be a HELL of a lot more done to get rid of the attitude of Too Posh Too Push. Most of the remarks blame that - not healthcare problems and there certainly is no understanding whatsoever of mental health considerations.

I really wish that recommendations made in 2003 by the select committee where actually followed through and that recording of ELCS and the reasons behind them were actually being researched properly.

Its appalling they haven't been and is a massive part of the problem with this. It just means that organisations think they have free licence to justify decisions using the arguement that they have public support.

[HmmThinkingAboutIt]

Well removed from the website is a really good start.

Good to see its made the newspapers then. Will have to look later and see whats been reported.

Going back to problems with the document - I think there is one other point pretty important point I've failed to make in this thread; the lack of distinction between ELCS and EMCS in the document (Not just a failing of this document but in pretty much all planning and documentation regaring maternity and endless research papers).

We need a wholesale change on that score as so many decisions are being made based on very fundamentally flawed methodology and collation of data. Its misleading to a point where it is almost negligent.

[PMHull]

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.

[mimmum]

I also find this document to be worrying, but I think it's a reflection on what is already happening. I gave birth on a mlu for my first and second births, but after a traumatic second birth including a traumatic emergency transfer to a clu had decided that for my third birth I didnt want to put myself through that again and would rather give birth in a clu where the interventions I needed where readily available.

Well my midwife deemed I was low risk and she did her best to "persuade me to make a good decision" and give birth on the mlu, read bullying hectoring behaviour, which left me extremely anxious about giving birth again and experiencing this again. In the end it turns out that I wasnt low risk at all and all the complications I had in my previous birth were likely to reoccur and so the mlu would have been a v bad choice. This was discovered not due to bullying midwife, but because I fought to have a consultant appointment, which midwife really wanted to deny me.

So I have experienced being persuaded to make a "good choice" not an experience I recommend and I would also add that midwifes are not always able to distinguish between, low risk and high risk. It's all v frightening.

[Want2bSupermum]

CouvelaireHair Thats the thing though. Maternity wards should not be running at crisis management levels on a regular basis. When I had DD they were full and beyond capacity with regards to beds so part of a ward was converted into a maternity unit. Everyone still got an epidural if they requested one and extra nurses were called in to cope with the demand. When my cousin had her baby last year in Canada the same thing happened and she received a letter of apology from the hospital because she had to wait an hour for her epidural.

If the US and Canada can cope with giving epidurals on request even when at cull capacity then why not the UK? Shouldn't RCM/RCOG be striving to offer the best care to women in labour? IMO part of offering the best care to women in labour is offering epidurals on demand and assessing if a CS is needed based on medical facts, not targets.

[seoladair]

Couvelaire, when documents like this are issued, it makes it easier for the ante-natal and birth teams to justify ignoring a woman's stated wishes.

However I agree with you that closing MLUs is terrible policy especially when there is such a shortage of midwives. Why don't you start a parallel thread about it?

[HmmThinkingAboutIt]

And its not nickpicking if it actively is SCARING women or making them feel like an inconvenience that needs patting on the head and told to be a good like girl.

[HmmThinkingAboutIt]

Why put out a joint statement encouraging these things if they are already happening?
Why put out a statement that goes completely against what the Department of Health says about targets and completely against the updated NICE guidance about C-Section?
Hospitals HAVE put in targets deliberately as a response; especially to the changes to Maternal Request - precisely to make it harder for women.
Why focus on procedures and targets rather than quality of care, individually tailored care and satisfaction for women?

It is all about politics and ideology; with no regard to the women caught in the middle of it.

You know the NCT lists its campaign objectives for pregnancy and birth as:

1. One-to-one support in labour
   
2. Birth environments designed around women's needs
   
3. Easily accessible, individualised services for all
   
4. Choice of place of birth
   
5. Well informed parents and professionals
   
6. Protection and promotion of the normality of birth
   
   Given whats in that document I can't help but think that the biggest load of crock going.
   
   And then theres all this business about influencing and persuading women. Which is highly questionable and unethical if its backed by pressure from targets.

[cazboldy]

very well said Couvelaire