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/images12-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...

Brilliant post Sioda Total misogyny that will end up with women losing babies and being denied pain relief. I am going to do just what you suggest.

I am also writing to my MP - you can send them a direct email on line on the 'Theyworkforyou" site and they monitor how quick the MP replies.

You just put in your postcode and a template letter to the MP pops up.

www.theyworkforyou.com

Mumsnet power

Posted up in Women's Rights/Chat...

Feel too upset by this and think I will have to step away from the thread for a bit (but I hope I will be back and able to post meaningfully). Just wanted to say that 23 months after DC1's VB, where I sustained multiple serious birth injuries, I am STILL severely traumatised and in a real mess. I was given an epidural, and promptly, for which I am very grateful. The pain prior to the epidural was so severe that I thought I would die just from the experience of it. Although my PTSD relates more to the injuries and the impact of these, the memory of that pain still haunts me. If I had not had an epidural, I can't even begin to think how bad things could be for me now. I probably would have tipped right over the edge and killed myself.

Do these people realise what they are consigning women to? Do they care in the slightest?
Too upset. Back later I hope.

I agree that wheresmespecs that this subject is too sensitive for the rough and tumble of AIBU. I will watch the Feminism and Women's Rights thread with great interest.

Appalled at and worried by this too for all the very well expressed reasons of previous posters. I will certainly write to my MP about this (first time I've ever been moved to do so). Thank you for the "theyworkforyou" link.

Not something I want fellow women to have to deal with.

wheresmyspecs "You see, if you overlook the notion that extreme pain can be dehumanising, traumatising and cause severe mental and emotional suffering, then getting rid of epidurals, and all other anaesthesia, makes total sense. Cheaper, isn't it? And that's what matters"

Great post...and just to add babies will die too and the brain damaged ones will cost more than the few measly pounds they save on 'targeting' a reduction in caesareans.

Is this the new policy "Women and babies last"?

A twitter campaign might help to stop this unless anyone has got any other ideas

I was thinking that we should try and get the story in the press somehow. I'm slightly surprised it hasn't been today or yesterday given the press release.

Not sure how you go about doing that. Harass health correspondents? I guess I was hoping for a little more outrage on MN to push that and show how upset women are about this. Maybe its going to take a few days to do that... Dunno.

I think possibly this needs to go on facebook and get some wider exposure there... Much as I hate fb sometimes, it IS a good way to spread information.

Some of the stuff on there is silly too - GPs have an influence? Well they might if I ever saw mine while pregnant! It's the good old 5 min appt with the midwife every however many weeks, where she's too busy to do more than test pee, blood pressure, fundal height and heartbeat! Should be grateful she does that tbh!

Whole thing makes me want to save up before the next one for private care...!

I agree with the posters who says that while reducing medical intervention in births may be desirable in some respects, using targets and money justifications is absolutely not the way to do it.

Decreasing fear of labour/childbirth and increasing understanding of the processes involved, plus the teaching of effective pain management techniques - not to mention a stern look at the way HCPs interact with labouring women and delivery environments would be better ways towards this outcome.

BUT if a woman needs/wants pain relief she should be allowed it and if a CS is preferred for whatever reason, it should be as much the woman's choice as the HCP's. Removing choice in the matter must NOT happen. Jeez, what a step backwards.

I'm going to report this thread to MNHQ and suggest they consider a campaign. For anyone thinking of contacting the press, I would wait until the English bank holiday is over then go for it!!

Thats what I was thinking IC - to wait until after the bank holiday. I completely agree with you about what you say about reducing medical intervention too; I think the thing the NCT, RCM and RCOG are forgetting is that the methods they are thinking of using are going to INCREASE fear rather than reduce it. I guess they are just so used to and caught up with a culture of targets that they can't see past that. Then again, maybe they are trying to scare women to provoke a reaction... (is it a coincidence that this comes out just days after the petition for more midwives fails). If thats the case, I have to say its completely cynical and ethically questionable due to it preying on women's greatest fears.

I think the FB idea is a good one. I'll have a good think about how to do that. And if I have time today, I might try and write a piece for the press...

Horrified by this. I'll write to my mp too and try to raise awareness.

I was refused an epidural (ended up with a spinal block in theatre tho) and prior to this the pain was so severe I honestly thought I would die. It was so traumatic that if I didn't at least have the option of an elective section I'm not sure I could contemplate dc2.

I am only going to post on this once as I hate being villified but feel we need some perspective.

I read the original guidance that was originally referred to on the website piece.

I expected to read about quotas and denial of pain relief but it was nothing like that. Its not bad to want to lower cs rates and the way to do it is positive advice. There are actually lots of good ideas in this document but the best is positive reinforcement. I have seen on mn the frustration some midwives have about the negativity that some first time mums feel and how that is reinforced by the bad birth story. its totally understandable as even on dc3 i am extremely nervous. What is wrong with increasing the availability of advice and guidance. Every terrible birth story makes first time mums blanche and ignore the fifty good stories after it.

Mysogyny it is not. You just need to read the Daily Mail for examples of mysogyny (or US republican policy but that is another story)

This is a document advising consortiums on the organisation and cost of maternity services so to be horrified that costs and figures are included is naive.

Also I may be one of those natural birth idealogues" but I think there are an awful lot of elcs idealogues too.

I had normal deliveries but fully support anyone having a cs and would have one myself. Feel free to have a go. I am heading for the hills.

Brockle You are wrong about this. Of course, they are not going to directly say 'deny women epidurals' but that is EXACTLY what it is saying in more cleverly worded language.

It says "promote more 'normal' births without epidurals." IN realspeak that means make them harder to get.

The recommendation that a 20% target is there is as plain as plain and babies will die as a result.

You say you are a natural birth idealogue and that there are elcs idealogues.

Yes, but there is one difference; the elcs idealogues talk about choice, they never try to impose elcs on women who don't want one.

Please don't divert this debate. This is about women being denied choices like pain relief in labour which any humane society would find abhorrent.

It is disgusting, mysogynist and medieval.

I'd just like to say thank you to all the posters here, and for all the ideas being suggested about how we can get this story out to the wider public.
When I first read this document, I was actually doing research into other documents that are circulating within the NHS with guidance on how hospitals should and could reduce their CS rates to target percentage figures (yes, this is not the only document of its kind...).

I immediately got in touch with all the other maternity organisations (plus doctors) that I knew would be opposed to the guidance, and I wrote the press release. Unfortunately, as some of you have mentioned, the news has not yet captured the media's attention. There is still hope however... following the thread here, I am going to re-contact members of the media and show them that women are not happy about this guidance either.

I think that writing to our MPs is an excellent idea (I have written to mine in the past), as is posting here on mumsnet and supporting smaller organisations.

Thanks again for all your support.
Pauline Hull, co-author of Choosing Cesarean and editor of electivecesarean.com

Brockle You need to read it more carefully. The devil is in the detail - usually the definitions section where people's eyes have conveniently started glazing over... No one is horrified that costs and figures are included. Firstly the costs and figures are wrong. Secondly what they are talking about is prioritising cost cutting at the expense of women and babies lives, health and access to pain relief. That's wrong.

As for 'elcs ideologues', I think you could do with more perspective yourself. If you bothered not to make assumptions you'd find that those of us who support maternal request cs also support other women's choices - midwife-led, birth centres, home birth - whatever. Your baby, your body. The anger directed at 'natural birth ideologues' is directed at those who support restricting choice and even access to pain relief for other women. That's a reality we face all the time. You support other women's choices - why would anyone vilify you?

PM Sorry you didn't manage to get anything in the press -perhaps they will realise how angy MNers are from this thread.

I think Hmms point is important. If women know the NHS is looking to save money by cutting epidurals or leaving them struggling in a traumatic labour for days on end to avoid doing a c/s, they are going to be TERRIFIED.

Personally I would not use the NHS if this guidance were put into practice.

So is the real message, you got pregnant by choice so pay for your care?

The plebs can scream for pain relief all you like but they shouldn't expect to get it on the NHS. Nor should they expect anyone to being doing anything too urgently to save the lives of their scraggy little brats

Well said ushy. I have nothing but respect for women who choose to go for a natural birth. But my vb was anything but natural. After 18 hours completly drug free I needed an epidural. I wasn't contracting or progressing normally. I needed sytocin (sp?), then needed ventouse, then had SD and a full crash team. The reason I wouldn't do it again is not because I am scared of the pain. It is because we both nearly died and I am scared we wouldn't be so luck as to survive if it happened again. Now I am terrified that I may be denied a cs just to meet targets. Is that right? Or humane?

i had my children over 40 years ago, before epidurals were invented, so I am well out of touch.

However, I am horrified at the idea of reducing CS in favour of forceps. OK, forceps can sometimes be necessary but do these authors begin to understand the damage they can do, especially the type used to rotate babies that are malpresentations?

My first was born that way after a 48 hour back to back labour and, contrary to the instant amnesia about pain that people who don't know better insist occurs after childbirth, I can still remember every minute of that experience and the subsequent months of pain it caused.

Stupid, stupid. And yes, it was NCT whose classes at the time 'forgot' to mention things like forceps, persistent posterior presentation etc. because it is all supposed to happen in a happy daze of woo. Don't tell me this organisation has not moved on in 40 years?

I really cant stand the NCT and this just gives me more proof I am right. Its simple women deserve choice and a sensible full picture. If you look on the NCT website there is a massive list of disadvantages with only one advantage for epidural.

A friend recently had an assisted birth without as by the time baby got stuck it was 'too late'. This is a real risk of not having one earlier imo.

Conversely the amount on homebirth which only a small minority have is massive. (and I had my second at home before I give the impression of being anti home birth). It is just completely agenda driven rather than being about informing and educating women in a balanced way.

Brettgirl2 yes, yes yes, women deserve choice and good information.

There are so many s on this thread - they can have no idea how ordinary women feel about the prospect of going into labour and being denied an epidural or left in traumatic labour for who knows how long just to get their b**y c/s targets down.

Several people have said about an MN campaign. Sorry to be ignorant, but what is that?

Just that if there is one, I definitely want to sign up to it.

MN campaigns tend to be fairly high profile because the website has become such a force to be reckoned with in terms of mobilising/reflecting the opinions of the parents (mostly women, of course) who use it. And it helps that Justine MN's other half is a prominent Guardian journalist, so national press interest isn't as difficult to come by as with those who don't have the contacts. Justine herself has also become a prominent and respected spokeswoman with her views frequently sought by the media.

Campaigns take various forms, but often there are member surveys, big media launches and efforts to contact all the relevant organisations about the issue.

examples here

Hope that helps Ushy!

Immaculada Thanks so much. I just read your earlier post - are you going to start the campaign?

I think there are so many people who are very over this so lots of us would sign.

Unless we do something I think women are going to be terrified of giving birth in an NHS hospital.

They will feel they have to save up for private care if they want an epidural or are scared of being left for hours in obstructed labours while doctors check their latest caesarean stats. Basically goodbye to the NHS.

Just been brainstorning some campaign titles:

"No to putting women and babies last"

"More ways to trick us out of epidurals"

Maternity clearly doesn't Matter

actually I am no good at this - perhaps someone may have a good suggestion.

Worrying
What about the ladies who by having an epidural, prevent having a cs?
I went in to labour on the Sunday evening and had only reached 6cm by tuesday afternoon. Ds was 9 and a half pounds and back to back. I was exhausted and in agony. I ended up having an epidural on the tues evening and managed to get a few hrs sleep which gave me the energy to push for two and a half hrs and succeed in a normal delivery., my midwife was excellent and turned down the epidural when I got to 9 cm so I could feel to push. I am confident I would have ended up with a cs without that epidural.
My point is, that epidural doesn't always mean cs, in fact sometimes it's quite the opposite. You'd think they'd know that seeing as they are supposed to be the experts!
Makes me very angry indeed.

Good start, Ushy!

Well, I've reported the thread in order to ask MNHQ if they would consider a campaign, but I doubt I'll be able to do much more for the moment than add my support should such a campaign get going, as I'm due to give birth to DC2 either tomorrow or Wednesday at the latest (ironically, that would be by ELCS if I don't go into labour naturally by then....)