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...

Immac you kept that a secret!

Lots and lots of luck for tomorrow or Wednesday and I think you are just amazing to be campaigning to help other women at a time like this.

Inspiring.

Women should not be refused pain relief in labour or be subjected to long traumatic labours just to get the c/s down. You're are so right about this.

I am sure lots of others on this thread will do all we can to add to your campaign. Good luck

Thanks Ushy!
Stretch and sweep this morning, we'll see if it gets things moving - if not, I'm under the knife.

Meantime, here's hoping MNers can kick up enough of a stink about these proposals that they don't percolate through to the hospitals/MLUs through the back door.....

Ushy

What about
"Don't Target Our Babies and Bodies" or variation of...
It needs to make people sit up and look at it. So it has to be emotive.

InmaculadaConcepcion

Good luck today/tomorrow. I hope everything goes ok!

What about 'Targets for treatment?'

Treatment should not be about targets where care is restricted. The CS rate is high for a lot of factors. It would be interesting to compare the rates of CS in the 20-35 year old age group from today and 20 years ago where the womans weight falls within the normal category and no fertility treatment was administered. This is the only way to get a true picture of what is going on.

Truth be told that obstetrics has changed with women having children later in life, the fertility treatments resulting in many more multiple births where CS are pretty much a given and the fact that on average we all weigh more. It shouldn't be a surprise that the CS rate has also increased too.

Isnt the REAL elephant in the room here the soaring birth rate due to un fettered immigration?

Isnt it a question of numbers not race?

If you have a hospital with x beds - you have a hospital with x beds?

Labour apprenty budgeted for 13 thousand eastern europeans to come over and yet hundreds of thousands have come over.

My local hospital was excellent - clean, well run etc...but 5 years ago a friend who worked as an administrator in it said the MW complained of labouring women turning up - out of the blue, in labour - with no english and no notes or no notes in english. The extra time taken on these women, the time, the cost etc clogs up the whole system.

we were short of MW in the first place, how on earth were they supposed to cope with a masssive surge in population and then no back up to support it?

It makes me feel sick to hear about reducing cost by asking women to go without pain relief or c section options when our policiticans have allowed us to be simply flooded with too many people that our systems cant cope with.

Its as simple as that.

My polish friend is now an expert on births without having a child herself as she works as an interpreter at £40 an hour! She has been at all kinds of births and indeed abortions!

£40 an HOUR??????!!!!

Unfortunalty, until we can work out how to stem the tide of people coming here ( who can blame them>? I would be off to another country like a shot if it offered what we do), the situation will only get worse.

A lady reportedly came over from nigeria i think to have her babies here in manchester and it cost that trust TEN THOUSAND POUNDS. She has gone back to nigeria. And she hasnt paid for her medical treatment.

Europe is not a level playing field, some countries offer vastly more than others do and therefore they will be a more attractive destination.

I love the fact that Europe is open, I love Europeans, I love different cultures...I love the fact my DD school has about 40% of Europeans in it - from all over including but not dominated by Eastern Europeans. I love that she is exposed to that.

What I do not love is that my once excellent local hospital that I used five years ago is now barely fit for purpose with a horryfying rate of still births in it. I do not love the fact that I know of many people who have been in labour - and been turned away by it as they do not have the resources to cope with the surge in population.

I've had 2 friends who have given birth recently with 3 and 5 day labours respectively (2 different hospitals).

It seems long traumatic births are already becoming the norm. Makes me pretty nervous for my impending birth

I think there is going to be a massive boom in private births in this country in the next 20 years. The NHS will probably just offer basic care and 'extras' will be means tested.

After all it's only women...

It was impossible to get one when DD was born in 2010.
MW actually said 'well you can put it in your birth plan but it won't make a difference', was told 'not a chance' when I went into labour, they were too busy and no staff available to do it.

Maybe an angle to give to press is a survey of MN's and whether or not an epidural was offered and say that that figure is proposed to be cut by 20%?

elizaregina There was a thread on here about the woman from Nigeria who had her baby in Manchester. It is very wrong that pregnant women or those who have previously received treatment for diseases such as AIDS are allowed into the UK without showing they have either the means to pay for potenital healthcare costs or travel insurance which would cover these costs.

I also think that those coming to the UK should have to pay a premium to receive NHS care in the first five years that they live in this country. Even if the charge was GBP500 a person per year during the first 5 years (no matter if coming from the EU or elsewhere) it would help the NHS adjust to the population change. It is a privilage to live in the UK and if we are to keep the NHS it has to be protected from abuse.

whatsoever Every birth is very different. If this is your first birth then it is only normal to be nervous. Do try to relax because I think a tense body and mind doesn't help labour at all. It doesn't hurt to have a strong advocate with you.

Immac
"Stretch and sweep this morning, we'll see if it gets things moving - if not, I'm under the knife.
Meantime, here's hoping MNers can kick up enough of a stink about these proposals that they don't percolate through to the hospitals/MLUs through the back door..... "

Fingers crossed for you. Let us know how you get on and we'll definitely all get behind your MN campaign

I'm hoping it'll be MN's campaign, Ushy! But I'll happily sign up.

As for the increasing UK birthrate, while immigration is a factor eliza, I've read recently that native residents of the UK are also tending to have larger numbers of children across all demographics - the rise is from two to three, but add that up and it's a significant increase. So while it's easy to point the finger at immigrants to the UK, it is only part of the story.

And anyway, weren't the figures quoted percentages? The proposals are to reduce the percentage of women having epidurals/sections which is slightly different from proposing to reduce the overall numbers (although admittedly, reducing the percentage would also reduce the overall number....)

I'm seeing this from a different perpective from most here and feel I'm sticking my neck out a bit here, so please be gentle.

This is not a piece of clinical guidance here, it is a guide for GP's who are now responsible for purchasing the services for their patients.
There has been a drive to try and reduce the c/s rate and increase the normal birth rate for years. Its nothing new. The arbitrary numbers are an 'ideal' guide, not a target to adhere to.
Maternity services are not run with targets as the basis of care. I hope none of you truely believe that a women needing a c/s or an epidural would be denied one in order to reach the non existant 'targets'. (I'm not saying epidurals are not denied, they are, too often).

'Every provider unit should have a clear action plan for increasing its normal birth rate, addressing staff levels and staff deployment, models of care, support and information.'
Evidence shows that women who have one to one care from a mw during labour have less need for epidurals and intervention.
They are not saying for women to be denied an epidural but that with better support, less will be required. Better staffing and keeping women who don't need to be on labour ward off it (as also mentioned) will also free up staff to be able to administer an epidural when it is requested.

I don't think what there saying in principle is as bad as you think....but

'since the 1990's it has been goverment policy that women should have a choice about how and where they give birth...'
Despite this we are seeing MLU''s closed and obstetric units getting larger, home birth services suspended and denials of epidurals due to capacity issues and staff shortages.
This is the issue you need to concentrate on. The service again needs to become more women centred. More mws are needed.
Although I don't quite agree with what you're reading into this document, but I am really pleased that I am at last seeing some anger about the shitty state of matenity care in this country.

The evil is in the small print in this document, please don't defend it.

Slightly rearranged to shorten but these are quotes :

"It is important to increase the 'normal' birth rate without ...spinal or epidural anaesthetic before or during delivery. It is important to try to increase this rate as well as that of vaginal birth which includes delivery by forceps and ventouse."

Really? Just a minute? Whose body is this? Why is there this obsession with avoiding pain relief in labour? And what if I would prefer a c section to having a pair of metal paddles stuck up me?
Why should I be subjected to someone else's ideological views about childbirth when it is MY body?

"a 20% caesarean rate is sustainable and achievable"

If I had problems in labour in a hospital where targets were employed I just would not feel safe. Unsurprisingly, I would like a doctor to be focused on me and the baby not his/her bl**dy statistics.

I agree with you about more midwives but reducing access to epidurals makes me want to vomit.

As for choosing where you give birth, this document says women should be advised to choose a non-obstetric birth. That's not choice, that's pressure.

There may be 'good stuff' in this document so okay, withdraw it and reissue with the poisonous ideology taken out.

Much of the document does read ok. Several things really bothered me:

1. wanting to increase vaginal operative deliveries in order to reduce cs. This limits choice where choice should definitely be available IMO (forceps don't get the best outcomes always). I recognise that choice may not always be possible - but this document ignores that altogether.

2. limiting pain relief. Other wards in the hospital will routinely offer spinal blocks for procedures potentially less painful than childbirth. Why should maternity be the exception?

3. pushing everyone down a low risk non-obstetric route, if they are not obviously high risk (which often can't be proven in a first pregnancy!). In my experience (detailed on other thread) primary and community care do not have the knowledge to cope with a pregnancy going rapidly and tragically wrong. It is not an exageration to say I could have died because of this (my DD1 did die). The document does not acknowledge that these services need more skills in order to cope with cases like mine. Pushing people away from day assessment units and into primary care / community midwives was exactly why I ran into such awful problems.

Over on the other thread, someone said something along the lines of
"I am a feminist so I don't want childbirth to be medicalised because doctors are mainly male and midwives are mainly female." I paraphrase, but that was the gist of it. So she was using her feminism to justify the notion of denying women a wide range of choice in how they give birth.

That happens in a few of the Feminism threads. :(

male controlled birth is generally not a good thing for women or babies

a feminist saying they want a femal controlled birth is not limiting other women's choices

(although is that choice a free chioce when we live in a patriarchy?)

this is all very very very scary
im due to give birth in january (2nd) and am already worried about lack of staff / number of people in the hospital due to new years etc.. and about getting snowed in at home

ive had to push damn hard to get into a clu as apposed to a mlu because after a hell of a lot of probing i found out that the transfer time to be blue lighted from mlu to clu incase of any problems was currently at 40 mins.. which i wasnt happy with, but as its my first child i had to fight to be in what i deem the best place. looks like we are all going to have to battle long and hard to get the care we want.

happy to join any campaign as this is disgraceful, i know a few people who have given birth and followed the 'advice' from docs and mw's and have told me afterwards they didnt really know what decisions were being made for them / what the other options were...
scary stuff

I an stunned, disgusted, horrified and absolutely flabbergasted by this.

How on earth can this be what is best for women or babies? I shall be contacting my MP.

Natural birth is not always the bet or safest option. I along with my sons are living proof of that.

I am deeply worried that these targets will result in more dead babies and severely injured/traumatised women. I thought we lived in a civilised society?

Afaiac there should be no targets attached to childbirth and antenatal care. I think we have forgotten that it is actually a very dangerous period in some women's lives. Sickening.
Of that.

if every woman was able to have proper midwife care, where she was properly supported, throughout her labour - not left, while the mw sees to other labouring women, then some of these cs/epi might be reduced anyway.

I don't personally think anyone should just be able to demand a cs, without having a medical need to have one - so flame me!

however when even cows are given epidurals for a difficult calving, I can see no reason for limiting these, even though i wouldn't choose to have one myself!

Margery Kemp said male controlled birth is generally not a good thing for women or babies
a feminist saying they want a femal controlled birth is not limiting other women's choices (although is that choice a free chioce when we live in a patriarchy?

Margery, I have no problem with what you have said. But you can opt to have a homebirth with female midwives, or to go to a MLU.
This thread, and the one on the feminism board, is not about limiting womens rights to a female-controlled birth. It is about making sure that the voices of women who actively wish to have access to epidurals and c-secs are heard.

I think it was Ushy who made the point up-thread that women who are pro-epidural etc do not try to lecture the natural birth ideologues, and yet the converse is sadly not the case.

caz this isn't even about non medically indicated cs. It's a target for restricting all c sections and pushing forceps and ventouse instead based on ideology and the misguided belief that it's cheaper. Which you no doubt also believe, hence your opposition to other women being allowed to choose how to give birth. You'd hardly have an opinion about what other women should or shouldn't do with their bodies otherwise since it would be nothing to do with you. And, um, since when are the pain relief requirements of cows an appropriate a guide for what pain relief should or shouldn't be provided to women? I don't know where to start with how offensive that is, even if you were joking (which I really hope you were...).

Margery Are any of our choices free choices when we live in a patriarchy? I find it odd that choosing a c section is seen as a the result of patriarchy while choosing midwifery care is assumed to be a choice free of patriarchy. Why on earth should that be so? The natural childbirth movement has a charming biological essentialist element which has more in common with religious fundamentalism than feminism.

Couvelaire I think it's extraordinarily naive to think that an 'ideal guide' is not another word for a target and that that doesn't influence care decisions.

BTW my c section was female controlled - my OB, not unusually, is a woman and supports women's right to autonomy in birth. As do plenty of other obstetricians, male and female.The midwifery profession, which is overwhelmingly female-dominated, as a whole does not. The notion that a medicalized birth must be male controlled is odd.

scary reading :(

I've had 2 'if forceps don't work 1st time we're doing a c-section' births.

both time, pain was so extreme by 4cm I was unable to communicate in anything other than animalistic moans (according to DH), and in the 1st labour, my amazing wonderful midwife (and DH) argued with the male consultant until an epidural was agreed on. he wanted me to walk around the hospital instead.

2nd time I had an early epidural planned, and pretty much screamed 'epidural' at anyone who came near me from ~3cm until I got one authorised (at 4cm - was in hospital for induction), then it didn't bloody work. midwife this time waited until DD had been born with cord round her neck and been resuscitated to tell me (in very judgemental tones) that I'd have had a natural birth if I hadn't had the epidural . Instead, I have just been left pretty fucking traumatised, having panic attacks if I hear a woman in labour on TV, and adamant that 2 DC are enough.

why do some people feel that because they or someone they know had a natural drug free birth, that everyone else must be able to have one too?

How can any midwife possibly know what would have happened if you'd not had an epidural? What is she? Some kind of fortune teller. What is the actual point in telling you that? How does that benefit you in any way whatsoever? Health care providers are there to do exactly that provide care - providing judgmental is actually completely unethical - and could have implications to your emotional and mental well being.

I don't care who does stuff like that; midwives or doctors - they should be struck off.

no idea Hmm - she spent a lot of my labour telling us about her amazing homebirths, so not sure why she was working in a CLU tbh. I decided to ignore her judgement and just didn't send her a thank you card. I still maintain though, that labour #2 was less traumatic overall as I felt more in control - I was very demanding of pain relief from about 16 weeks onwards, and it made the labour a lot less terrifying. not the actual birth, but the labour, certainly!