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...

Sioda Please don't assume to know my opinions!

How is what I said about cows rude? I was merely stating a fact. When the vet turns up to a difficult calving he routinely administers an epidural.

All I was saying is that if they feel that animals should have them, then why would you restrict it in a human?

sorry if that offends you......

and as to your other point , surely if they reduced unneccessary cs that would bring the number down anyway?

Agree that this is not about the health and safety of babies and women. It's about cost cutting. I've always thought the NCT was totally 'woo' and agenda-loaded and never understand why people fork out for expensive ante-natal NCT classes when the NHS ones are actually more realistic.

This document does frighten me. I'm pregnant with DC2.

With DD I developed pre-eclampsia and was induced at 37 weeks. Put straight on the syntocynin drip. Nothing happened for an hour or two so they kept increasing the amount. Then suddenly pain went from zero to 100%. There was just one, never-ending contraction. No spaces between contractions to recover. I was hallucinating with pain. The room was spinning etc, couldn't hear what people were saying, thought I was going to die. I begged for an epidural and to this day I am so, so thankful that I got one. DD was born with ventouse.

As my pre-eclampsia was mild and late on-set there has been no talk of getting a C-section this time, and I don't want really want one anyway. However, if the birth is anything like last time, I DO want an epidural and will be asking for one upfront.

Would just like to add: what is a 'normal birth' anyway? Who defines normal? In years gone by, it was fairly common for women and babies to die in child-birth. Was that normal? It was certainly natural.

My experience for instance. Yes, a vaginal birth, but being induced two weeks early on a drip was NOT normal. Perhaps if I had waited for my body to go into labour naturally, it would be more 'normal'. But that would have put my life at risk.

:(

Sioda- from my experience midwives give women a lot more autonomy that OBs

This thread is getting diverted into a midwives v. obs, natural v. medicalised debate. It's not about that - there are plenty of other threads where people can debate pros and cons.
This thread is for women who wish to express their concern at paternalistic attitudes which ultimately seek to limit women's choices over their birth plans.

Margery That wasn't really my point but Seoladair has said it better than me.

I don't know if I would call them paternalistic attitudes. I only encountered women when it looked like we were moving to the UK when I was 5 months along with DD. Their attitudes towards epidurals were terrible. I was under the care of an obn here in the US and I had been turned down by the local midwife unit because of a problem with my back. As my pregnancy went on I developed preclampsia towards the end so I was no longer low risk. The midwives I spoke with were very rude to my obn and myself on more than one occassion.

I don't understand how midwives, the majority of whom are women, are not more vocal about women having the right to epidurals during labour.

I am absolutely disgusted by this. I was about to book some NCT antenatal classes but certainly won't be now. As other posters have said this is completely misogynistic....how can you set a limit on epidurals and CS??? It's ridiculous and is not only dangerous and insulting to women, but also to health care professionals -implying they are just handing them out like candy without consideration for the medical and emotional needs of the women and their babies. I had a traumatic labour experience. Nothing went wrong, had a "natural" birth but with no pain relef at all. It was horrendous, I was in shock for days, had no interest in my baby when he was born and I have never got over it. Am pregnant again and am weighing up trying to get a CS because I know I can't rely on pain relief during labour. This paper terrifies me to the point I don't know whether I can continue with my pregnancy...is that what these people want women to do?

No one is setting a limit on epidural or c/s. Women are not going to be denied c/s or epidural because of this document.
This is not even clinical guidance.
There's been an initiative to reduce c/s and increase normal birth for years and yet we have still seen a steady increase in c/s (with no improvement in neonatal mortality and morbidity) Hospitals do not work to these 'targets' and there is no consequence to them even if their rates are really high.

Women are being denied choice because of the current practice of closing MLU's and centralising services in large CLU's that run at full capacity with low staff numbers and low risk women go to the bottom of the list of priorities for pain relief!

Yes I agree there are lots of problems both ways but I still don't think that organisations like RCOG, RCM and NCT should be advocating limits on CS's and not using epidurals. Certainly not becuase it saves money. The focus should be on supporting women and encouraging health care prfessionals to make good medical decisions (whether that is for physical or emotional/mental reasons), and empowering women by giving them choice....whether that's a natural birth a home or at a MLU, or an ELCS at a hospital.

I think what I really want to say is that women are understandably not happy with the state of maternity services but I think focusing on this document and nit picking the language you are creating a bit of a red herring.

The RCM/RCOG have been coming out with this sort of blarb for years. I've heard it all before.They can say all they like really because their ideology means nothing in the reality of a busy unit.
It really doesn't mean much when they talk about giving women choices, when in reality if your local unit is very busy on the day (highly likely these days) then the real concept of choice is completely taken away from you and you are at the mercy of the crisis management employed daily in most delivery suites in the UK.

If you are already 'high risk', then its far more likely you'll get your chosen pain relief, but if you are 'low' risk, then an epidural for you is deemed 'not medically necessary', and you go to the bottom of the queue.

This is not the fault of the medical staff or mw's, but because the unit is so busy they cannot prioritise the need of one individual any more, but have to consider the safety of the whole unit. This (amongst others) are the real reasons women are being denied choice and pain relief, right now, every day (and not because of this document)

This is what need addressing. And I think the anger here could be directed in a more constructive way.

very well said Couvelaire

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.

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.

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?

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.

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.

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.

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.

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.

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....

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??

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.

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.

Mail reporting today.