Woman's Hour Childbirth special on now - with Kirstie Allsop

[VinegarDrinker]

Not sure if this is being discussed on any other threads?

Not bad. Outed NCT as CS discussion avoiders?..

I have never had any dealings with the nct but isn't blaming them for not offering enough c section support a bit misplaced?

Wouldn't it be better for Kirstie Alsopp to use her 'celebrity status' to ask the health professionals why the c section rate is high instead of blaming someone else? It's not the fault of the nct that women have c sections.

Or is it to do with the fact you have to pay for nct classes?

I heard the first half of this. I think they were saying that people have bad birth experiences because they prepare for a 'normal' birth, then end up having to have medical intervention. These women are more likely to feel like they've let themselves down because they haven't prepared for the eventuality of intervention. Whereas when women are prepared for the fact that they may not get the birth they want, they don't feel so disappointed. Hence, NCT classes not mentioning C-sections are letting women down. I think the obstetrician said birth wasn't just about thinking positively and that by suggesting this to women, then we give them a reason to feel like they've not 'performed' their best.

The obstetrician also said that their c-section rate was about 40% because people requested them and she prefers people to feel that they are controlling their birth experience.

I'm sick and tired of KA and her anti NCT agenda. I had a csection and NCT classes and was never made to feel like a failure. In fact I feel I got through the experience because of the support I had from my NCT teacher when my named midwife was no bloody help at all.

For KA's experience of NCT to be regularly wheeled out as the norm is irresponsible and unnecessary.

Well said nancerama! I am unimpressed with Radio 4 lately after their unbalanced segment about breastfeeding the other week and now this. Just because Kirstie Allsop is overexposed on tv making utter crap and has two kids doesn't make her an expert worthy of hosting a Radio 4 segment on childbirth and blabbing on about her own agenda of first world problems.

Everyone who signs up for the NCT course knows they encourage natural birth and breastfeeding. My NCT course talked about c-sections and we even had an exercise with a Playmobile c-section theatre to put together to understand who all the people in there would be. I ended up with the dreaded drip, epidural, forceps, episiotomy, it wasn't how I hoped it would be, but that has nothing to do with the NCT and why would I blame them? Why not also blame the ridiculously brief NHS two part antenatal course, they didn't talk about it much either. It was just how my birth went, I had a baby safe and sound afterwards and I hope to have another.

Perhaps the problem is people's experiences of NCT varies. There doesn't seem to be a 'curriculum' so perhaps KA had a poor teacher.

Ours did talk about c sections and the likely recovery. She devoted time to what happens if things go wrong including still birth or neo natal care. She was the only person who said 'if they put you on the drip get them to cite an epidural before it goes it so you're prepared if you need some serious pain relief and have that choice. There's no shame in it.'

I thought there was a curriculum. I know the teachers go through several years of training on a degree course. They're not enthusiastic amateurs. I was under the impression that they are heavily monitored and audited.

Their PR is shocking though. They do little to defend themselves or promote exactly what they do. Simply calling themselves "britains biggest parenting charity" means nothing.

I listened and didn't actually realise that it was KA until the end.

The only opinion which irked me was the guest who said that she focused on the baby and encouraged women to 'grin and bear it'. I can't remember the analogy she used but she was basically saying that women's experiences of childbirth were not important.

I didn't pay any attention to the anti-NCT stuff, it was clear the presenter had an agenda.

Wouldn't it be better for Kirstie Alsopp to use her 'celebrity status' to ask the health professionals why the c section rate is high instead of blaming someone else?

Why are we making the automatic assumption that CS are bad? There is a case to be made for certain groups of women to have a CS if that is what they would prefer based on the evidence we currently have available to us.

Plus there isn't a discussion about the type of CS that is taking place. A EMCS is a very different kettle of fish to an ELCS.

Why is the focus purely on method of birth, with no thought to complications that might arise from a VB? We shouldn't assume that a VB is better automatically, even if it is natural. If we were doing what nature intended, we would be having children much younger, there would be less issues with obesity and more women and babies dying.

We need to look at this from a modern point of view; which includes maternal satisfaction and takes account of other negative outcomes.

Perhaps if we did this, we wouldn't be questioning why the CS rate was so high and instead would be asking why the needs, emotions and physical and mental health of women were being ignored in pursuit of ideology over research and evidence.

VBs might be right for a majority of women. However a CS might be right for a sizeable number of women and yet they are forced to try for a VB ultimately ending up in an EMCS or complications because of this attitude that CS = Bad.

Its only bad, if there is a blanket culture that thinks this instead of treating women as individuals.

I think focusing on CS in this debate is an almighty red herring. We should be focusing on why there isn't a debate about women being treated as individuals and humans who are involved in their choices and not judged for them.

I didn't think that Kirsty Allsop had actually taken any NCT classes? If she feels strongly, why doesn't she start up a CS Birth Trust?

I must admit, I wish the NCT would go back to being about Natural Childbirth instead of trying to be all things to all people. Then people who weren't interested in natural childbirth wouldn't need to bother to go to the classes.

RedToothBrush I think that's basically what KA was saying, that the discussion often focusses on the risks of CS vs pros of VB and doesn't acknowledge any pros of CS or potential risks of VB (3rd/4th deg tears etc).

It sounded like they were being careful to talk about "antenatal classes" rather than NCT a lot of the time.

It's much like the thread we had on here a while back. It seems some people are strongly convinced that hearing about the potential risks of VB will terrify women and may in fact make those complications more likely.

I was only half listening tbh as both DCs were being demanding!

KA was pushing Belinda Phipps (?) The NCT CEO to state either way whether they support a woman's right to choose or whether that only extends to VBAC and home births. She basically refused to answer.

I had NCT classes as thought they were way over the top with preparing for the worst - natural or medicalised. I have done a lot of research myself and am fully aware of what can go wrong and I feel as prepared as I can be for any turn my birth takes.

The NCT classes that I attended went on and on about c-sections, forceps, tears, prolapsed cords etc - to the point that I think most the women were expecting it will probably end up that way and they'll be lucky if both woman and baby survive.

I guess there is a delicate balance between their role of educator and trying to manage individual expectations. But I'd prefer just the educating with clear unbiased facts and statistics, and leave the mental preparation and expectation management to the individual.

I don't care if they support VBAC or elective c-sections or whale noises or Tibetan chanting - it's of no importance when it comes to a woman making choices on how she births.

VinegarDrinker Mon 12-Aug-13 19:15:57
KA was pushing Belinda Phipps (?) The NCT CEO to state either way whether they support a woman's right to choose or whether that only extends to VBAC and home births. She basically refused to answer.

Why would she refuse? Odd. Its really quite a simple thing to answer.

Vinegar and Red - I was listening and I thought the answer was that the NCT supports women in the choices that are available. KA was asking the CEO to say that they support women's rights to a CS as much as to a homebirth. As a general rule of thumb ELCS is not available on the NHS, whereas home birth is. What I understood her to say was that they support (the few) women who have been given the ELCS option, but audits not an option for the vast majority, they can't promote it as an option in the same way they can home births which are an option for far more women.

I also understood her to say that the NHS is the body who sets these rules, not the NCT.

The "grim and bear it" lady gave antenatal classes for Will and Kate. Hard to believe the Duchess had any hopes if hupnobirthing with that attitude around her!

Yes, she just said she couldn't answer as it is for the NHS to set policies. Ignoring the fact that a) the NCT has lobbied for changes in NHS policies many times before, and B) I doubt they would just sit back and say that if for example an area stopped offering home births on the NHS

As a general rule of thumb ELCS is not available on the NHS

Have you read the NICE guidelines on the subject? Thats simply not true and unfortunately this myth is being peddled continually by professionals who haven't bothered to properly read the NICE guidelines.

An letter in the BMJ recently by sent in by Mandie Scamell, a lecturer in midwifery, Alison Macfarlane, a professor in women?s and child health, Christine McCourt, a professor in women?s and child health, Juliet Rayment, a research fellow, Judith Sunderland, a lecturer and programme lead in midwifery, and Mary Stewart, a research midwife stated:

?NICE says caesarean section is not available on demand unless clinically indicated?

However what NICE ACTUALLY say is and I quote word for word:

- For women requesting a caesarean section, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, a planned caesarean section should be offered.
- An obstetrician unwilling to perform a caesarean section should refer the woman to an obstetrician who will carry out the procedure.

The need for a CS to be clinically indicated is simply not there. Nor does a woman have be referred for support (note words - 'offer of support' - it is optional). It still says that regardless a woman should still be offered a planned CS.

There is a world of difference out there and people need to start sitting up and taking notice as it is important to question why various groups are deliberately misquoting NICE and suggesting the guidance is completely different to what it actually states.

CS on demand IS technically available - its just hospitals are choosing to ignore NICE and the reasons behind why NICE made this recommendation and issued this guidance. Women are not asking for ELCS because they are 'too posh'. And the sooner we acknowledge and properly address why women are asking for ELCS I honestly think it will benefit ALL women, regardless of how they choose to give birth.

People keep asking the wrong questions and blindly accept what they are told without properly looking into the matter. The media has a hell of a lot to answer for.

"CS on demand IS technically available"

The operative word here is 'technically'.

Guidelines are guidelines. They are routinely not being followed in a huge number of areas because resources are not there to allow them to be implemented.

"its just hospitals are choosing to ignore NICE"

Because they scarcely have enough consultant cover, theatre space and anaesthetist services to run a half way decent service with the present number of operative deliveries. They also don't have enough bed space on postnatal wards, or midwife cover in hospital or in the community to do this SAFELY. Massively increase the number of operative deliveries on healthy women under present financial and organisational constraints and the women who will be paying the price will be those with complex health needs, who will find themselves waiting longer for emergency surgery, and receiving less attention on even busier postnatal wards.

"And the sooner we acknowledge and properly address why women are asking for ELCS I honestly think it will benefit ALL women"

Often it's because of a lack of trust in a service which is under resourced, and where women are unable to access optimal one to one care in labour.

I am with you in wanting to see improvements in maternity services, but I think the place to start is bringing down the rate of emergency c/s by increasing midwife numbers, improving consultant cover in hospitals, widening access to birth centres and case loading care, and improving antenatal care for vulnerable women.

Well lets be honest about this all then. Lets not say that ELCS on maternal request without clinical need is not available in this country. Lets actually state what the real situation is, because if you do that it raises all the questions above that you state and that begs some very big questions about how maternity is funded and how there is a total disregard for treating women with dignity, respect and properly gaining consent.

Lets not lie about it and say its not available. Let say that hospitals are refusing to uphold best practise. Lets talk about why NICE made those recommendations.

(BTW, NICE also said that there is a level at which the percentage of women having ELCS rather than VBs, ELCS actually become the more cost effective approach... so I think if we really want to talk about how money driven this all is, we should actually be making all women have ELCS. Which is not what anyone really wants. So I refute that aspect of the money arguement on this).

And I totally refute the 'money isn't available' bullshit. Not when maternity accounts for so much of NHS litigation claims and pay outs and the two pots of money remain completely unconnected. Do some joined up thinking and actually the money is there; you just give better care and reverse the number of claims being made. And yes I do believe its that simple if the powers that be got their heads out their arses and stop obsessing over CS rates without looking at the issue properly and in depth. Its not as simple as 15% = good 33% = bad. Its high time they started looking properly at levels of care and how women feel they are being treated.

Stop making excuses for poor care and justifying the status quo. All you are doing it being complicit and tolerating a situation which is unacceptable. Until you start kicking up a fuss and asking the right questions and really forcing people to look at this as a problem rather than something we all have to just deal with, no one will ever change it.

Hence my point in the first place. Maternal request is deemed as cost effective, is comparatively safe given the evidence we have available and prevents so much of the distress that has gone hand in hand with refusing women one has done previously. NICE changed their guidance to recognise the problem and how it was causing an unacceptable level of anxiety and harm to a certain group of women. And yet, here we are still with the same problem even after the guidance was changed because the hospitals want to ignore the core issues and make it black and white rather than being an issue that goes far beyond maternity.

If you forced hospitals to offer ELCS, do you think it would focus their minds to find other ways to reduce this demand by other means?

I think there is a case to be made here; if evidence was properly done and presented to them about why women were asking for ELCS then I rather suspect it would ask huge questions about maternal care across the board - which is to the benefit of all women. Yet no one has done this. They don't even properly and consistently record reasons for ELCS across the country, which means that no one can collate this information in a way that is truly meaningful and useful. What does that really tell you?

I am totally convinced that there is too much power politics and too much self interest involved in this debate to get the people who are running maternity wards and work in maternity units to really be honest and face up to the magnitude of their failings to women.

We need to stop supporting what is allowing them to bury it.

Two other points.

NICE changed their guidance with the belief that the change would not significantly increase the rate of maternal request ELCS.

EMCS and ELCS are not mutually exclusive variables. Increasing the number of ELCS may in effect reduce the number of EMCS. There are a number of hospitals in this country which have a comparatively high ELCS rate and low EMCS rate. Why is this?

If any woman could choose an ELCS for any reason, why would they then want to fork out hundreds of pounds for an NCT class which is obviously going to spend at least half the time on VB, if not more than half..?
I just don't really understand what people want from the NCT in terms of C-section discussion. I didn't do NCT, I did birth prep classes with a different provider but my friends who did NCT were all informed what would happen if they had a CS etc.

If you listen to the programme you will hear Belinda clarify the right to c-section as per NICE guidelines. I thought she made valid points and was quite fair. She also pointed out NCT was involved in the consultation to determine NICE guidelines and that promising women something that NHS can't/won't deliver is not helpful. I agree.

I thought it was daft to go to an antenatal class half way through and complain half the stuff relating to birth hadn't been covered... well durr! Much better to ask people at the end of a course what they thought/covered.

It's on iPlayer if anyone wants a listen. I do wish Belinda had stressed the point that women who feel listened to, in control and respected feel more satisfied with their birth experience regardless of interventions or how birth occurs. I also wanted more from the Birth Rights lady.

I also wanted to slap Kirstie every time she said only healthy babies mattered... like how a woman feels isn't important or if her human rights are totally disregarded.

I thought NCT was about informed choice, based on evidence? Therefore they cover off everything (c-sections, pain relief options, physiological processes, interventions) because it's all possible and you need to know in advance so you can make an informed choice because there's not likely to be time to do your own research during labour.

That's what I thought too K8 but Kirstie Allsop seems to resent the fact the nct classes start from the assumption that most women will want to go into labour naturally and give birth vaginally unless something prevents that from happening.

As I say, I am not sure what she would rather the NCT do/say in their classes to make her feel that they are more in favour of CS?

It's funny isn't it? Kirstie seems so ballsy and not to give a crap about what other people think of her (or the unimportant ones any way) and yet she seems to need her birth choice validated? A birth choice that seems totally sensible to me - she has enormous babies! Why not a planned c-section if that's what she wants. I would.