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Childbirth

Share experiences and get support around labour, birth and recovery.

Hospitals told to abandon C-section targets

16 replies

Cheekypeach · 21/02/2022 21:05

www.dailymail.co.uk/news/article-10533313/NHS-axes-targets-natural-births-C-section-limits-dropped-improve-standards-care.html

Please don’t shoot me for posting a DM link Wink

I wonder how this will impact women on a practical level?

OP posts:
CheshireChat · 21/02/2022 21:20

Finally! That's all I can say.

EllieQ · 21/02/2022 21:25

Quite a positive article from the Daily Mail. It’s interesting that they made the link between c-section targets and unsafe maternity services, which the BBC was more vague about that issue.

www.bbc.co.uk/news/health-60462720

I don’t think the 20% target ever had a factual basis, as far as I know - I got the impression it was just an arbitrary number!

TheUsualChaos · 21/02/2022 21:44

Good. I opted for ELCS for DC2 as I had already had a planned CS for DC1 due to breech presentation. For both babies, I felt CS was the safest option. Despite my mind already being made up about ELCS I had to sit through a VBAC appointment where I was patronised and made to feel like I was ill informed when in actual fact I am a medical professional with experience in obs and gynae but I don't think they knew this. Funny enough, when I had appointment with the consultant later on in the pregnancy and was asked what I wanted to do, he just nodded and said yep that's fine and sensible. I suspect many women are pushed into opting for VBAC because there is a bias against ELCS in antenatal care.
Despite this change I think the outdated attitude towards ELCS will persist.

Hangthetowels · 21/02/2022 21:56

Fantastic. Women should be free to choose how we give birth, particularly when so many vaginal birth injuries are absolutely awful and take months or years to resolve (speaking from personal experience). I would definitely request a c section next time as everyone I know who had one was healed months and months before me

chickentikkawhatswrong · 21/02/2022 22:04

It’s often not ‘natural’ or c/section either, they gave me a drip to speed everything up (horrific) then butchered me with an episiotomy, tear and rotational forceps. Seemed like it was any length just to make sure baby came out vaginally despite it not being less risky or any better for me.

Those targets also don’t make any sense when guidlines state women should be allowed to make their own decision on mode of birth.

CheshireChat · 22/02/2022 01:33

It also completely disregards the trauma of interventions and subsequent damage to both mothers and babies with the end result of not even saving money Hmm.

Not that being cheaper is a good argument.

Movingsoon21 · 22/02/2022 10:15

They need to collect much better stats on the after effects of all types of birth and publish them in a clear way. I want to know:

  • how long does it take to fully recover from ELCS on average, vs
  • how long does it take to fully recover from EMCS on average

but you can’t find the info anywhere!

Also want to know what the recovery time is for various injuries caused by forceps / ventouse but again, I can’t find it.

It’s always presented as “c-section = long recovery, Vaginal = short” but from my friends’ experience it appears to be c-section = couple of weeks recovery, vaginal = either few days recovery or up to a year (and beyond) depending on luck!!

RedToothBrush · 22/02/2022 10:24

Its long overdue.

There is no clinical reason for the 20% target. It was a number just picked out of the air.

We know that women are having babies older and are presenting with more complex health needs to begin with. So the rate for cs from years ago is inappropriate to compare to today.

I've long said it was problematic because it effectively penalised hospitals who did more, even if it was appropriate to do more.

It was causing hospitals to refuse maternal requests at the expense of mental health and it was forcing midwives and consultants to persist with a difficult vb often with devastating effects to both women and babies.

There is a risk now that things could go too far the other way, but you can't have woman centred care and have a target for csections. The two are incompatible.

Its good news and something I've wanted to see for a long time.

They need to sort out the other end of the scale and staffing for homebirths and proper care for vbs in hospital to balance this though too.

What we want to be reducing is the number of EMCS as they are the most risky type of birth - and that comes from better more appropriate care for vbs, and potentially earlier intervention and more ELCS.

RedToothBrush · 22/02/2022 10:34

The target number came from WHO. It was originally based on a report which they said showed one thing but the data said the exact opposite and it wasnt appropriately challenged. It took a number of years to get that identified and dealt with.

One of the issues is that in some parts of the world CS have become almost default as part of a cultural basis. And this isn't necessarily a good thing for women. It was definitely happening in China - in part to schedule births and to make them as cheap as possible and because there was a crisis in staffing (there is a threshold at which if almost every woman had a cs it would be cheaper than a vb because you don't need as much night / emergency cover etc. I believe NICE have stated this on why cost alone should not be used as a justification for method of birth). Turkey also has a cultural preference for CS as its almost seen as a status symbol. The trouble is that the birth rate is much higher and if you are having 5, 6, 7, 8 babies having that many CS just isn't good for womens health.

In a society where we have complex health needs, low birth rates and older mothers the argument against CS is very different though.

As I say, its certainly should not be taken as something good without that massive note of caution.

What is important is that women get the best and most appropriate care for their needs. Not the method of birth.

DogsAndGin · 22/02/2022 10:56

Absolutely brilliant news!

AmandaHoldensLips · 22/02/2022 11:04

I've had 2 ELCS which I had to bloody well pay for to get. I have a morbid fear of childbirth due to childhood trauma. I was told in no uncertain terms that I was being ridiculous and no, you can't have a c-section. I've never been spoken to like that in my life - pregnant women are often viewed as sub-human.

Chasingaftermidnight · 22/02/2022 14:04

Excellent news - although I find it appalling that arbitrary targets were ever used to assess hospitals’ performance anyway. I hate to think how many babies and mothers have died or suffered grievous injuries as a result of the culture these targets have created.

Hopefully things will now change but it’s too little too late for many families.

DuggeeHugs · 22/02/2022 19:38

I'm really pleased they're making this change but still really angry about all the pain and poor outcomes which could have been avoided had this arbitrary target not been set up in the first place.

RedToothBrush · 23/02/2022 19:29

Tonight's panorama

www.bbc.co.uk/news/health-60434299
Mothers who helped uncover the biggest NHS maternity scandal

That criticism, Panorama can reveal, did lead the family's lawyer to raise in court whether there was "any kind of inbuilt policy or inbuilt bias towards trying to achieve natural births in as many cases as possible". The question also built on inquiries made by Kathryn's parents, Phil and Sonia. "I wondered about the fact that I'd been left so long before going to C-section," said Sonia. "I did a lot of research and found out that Shrewsbury Hospital had the lowest rate of C-sections in the whole of the UK."

Most of the cases the Ockenden review is examining date from 2000-2019. In their interim report, the essence of Sonia Leigh's concerns was strongly highlighted. The inquiry found that rates of caesarean sections at the trust in Shropshire were up to 12% lower than the England average for the period they are examining.

The trust's reputation for unusually high numbers of vaginal births was known. Panorama has discovered that just a month before Kathryn Leigh's inquest, a parliamentary hearing was held to discuss concerns about the rising number of caesarean births across England.

There was concern that child birth was being over-medicalised, and that too many women were having to undergo unnecessary surgical procedures, which like any operation carries risk. It also costs more money.

One hospital was praised for its approach however - the Royal Shrewsbury. At the time, its caesarean levels were half the England average, and a team from the hospital travelled to London.

In the evidence session, seen by Panorama, the then clinical director of the Royal Shrewsbury told MPs: "The culture of our organisation is that we have low intervention rates and once that is known we attract both midwives and obstetricians who like to practise in that way."

His colleague, the manager of women's service at the time, added that midwives who had worked elsewhere "almost need retraining to be able to work in Shropshire. We have recruited people who are like minded. If you want to keep something going and you believe in it, you do not want to employ people who do not believe in what you believe in.

Discussing the initial findings of her inquiry, Donna Ockenden told Panorama, "There were cases where an earlier recourse to caesarean section rather than a persistence towards a normal delivery may well have led to a better outcome for mother or baby or both. Low caesarean section rates were a prize." And the trust had been lauded for them.

My thread from 2016
www.mumsnet.com/Talk/childbirth/2598442-New-Data-Comparing-Hospitals-and-Outcomes-in-Childbirth

My thread from 2018
www.mumsnet.com/Talk/womens_rights/3370657-Shrewsbury-and-Telford-Hospital-Trust-with-significantly-lower-CS-rate-in-scandal

The stats made it clear as day to me that something wasn't right. I said it looked problematic.

WHY did no one else spot it? WHY did no one question it?

This is so upsetting to see in black and white.

The publication of the final report by Donna Ockenden is due next month.

cansu · 24/02/2022 07:53

The idea of targets is awful. I watched the programme and thought that we need to also get away from this idea that a c section is somehow a birth that has failed. C sections save lives of mothers and babies. It also highlighted the risks of not listening to women who felt something was wrong. Post natal care has been terrible for ages too. That poor woman with the birth injury received such appalling care.

Halfarsedjingler · 24/02/2022 08:06

Having worked in maternity care I never seen any evidence of these targets in any practical sense anyway. There are consultants who are more pro elective sections and others who are less accommodating but if someone needs a section they will get one

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