NICE recommend all women should be able to have a cs

[LoveBeingAWitch]

Just seen tomorrow's front page of the Sunday times saying that NICE are saying cd has become such a safe op that every woman should be able to have one if that's what they want. Im quite surprised by this.

I have, thanks.

Iggly you are unbelieveable.... all else fails, throw the fact i have a phobia at me, even though NICE actually support my position and support choice not forcing something on women.

Go figure. Have a nice evening. You really are a piece of work. I'll leave others to throw a few bricks at you or something for rest of night... I can't be bothered answering you after that. Low doesn't even describe it.

I'd rather spend time talking to other people thanks...

No - I get that you have mental health issues that relate to childbirth Quietly. I have read many of your posts on this subject on the childbirth board.

I feel sorry that the NICE recommendations on tokophobia (which set out that all women with this problem should be treated with respect, offered counselling, and given the option of planned c/s if they find the prospect of labour untenable) are not being consistently implemented and it's something that I'd like to see addressed.

But c/s on demand for all is not the answer to all the problems women are currently facing in regard to their maternity care in the NHS.

I had a lovely planned c/s on the grounds of choice. NHS hospital, couple of years ago.

Up the same evening, had a wash and change of clothes. Changed my sheets as well as I could see the midwives were busy.

Took my regular painkillers when offered and had no trouble at all.
Breast fed from day one to just over a year.
Best decision I ever made.

I love posting my story because I hope it encourages any woman who does her home work about the options and believes it'd be right for her to ask for one.

It's fantastic that NICE are supporting informed choice. Hopefully the shame that some (not me!) feel in requesting a section will lessen in the future.

agree leningrad

SHagmundfreud "But c/s on demand for all is not the answer to all the problems women are currently facing in regard to their maternity care in the NHS."

No one is saying it is, least of all NICE.

The medical profession wouldn't deny a dying person the appropriate pain relief they need, but, from what I've heard and read, women undergoing natural childbirth have to endure extreme pain and trauma. Why?

I worry that this won't end in choice. but instead will result in fewer and fewer Obs/midwives being properly trained to provide a vaginal birth so that in some cases that's no longer a realistic option. Be careful what you wish for.

This is not pie in the sky btw. I live in Hong Kong where the c-section rate is extremely high- almost 75% in the private sector. There are very few Obs who actively encourage vaginal deliveries (and those that do have a 80% success rate). The others always manage to find a reason at 36 wks why you shd really have a caesarian and earn them their extra £3000 operating fee.

In the public hospitals, c-section rate is also very high (close to 70%), largely due to lack of midwives, lack of 1-1 care, old fashioned ideas about positioning during labour, fear of litigation etc.

Counselling should be offered (not a one off either but properly followed through) this may cost as much as the £800 but ELCS should be private (the one exception being that if all the counselling sessions are attended and the psychologist or psychiatrist overseeing the care agrees then ELCS should be offered).

Cerealqueen you can ask for pain relief.

iggly - cerealqueen CAN indeed ask for pain relief but if it'ssomething that actually works ( epidural) its anyones guess if she will get it

Also, if they've got an extra £800 per birth floating around, why don't they spend it on some more midwives? Birth experiences could be transformed if you had a properly trained midwife with you throughout, rather than one sticking her head around the curtain every 2 hrs.

"I'd like all that put in place too, and elcs on demand, it's the right and humane thing to do. They could do a lot more research on effective pain relief options too."

Ok - plus all women who want it have access to caseload midwifery care in pregnancy and labour (where you have one named midwife provide all your care from booking visit to four weeks after birth), an experienced homebirth team, an obstetric flying squad to improve outcomes for homebirths, one to one care in labour, a well-equipped birth environment, access to a birth pool (should they wish it), consultant input in the case of complications, fetal blood sampling in the case of complications in labour, breastfeeding support from specialist midwives following birth, a minimum of three postnatal visits at home from a qualified midwife and immediate access to physiotherapy for women experiencing SPD during pregnancy.

These things would improve outcomes in terms of the physical and emotional health of mothers, emergency c/s and instrumental rates, hospital readmissions, and the likelihood of hospital readmission for newborns in the first 6 weeks of life.

Has anyone else argued for these things on this thread - given that they're all cheaper than planned c/s for individual women and are proven to improve outcomes for the majority of mothers and babies?

Or are we only interested in offering surgery to the minority at great cost, while the already neglected majority wanting vaginal births are just left to get on with dealing with poor quality and under resourced care?

By counselling, what do you mean, exactly? Persuasion? A discussion of the miriad of reasons that a woman might chose ELCS? What?

And how should all ELCS be done privately? Currently in the UK the only private provision is in London, and is rather more than £800.

So we're back to my earlier point - women should have choice/make informed decisions so long as they're YOUR decision.

Whatever next for women? The vote?!

cereal, it's not as straightforward as you say. The pain aspect of natural childbirth is not comparable to the pain aspect of illness, because (as I'm sure you already know) when the pain of childbirth is taken away through medication it has the potential to negatively affect the overall outcome of the labour and birth - and can lead to unnecessary intervention, etc, etc. I won't go into detail as I'm sure most people on the thread know this stuff already. Suffice to say it's not a reasonable comparison to make.

I am now wondering if there is a reasonable comparison one can make...?

Also it would be interesting to see if there are statistics detailing how many assisted labours do and don't lead to CS - i.e. what are the stats on the cascade of intervention?

notanotter But that's another thing I'm querying. They don't have enough anaethetists to give and monitor epidurals, but suddenly they've got enough for everyone to have a c-section if they want one. I know the c-sections would be scheduled, but even so.......

NICE have made some truly bizarre decisions before and had doctors up in arms about their pronouncements which take no account of resources and other departmental budgets. I'm wondering if this might be another case of the left hand not knowing what the right hand is doing

BrideofFrank - actually, if there's an extra £800 floating around per birth, I'll pocket it, ta very much!

can someone copy the big bold text to brideoffrankenstein please?

And oh looky...

"The Birth Trauma Association has approached the Equality and Human Rights Commission to investigate whether Trusts who permit denial of pain relief to women in labour are breaching equality legislation. There certainly appears to be a case to answer as there is no other field of medical practice where individuals are denied access to pain relief for prolonged periods. The case has now been ?under consideration? by the EHCR for six months and is proving ?controversial?"

Just cos you ask doesn't mean you shall receive...

... you wonder why women want choice. Insert big neon sign here.

Right bedtime before I start saying things I shall regret in the morning.

Funny, thing is talking about my phobia is about trying to break a taboo, and try and explain a few things and then I get it thrown firmly back in my face... go figure.

"Has anyone else argued for these things on this thread - given that they're all cheaper than planned c/s for individual women and are proven to improve outcomes for the majority of mothers and babies?

Or are we only interested in offering surgery to the minority at great cost, while the already neglected majority wanting vaginal births are just left to get on with dealing with poor quality and under resourced care?"

No, but that's because it's about the NICE guidelines for ELCS, not the impact of the implementation on current maternity services. That's an entirely separate subject.

I had pethidine and gas and air, didn't detract that much from the pain and trauma. Being strapped to a bed didn't help, felt powerless.

I just think the NHS should prepare women more, not rely on the NCT as they are biased. GP or midwife to do a de-brief if you need or want it, plus counselling and support. In some areas it seems an elective CS is a choice. In my notes it says in bold no CS given without a medical reason. I just want to choose.

NOT persuasion. Look into why they are scared, how can they be helped? I seriously think just giving CS ion demand will not be beneficial in somecases. Maybe they should look into GPs asking about tokophobia more regularly.They would be taught how to look at facts , how to access them as well. Often knowledge helps as a feeling of control can come with it. Another poster looked at a list of points quietlyafraid posted and came up with counter points.

"NICE have made some truly bizarre decisions before and had doctors up in arms about their pronouncements which take no account of resources and other departmental budgets. I'm wondering if this might be another case of the left hand not knowing what the right hand is doing"

Quite right, really. NICE shouldn't be pressured into making clinical decisions on the basis of what has already been spent by the current NHS. They're there to make a judgement about drugs and treatments REGARDLESS of whether individual trusts have the money to implement.

That may seem unpalatable at face value, but it's right that they remain independent of NHS budgets. That way they can make unbiased guidelines.

Yes quietly, I understand that, but your big bold writing actually means jack shit when they (or you- I'm not sure which) are saying "under certain circumstances" without quantifying those circumstanes, so if "certain circumstances" means 5% of the time, then that means that in 95% of the time that's not the case and a fully costed VB is cheaper.

"NOT persuasion. Look into why they are scared, how can they be helped? I seriously think just giving CS ion demand will not be beneficial in somecases. Maybe they should look into GPs asking about tokophobia more regularly.They would be taught how to look at facts , how to access them as well. Often knowledge helps as a feeling of control can come with it. Another poster looked at a list of points quietlyafraid posted and came up with counter points."

I wonder do you mean to be as patronising as you sound. You're assuming that women who request ELCS are either scared or unaware of "the facts." Can you see why that might be patronising? Can you see that there may well be situations where a woman might chose ELCS without fear of VB, and in possession of the facts?