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.

Assuming it was labour with PFI they also didn't have a pocket calculator for GP contracts (lets up thier wages by a third and let them opt out of on call ).

Posted the response from RCOG, and hadn't had chance to find response from Midwives POV until just now.

Found blogpost at Huffington Post from Cathy Warwick, Chief Executive of the Royal College of Midwives
www.huffingtonpost.co.uk/cathy-warwick/caesareans-nhs-women-choices_b_1067710.html

I have to say, that I think she has a missed a lot of important points and has a certain lack of understanding about what women's experience and perception of the NHS and whether they will be allowed to have a c-section under the current guidelines especially in view of the public Trust bans on ELCS on request.

That said, she welcomes the debate and says the RCOM is pro-informed choice.

What's annoying though is she has been quoted by the Daily Fail and others as: "Cathy Warwick, a professor at the Royal College of Midwives said c-sections for non-medical reasons were ?inappropriate?."

What she actually said was far different as you can see on the link. I'll just quote the final line - "The NICE guidelines and the debate they are generating is not about denying women choice. Ultimately they are doing something very important, they are promoting informed choice." Does that sound negative? Hardly.

I actually would quite like to murder a few journalists as their reporting is COMPLETELY different and gives a totally different view of the RCOM line.

Grrr....

But if you want the cheapest birth for all women, you need to be looking at compulsory homebirth, whatever a woman's preference, with no access to epidural. Not a hospital VB in any case.

As I've said before - there are many instances in the NHS where patient choice and circumstance are taken into account ALONGSIDE pure basic cost. You can choose to have some dental work under local or general anaesthetic - you can choose to have carpal tunnel syndrome surgery on one wrist at a time, not on both in one go, even though that's cheaper. It's false to suggest that childbirth is simply a matter of the providing the cheapest option.

I think my views are pretty similar to the

"The RCOG does not comment on draft consultation documents since the content and recommendations are subject to change.

However,in light of the misleading headlines on the availability of c-sections on the NHS, the RCOG would like to state that:

?C-sections are a safe medical procedure but as with any intervention, there are risks involved. All doctors must ensure that women are informed about the risks and/or benefits of procedures undertaken and the alternative options. Women must have access to good quality information so that they can make informed decisions

?Tokophobia, or the morbid fear of childbirth, may lead to maternal request for c-section. Tokophobia is a complex rare condition and women need to be supported by a range of healthcare professionals, including midwives, obstetricians and occasionally perinatal mental health specialists, so that the most appropriate choice of delivery can be made.

The headlines ?Now all women have the right to NHS caesareans in hugely expensive move? and ?All women get right to caesarean birth on the NHS... even if they don't need it? are inaccurate. There is no proposal in the current NICE guidelines which state that women should have the automatic right to a caesarean section. Indeed, the current Hospital Episode Statistics show that the c-section rate over 2009-10 was 24.8%. This shows that the majority of women currently deliver normally or by assisted vaginal delivery depending on their circumstances.

There are well defined indications for caesarean section for both elective and emergency and these should form the basis of clinical practice.

Healthcare providers have the responsibility to ensure the safest, most cost-effective method of delivery for women and babies accepting that very occasionally women will request an elective c-section in the absence of conventional obstetric indications."

I have made it clear I believe in decent therapy and counselling for those suffering from tocophobia (primary or secondary) I believe in fully informed choices (though was told I was patronising for suggesting some may benefit and feel in control more from being taught how to find reputable facts and evaluate them-whether pro or con ELCS etc). That those in the situation where their psychological well being is at risk should have access to ECLS if this is the birthing plan they feel is best for them.

When it comes to the other NHS cost scenarios FC mentions I believe the NHS should offer the cheapest if they have looked into costings.

When I mentioned educating sufferers that was an example of what a therapist may think will be advantagous to their patient, of course they know best. It would not be for all.

Opps! The educating is part of the counselling (and only if therapist things it would benefit). I think a wide variety of psychiatric problems are due to control issues (to some extent, and for a wide variety of reasons) and some benefit from feeling they have information to hand.

Being well informed (as I was) is no advantage if hospital staff will not give you a say in what procedures they carry out on your body.

When I complained about protocols and policies not being followed, the response was that I needed counselling. I was offered CBT, one of the objectives of this type of counselling is to cure women people of the aberrant belief that we ought be treated well.

So, yes, control issues.

Wholly,

my thoughts exactly! How can you be counseled out of your survival instinct and respect for your own dignity, right?
Know your place, woman, and never complain, that's the whole point rather.

That is a horrendous situation Whollyghost.

Did you have primary tocophobia and then a bad experience on top or did giving birth and the subsequent events lead up to secondary fear?
Sorry not read ALL the post!

I do believe primary and secondary tocophobia will need different approaches (a better birth first time certainly important with the later) . Primary needs to be well addressed according to the abstracts I posted earlier it appears beneficial (think it was Norwegian study) as those that had it had a reduced chance of a negative birth experience. As with most things it is how it is done.

Personally control will always be a (major) issue for me. I saw junior doctors unable to carryout proper clinical exams , also they were unwilling to call for appropriate CS, the medication administered to my son who was at significant risk of dehydration was nephrotoxic (can't be helped but was not correctly monitored).

The Dutch have a very high percentage of first time home births but as one of my colleagues commented rather cryptically:

they cycle everywhere so they would, wouldnt they

So if we want to increase homebirths then women need to get on their bikes.

OH FFS. With respect Iggly2

If you are suggesting I need 'educating' then frankly insert expletive. Counselling is something else entirely. I take exception to your remarks there. Its patronising and rude. Comments like 'needs to be addressed' make me want to punch people. Its sounds like someone saying they are trying to correct homosexuality.

I think I'm better off ignoring your comments. Again.

"Primary needs to be well addressed...."
So a potentially live altering phobia should not be looked into........

interesting to see Germany mentioned - my sister found that maternity/fertility was a 'lifestyle choice' not covered by her health insurance and had to pay for all her fertility investigations herself (she had them repeated on the NHS and found out rather more..). As a woman of childbearing age she paid a higher premium than her husband...

2 separate issues -

Counselling isn't a magic wand. I say that as someone who has benefited hugely from it during depressive episodes, and as someone who thinks it's generally a good thing. But it can be lengthy, uncertain in terms of outcome, and (sorry, iggly2) - costly. The perinatal psychiatrist who diagnosed me with primary tokophobia recommended me for a CS and not counselling, for several reasons. I was already pregnant and time was not on my side (The psychiatrist pointed out that, given my age, time wasn't on my side at this point even if I hadn't been pregnant at that point). Counselling can help you progress with your fears, and be able to tolerate situations you couldn't previously, like deal with an unexpected labour scene on tv without having a panic attack - but still leave you MILES short of being able to contemplate a VB yourself. Given that there were no medical reasons for me NOT to have a CS, she and the consultant, and the Head MW, were all in agreement that a CS was the answer.

None of the above is relevant for those women who choose a CS based on a secure knowledge of the risks and benefits, and a considered analysis of what is best for them. Counselling is not appropriate. By all means provide them with accurate info - but that goes for all birth options.

To answer your question iggles - I had no particular fear or anxiety around childbirth, until after I had experienced it. I was confident that however difficult it would be, all that mattered was a healthy baby. I was wrong.

I don't know if my fear now is really tokophobia, since I would be ttcing tomorrow if I could be assured of a home birth. I still have no fear of pain or the process of childbirth. However, I am utterly terrified of being incapacitated in a maternity hospital. I've been told that any subsequent pregnancies would be likely to be complicated and need a higher level of monitoring and "care" so that rules out home birth then.

The most frightening part of my hospital experience, the bit that goes around and around in my head, is that first night on the postnatal ward, when I wasn't able to stand and also wasn't able to get any help with looking after my newborn.

I do not think it is a magic wand either, I do think looking at the problems that women with primary tocophobia have suffered from (sorry posted abstract earlier but there was a high percentage who suffered from abuse and eating disorders) it could help some maybe even identify previous non investigated problems. I think it should be there regardless of cost especially if it can offer some help (eg lessen chance of negative birth experience). I also think if GPs broached the subject more often it would be better. I think it would certainly be better if it could be offered earlier and pre pregnancy. The idea of having a panic attack whilst seeing a birth scene on TV would be very upsetting (sorry can't think of a stronger word at the moment). I have never said the NHS should not offer ELCS in such cases You have the support of a psychatrist, midwive, consultant. I hope it went well.

"I would be ttcing tomorrow if I could be assured of a home birth." I wanted a home birth more than anything we had everything arranged, but pregnancy didn't go to plan as very large baby (extra checks/scans). We even had the supplies eg oxygen delivered. I had no problem with the idea of labour pain etc I was terrified of ever being operated on and admitted to hospital.

Iggly2:"We even had the supplies eg oxygen delivered. I had no problem with the idea of labour pain etc I was terrified of ever being operated on and admitted to hospital."

If only you'd had some counselling and education you might see how wrong this view is and that a nice medicalised birth in hospital would be just the ticket.

I am booked in for a section soon and reading this makes me feel so bad, I don't have 800 lying around to spare. I know I am being really selfish but I don't want to die in childbirth and more importantly I don't want my baby to die.

I am perhaps being irrational in hoping that my recovery is better this time as opposed to the last time when it was a crash section after 4days of contractions no more than a few minutes apart and after dd got into distress and me passing out. Coming round in recovery when your last memory is trying to say I don't feel well and a vague notion of alarms is terrifying. As I said I may be being irrational yet in my head it feels logical

Minus273. PLEASE do not say you are selfish. YOU ARE NOT.

Of course you're not selfish Minus, it's hardly your fault, is it! Think of it this way, it would probably cost a lot more if you didn't have the elective section and you or baby had serious complications as a result.

I'm sorry to hear you had such an awful experience last time, wishing you luck for a safe calm birth this time round!

Minus273 given your experience, your experience, your fear is not irrational, and you are certainly not being selfish.

You can expect your recovery from an elective section to be a lot better, best of luck!

Minus273 - you are not being selfish, irrational or shouldn't feel bad. I am sure your experience this time round will be a positive one and what is important that you are happy with your choice. I found out the day before I had DS that I would be having a CS and was very scared (am sure would've felt the same if I had gone into labour naturally so more fear of he unknown than anything else), however all-in-all the experience was positive. If you have any choice (I didn't) I would request a morning CS as mine wasn't until mid-afternoon and I had to fast all day so by the time I came out of theatre I felt extremely nauseous due to hunger - I am a greedy guts though!!! I would also make sure you have lots of snacks to hand as you will be starving due to fasting even if you had an early CS. Good luck - bet you can't wait to meet your baby! I'm not due until May (having ELCS abroad as advised but have no problem with this).

Re:cost I think (having read many of these posts) that the majority of people who had an issue with this (well certainly me anyway) were more worried about the fact that if mothers who were not tokophobic/had not had a previous traumatic birth experience like you did perhaps might choose an elcs over a VB thus increasing the CS rates significantly which could bring maternity services in the NHS (in it's current form - I think many of us believe things have to change and add-ons implemented where appropriate) to it's knees. I do not and would not criticize someone who chooses to have a HB, ELCS, hospital birth naturally whatever as I strongly believe it is upto the mother (I don't see one as being better/easier than the other) I just feel that the NHS would not cope if ELCS rates increased dramatically.