NICE consultation on draft quality standards for Caesarean section - what are your thoughts/experiences?

[MylinhMumsnet]

Hello,

We've been asked by The Quality Standards Team to contribute to a National Institute for Clinical Excellence (NICE) consultation on the draft quality standard for Caesarean section (CS). The draft standard is made up of a set of measurable statements and the consultation asks for your thoughts on these statements.

The background information provided by the consultation states:
"Caesarean section (CS) rates have increased significantly in recent years. In the UK 20-25% of births are by CS, up from 9% in 1980. The draft standard focuses on improving the information available to women who may request or need a CS. The draft standard also focuses on reducing potential risks or complications for the woman and the baby."

The consultation is interested in hearing your views on nine draft quality statements, listed in the consultation document (pages 3 & 4). These range from ensuring pregnant women who request a CS discuss their choice with their maternity team, to involving a consultant obstetrician in the decision-making process, and to exploring procedural options when there complications arise during labour.

The questions asked by the consultation are:

1. Can you suggest any appropriate healthcare outcomes for each individual quality statement?
   
2. What important areas of care, if any, are not covered by the quality standard?
   
3. What, in your opinion, are the most important quality statements and why?
   
4. Are any of the proposed quality measures inappropriate and, if so, can you identify suitable alternatives?
   
   Please post your thoughts on these questions and, of course, anything else you want to say on this thread. The consultation closes on 24 January 2013 at 5pm.
   
   Thanks,
   MNHQ

[swallowedAfly]

my future prognosis btw was that, 'it might be alright, or it might not' most helpful.

also i had a totally bodged episiotomy repair and ended up back in hospital for a secondary repair that i was extremely lucky worked or it would have meant plastic surgery.

i honestly don't think i'd risk a vaginal birth again due to the ineptitude of my care and treatment with a VB.

[JumpHerWho]

SaF - my ELCS was amazing and perfect, so calm and lovely. Peaceful, lovely caring anaesthetist and assistant, professional but sting atmosphere.

It's the post-natal bit that is awful.

[elizaregina]

Its the removal of the placenta that stimulates milk, I too do not understand people saying the section affected milk.

Its only personal to me and my friends - but I had elc and my milk came in normally and Bf was all fine, and between friends its a total mix of who BF and who didnt it was all personal and not down to mode of delivery.

"Andcake I think it's important that you clarify precisely what you mean about your "women who have CS for the wrong reasons" comment. It's this attitude that we are desperately trying to move away from in order to make CS another birth choice."

Absoluty its no one else business what people want or chose quite frankly, I cant belive the arrogqance of telling some one else to do with thier very own body!

[JumpHerWho]

Eliza I struggled to breastfeed after my section and ultimately failed. Nothing to do with milk production and everything to do with the pain I was in, and when DS latched on my uterus contracted (as its meant to) which having been cut open hours earlier meant it hurt quite a bit... I received no help with positioning which would have helped - I was told to do it whilst slightly raised and I was in so much pain. It's disingenuous to say it doesn't affect bf, it clearly does. My milk came in on day 4 fwiw but I know this is similar to vaginal births. I was released after 2 nights having failed to establish bf, this is something I will always be upset about. The bf counsellor just didn't believe I was in pain, she kept saying 'what's wrong' when I was flinching and crying out, when I said it hurt, she didn't accept how much and that it might just make me unable to focus on the 10 pound weight lying on my open wound! All I wanted was for him to be taken off me! It was nothing to do with nipple pain, no problems with latch, and that's all she wanted to talk about. And I wanted constant skin to skin, which they wouldn't allow as I kept falling asleep and DH was kicked out at 9pm til the morning so I couldn't bf unless I rung the buzzer for a crappy hca to come and stand arms folded while I tried to hold DS comfortably.

[poppy283]

Andcake, how offensive. 'wrong reasons' indeed.

[growyourown77]

I absolutely echo the comments made by redtoothbrush and PMHull and would each that measuring by numbers of CS as outcomes is just arbitrary and has nothing to do with offering what women need.

Stats about CS need to be separated between EMCS and ELCS. And I'd go further to show, especially for first time mothers, where EMCS followed attempts at assisted delivery as this can be a big part of people's fear.

I'd also add how critical it is that any guidance, standards and midwife AND consultant training to be around equal importance on mental or physical reasons for ELCS and stipulate this in the wording of these documents with definitions that go beyond a simple 'tokophobia' as there are often complex sets of mental, emotional or physical factors affecting birth choices or fears.

The standards as currently written talk about timeframes for 'discussing' fears with members of the maternity team without specifying a timeframe for making a decision - which is just as crucial as when the discussion starts - it shouldn't be a long, drawn out process as this is likely to add to anxiety.

The working 'patient satisfaction with involvement in decision making - does not demonstrate actual shared decision making nor respects that it's ultimately the woman's body and bay - for the medics is just a job in the end...its not their life that's affected.

Patients and medics need to both be clearer on whether the 'offer' of mental health support is an offer or is obligatory and what effect/input it has (or not) to any ELCS request decision.

Steps shoud be taken to make sure that women having ELCSs are not viewed or treated negatively by staff and that wording on notes for ELCS is handled sensitively and in agreement with the women.

And care and understanding (the soft, communication skills) of the medica, especially consultant, should be an integral part of the ir re-training and these standards.

[MylinhMumsnet]

Hello

Thanks everyone for sharing your experiences and your thoughts on the consultation. It's clearly an issue of importance to mums and soon-to-be mums, and we're sure the people over at NICE will value all your contributions.
We've pooled your responses and sent over our response. We'll be sure to post the published findings from the consultation, so watch this space!

Thanks again
MNHQ

[Rosduk]

I had an emcs 8 weeks ago. My little boy was born at 27 weeks and sadly we lost him 2 hours after he was born.
The experience I had of the hospital and staff at Hastings Conquest was fantastic. I had gone into hospital with reduced movements when I was 2 hours from Home visiting family. I had forgotten my pregnancy notes.
Within an hour of stepping into the hospital my son was born. Although the reason he needed to come out wasn't explained fully they did explain the urgency of the situation. As my partner was 2 hours away he wasnt there but the midwives etc in the theatre looked after me and made sure i was supported throughout until my mum arrived. I received a full debrief a few days later and a doctor went through our post mortum and funeral choices.

My recovery was difficult dealing with the grief and pain but every midwife was fantastic, drugs offered regularly - I didn't have to wait and I was constantly kept informed of where my son was even after he had died. The only thing I would say was for the first night I was kept (in a private room) on the labour ward so I could be checked regularly but I could hear other labouring mothers and their newborns, but was moved to the bereavement room on the 2nd day.

My aftercare was offered through either Hastings hospital or my local Royal Berks in Reading. They did their normal checks aswell as asking how we were doing emotionally.

I am now fighting with my local GP for councilling and the nerves regarding my next pregnancy (hopefully!) have kicked in. My partner and I want to try again ASAP and would like to know what support is in place, will I be monitored more and my birthing options next time round. My GP would not discuss this until we get pregnant. No risks have been discussed with me for future pregnancies and having being fobbed off by my GP (who congratulated me on my baby and asked where he was at my 6 week check!) I'm now not sure of my options. I am now changing surgeries.

[Gatorade]

Rosduck I am so sorry to hear about the loss of your son. The lack of support from your GP is completely unacceptable.

I lost a baby around 20 weeks (which I appreciate is no where near as terrible as what you have experienced) and I found the best support I received was via my NHS trusts counselling midwife service, I was referred by a midwife.

If possible I would try to contact your local midwife team and ask for a referral. You basically see a midwife who is trained in bereavement counselling (my understanding is that all trusts should have at least one) and she will discuss your fears in relation to future pregnancy and refer you for appointments with any specialists (be it obstetrics or geneticists or similar) who you should see before you get pregnant again, or just to help to reassure you.

Good luck with everything and take care of yourself.

[Pandasandmonkeys]

The after care following my cs was awful. I had a very difficult section - baby was stuck, retained placenta, I had some horrible brushing from being pulled and pushed around to get baby out. Once back on the ward I was given minimal pain relief, dh was constantly having to go and get help as I was in so much pain. Eventually, I was given morphine, dh we sent home and I was left to cope alone with a newborn. The morphine worked for the pain but made me feel very light headed and wobbly. No one came to check on me or help me with the baby. While desperately trying to breastfeed I blacked out/fainted and baby ended up on the floor. Had I been cared for properly this wouldn't have happened. Also, the policy of sending partners home is ridiculous. It's a time when you need 24hour support and the staff are unable to provide it.

[Pandasandmonkeys]

The after care following my cs was awful. I had a very difficult section - baby was stuck, retained placenta, I had some horrible brushing from being pulled and pushed around to get baby out. Once back on the ward I was given minimal pain relief, dh was constantly having to go and get help as I was in so much pain. Eventually, I was given morphine, dh we sent home and I was left to cope alone with a newborn. The morphine worked for the pain but made me feel very light headed and wobbly. No one came to check on me or help me with the baby. While desperately trying to breastfeed I blacked out/fainted and baby ended up on the floor. Had I been cared for properly this wouldn't have happened. Also, the policy of sending partners home is ridiculous. It's a time when you need 24hour support and the staff are unable to provide it.