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New guidance to reduce epidurals and a target rate of 20% for C-Sections

189 replies

HmmThinkingAboutIt · 26/08/2012 16:40

New guidance being issued by the RCOG, the NCT and the RCM is urging to decrease C-Sections to a target of 20%, to decrease epidurals and to make Midwife Led Care the default for low risk women. The document is here

This guidance is controversial and goes against the position of NICE, the NHSLA, and the DH.

I've already posted this in the Childbirth section, but I do think this needs a wider audience, and to get this seen by as many people as possible and it was suggested I posted this here rather than AIBU. Original thread is here

I do think this is definitely a Women's Rights issue for a couple of reasons:

Firstly its the language being used in the document. Its extremely paternalistic. It talks about getting the GP to influence patients to make 'good choices'. (I've expanded on how I feel about this on the other thread) and is extremely patronising and almost about trying to get women to behave in the correct manner rather than doing whats in their best interests.

Secondly theres the conflict of interest this causes - if a midwife/doctor is under pressure to achieve a target of 20% how are they going to do this as well as put the needs of the woman first?

Then theres the issue of restricting women's choices and options; especially with regard to pain relief.

The RCM, RCOG & NCT document has caused so much concern amongst a number of campaigners that its lead to them to issuing a <a class="break-all" href="https://docs.google.com/viewer?url=www.electivecesarean.com/images//12-aug-24%2520rcog%2520ccg%2520press%2520release%2520final.pdf" rel="nofollow noindex" target="_blank">joint statement which sums up all the issues far better than I can.

I find the whole thing quite alarming and frightening. I don't appear to be alone if the other thread is anything to go by.

I know its all a bit of a read and apologies in advance, but this is important and doesn't seem to be being reported anywhere else, and I do think this needs to 'get out there' for discussion and debate.

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HoleyGhost · 26/08/2012 18:18

Thank you for posting this. Last time I'll support the NCT Angry

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ArthurandGeorge · 26/08/2012 18:30

Very interesting reading and a bit depressing.

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LackingNameChangeInspiration · 26/08/2012 18:35

fuck! thank god we're not planning more after this one, how depressing Sad feel sorry for women who have yet to start their families if that's how it's gonna go!

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wheresmespecs · 26/08/2012 21:36

How come the NCT keep getting away with this bullying, disempowering nonsense? If this was a predominantly male
organisation, we'd have no problem recognising it as patronising dictatorial misogyny.

All this does is tell the providers of birthcare
not to listen to women but to dictate their choices
and ignore their voices, wishes and experience. So depressing.

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avenueone · 27/08/2012 09:41

lives are going to be put at risk. It is just a cost cutting exercise.

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Whatmeworry · 27/08/2012 10:08

When I came first came into contact with the NCT (when DS1 was on the way) I was horrified - I felt it was all belief and woo, and a good example of what an unfettered Matriarchy would look like.

When I think about what they are preaching - ie effectively saddling women with the child-rearing workload of a pre-technology age (and making them feel guilty for using technology), it make me cross.

IMO Feminsm has let them off far to easily.

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Ushy · 27/08/2012 11:03

NCT/RCOG/RCM have so much to answer for.

On a lighter note, someone just posted this on the other thread. It is hilarious but sadly true.

The background to the 'hatstand' link was that a male midwife called Professor Denis Walsh called for the 'epidural epidemic' to be curtailed because pain was a 'rite of passage' for women and if they didn't suffer pain they wouldn't bond with their babies.

All based on absolutely no evidence at all, of course, and with no suggestion that putting male bits in a nutcracker might improve the bonding of fathersSmile

www.thedailymash.co.uk/news/health/women-to-force-hat-stand-into-anus-of-male-midwife-200907131899


There is no way we would have to be arguing to retain access to pain relief in labour if men had babies.


Just exactly do we do about this barefaced mysogyny?

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InmaculadaConcepcion · 27/08/2012 14:02

Women's pain just isn't as important - especially if it is for something as "natural" as childbirth Angry

I'm in favour of less medical intervention in childbirth, but this is NOT the way to approach it. Promoting better/more sympathetic approaches from HCPs, improving birthing environments, offering more practical ways of managing labour pain (JuJu Sundin's "Birth Skills" ideas, natal hypnotherapy etc.) and giving pregnant women much more support and education when approaching birth would be better than just setting targets in what looks to be a basic cost-cutting exercise.

All women are individuals and just because some cope with labour without medical pain relieving techniques or don't need or want a CS, doesn't mean there aren't plenty of others who need the extra medical support. Why should they be denied it?

I've asked MNHQ if they will consider campaigning on this issue.

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Ushy · 27/08/2012 15:07

Immachulada well done for contacting MNHQ

I think the feminist movement has totally failed women where childbirth is concerned.

In the 1950's when the medical establishment controlled chldbirth, women were forcibly subjected to all sorts of indignity and drugs they did not want or need.

Then came the natural birth lobby - the RCM and NCT - with their mantra of 'women must be 'empowered' to 'achieve' natural birth' .

Far from helping, it has made hundreds of thousands of women feeling totally disempowered and demoralised because they could not 'do it' naturally.

In reacting against what it saw as the 'male medical establishment model' a female one that is equally if not more oppressive.

The real feminist achievement will be to say we respect women, understand their different choices and believe in women's ability to make the right choices for themselves.

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InmaculadaConcepcion · 27/08/2012 17:22

While I tend to agree with most of what you say Ushy, I'm not sure the natural birth enthusiasts come from a feminist perspective as such - woman-centred perhaps, but I don't think that is the same thing necessarily.

I unreservedly agree with the last line of your post though!

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HoleyGhost · 27/08/2012 19:51

I hope this does reach the press.

I've not seen any study which included the cost of incontinence, PTSD etc.

So they are effectively costing these complications of vaginal birth at zero Angry

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HmmThinkingAboutIt · 27/08/2012 20:11

HoleyGhost, the updated guidelines on CS by NICE did at least attempt to do that. They concluded there were too many variable and that incontinence alone made the relative cost fairly comparative so drew the conclusion that cost alone should not be used as a justification for restricting maternal request CS.

I will admit that NICE also had slightly flawed methodology in that they focused on women who had only had one child (not sure if this applied to costs as well and I can't pull up the guidelines at the moment as the NICE website appears to currently being having major issues with its server). But none the less given the fact that part of NICE's job is to look at cost effectiveness overall (and this isn't technically in the remit of the NCT, RCM and RCOG) and to make evidence recommendations for national guidelines, I think I know which set of information is from the most credible source.

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whenyouseeitwaveorcheer · 27/08/2012 20:13

FUCK the NCT.

FUCKERS.

Too angry to write anything else right now.

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PMHull · 27/08/2012 21:03

Thank you all for posting here and for writing to MPs etc. This new document (and others like it - this is not the only example of such documents being circulated around NHS hospitals that I've read) should not be left unchallenged.

I'm also very glad that the decision was made to post here as a feminist/ women's rights issue because that's exactly what it is, and interestingly some of you have pointed out the irony that what makes this fight for women's rights more unusual is the fact that it is predominantly other women (in the UK at least) that don't want to allow a full spectrum of birthing choices.

I wrote about this very issue in September last year:
The Biggest Change in Women's Rights since they got to Vote
cesareandebate.blogspot.co.uk/2011/09/queen-victoria-by-lytton-strachey.html

And the wonderful Dr. W Benson Harer (also quoted in my August 24 press release) wrote this when he read 'Choosing Cesarean, A Natural Birth Plan':

?A woman?s right to choose how she will deliver her baby is the last bastion to overcome in women?s long struggle to control their reproduction and sexuality?indeed, to control their lives. Choosing Cesarean is a powerful weapon to help women to finally win this battle.?

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GetOrfMoiUsain · 27/08/2012 21:05

This is a very important subject - thanks for posting it here.

Great posts ushy and PMhull.

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Treats · 28/08/2012 16:08

I was GOING to say that the NCT IS a predominantly male organisation, because when I was a member (2-3 years ago) and received the bumpf for its AGM, I was appalled to find that the majority of its board members were male.

I thought I'd best check my facts though and note that the current 15 trustees are 8:7 female:male. So its leadership is marginally more female than male at the moment.

I'm not sure if I think that a charity that strives so hard to represent all parents of both genders (which is, overall a GOOD thing) is also the right body to be so influential on the subject of childbirth - especially pain relief. These are exclusively women's issues and should be represented by bodies that are exclusively focussed on the needs of women in childbirth.

Incidentally, I'm pregnant with DC3 at the moment and will likely be offered a non-medically necessary C-Section thanks to the very traumatic delivery I had with DC2 (which sadly ended in my baby's death at 7 hours old). So, I'm a classic example of the kind of C-Section that could be witheld under these guidelines.

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BigOldFanny · 28/08/2012 16:39

I live in the states I could not find a hospital in my area that had a csec rate of under 40% some MUCH higher. When it becomes the standrd t is very difficult for women who dont want a csec to avoid them.

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BigOldFanny · 28/08/2012 16:41

Also I was held down when I tried to walk around, and was asked about an epidural every 5 minutes for the entirety of my labor. My labor in the UK where it was assumed I would give birth naturally and not have a csec went way smoother.

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Treats · 28/08/2012 16:49

BigOldFanny - that sounds awful Sad. I think it's the same problem but the other way round. Targets or standards are set for deliveries and the focus becomes meeting those targets or standards and not on what's best for the individual woman and her particular circumstances.

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BigOldFanny · 28/08/2012 17:11

NO, I don't want women's choice to ever be put to the side. But I worry that when doctors are allowed to medcalise birth you are more likely to lose your choice. Assigning a time for delivery via a csec or a shot of pitossin is easy for doctors and allows them to avoid the night shift 20% seems like it would more than cover women who need a csec for medical reasons or just because they are too scared to go through a vaginal birth. But it might out an emphasis on doctors helping to educate women who think csecs are "easy" labor.

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whenyouseeitwaveorcheer · 28/08/2012 17:30

Treats, I'm so sorry for your loss Sad

I really hope you get whatever birth you wish for this time.

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BigOldFanny · 28/08/2012 17:35

treats Blush sorry I didn't see your post, I'm so sorry for your loss. I also can't imagine a doctor denying your very reasonable request

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buggyRunner · 28/08/2012 17:57

I don't understand how it's got to the point of women having such little faith in their ability to give birth.Angry
surely this needs addressing socially not through kpi's in hospital.

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HmmThinkingAboutIt · 28/08/2012 18:25

buggy, I don't think its just about addressing socially. Not when you consider the UK has a demographic which puts far more women in high risk groups than most other countries in west society. We have far more women in low and high age groups than places like Spain/Italy etc. We are far more obese than the rest of europe. And yet we keep comparing ourselves to these countries.

We need to address the real reasons why rates are on the rise. Not just put it down to it 'all being in women's heads' cos frankly I find that naive in the extreme and actually really patronising.

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Sioda · 28/08/2012 18:36

buggyrunner Um, I'm not sure what faith's got to do with anything. Most women expect to have a vaginal birth. Some of them still end up needing c sections. Which is hardly surprising since bodily functions aren't exactly under the control of faith... Apart from which, some of us couldn't give a crap about our ability to give birth. Like I couldn't give a crap about my ability to run a marathon or climb Everest. I wanted a caesarean. I don't need my choices to be addressed socially thank you. My reasons are my business. Don't make such daft assumptions about what motivates other women's choices.

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