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

[HmmThinkingAboutIt]

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" 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.

How many are classed as low risk during pregnancy but would have needed to transfer to a CLU if they had been at home/MLU? It's ok to say 95% are low risk but not every labour can happen at home. I was always low risk in pregnancy but first labour required syntocin and second was induced. I think those figures would be important to make a decision about where to have a baby. I would be terrified of being transferred during a late stage of labour by ambulance.

I have found this thread interesting and informative and have tried to engage wiht it in a thoughtful way which I hope adds something to it. But, no, I do not intend to give every woman who would like to have a homebirth a detached house, particualrly as I'm sure many have experience of less medicalised births in homes of all shapes and sizes as well as in various types of hospital, clinic etc. My point was that, dismissing women who would like a more natural birth as middle class does imply that it is a choice not available for all. The reasons why others may not have that choice, or may not feel it is an avenue open to them, are probably varied but it is an important point to make if we are talking about all women being able to make whatever choice they want. In fact, if you are going to argue that natural birth is only open to those with large detached houses then surely it reinforces the point (that some have made on here) that choosing less medicalised intervention whilst still giving birth in a medical environment is a valid thing to aim for.

It frustrated me I guess that if I'd been able to opt for a HB, I'd have had 1-1 midwifery care. But it was not safe for mr or my baby. So I had to have CLU, where I had many midwives pop in but certainly not 1-1 care. Struck me as little unfair.

I'm coming to the thread quite late but have found it really interesting. I think birth is absolutely a feminist issue but not just around pain relief but the bullying of pregnant women and women in labour.

There are several groups working towards supporting women in getting the birth they want (I think one might be called The Birth I want) but they all have slightly different agendas and are small and not joined up.

In my group of friends in the last 12 months I have heard stories of a woman in pain requesting to move in labour being told she couldn't move off their back because "they were doing so well they didn't need to". Refusals of pain relief (again because you're doing well - surely the woman in labour should be the judge of that), women told they must have CS due to previous tear - even though a repeat tear was a less frightening prospect than CS. Bullying in labour, lack of support postnatally and with breastfeeding (a mum told she should bf because her preemie would have respiratory issues and then not supported to bf and encouraged by MW to bottle feed). Another friend told that she needed to have an epidural because she wasn't coping. She said she felt that she was but in the end she had it to shut them up.

Women carry all the guilt, regret and trauma for things they had no chance in achieving in the first place. It makes me very angry.

NHS antenatal classes are crap. I'm not a fan of NCT either but their are antenatal classes out there which equip women with coping techniques for labour but they cost money so aren't an option for all women. If the NHS wanted to reduce its csection rate or drug bill they could reach these techniques in Parentcraft.

Reduce the epidural rate by giving women alternatives and reducing the number of epidurals requested not the number of epidurals allowed.

And trust women to know what they want. I have been pregnant 3 times and have been patronised and spoken to like an idiot all 3 times.

Tell women the facts and all of their options & let them make the decision.

The Daily Mail comments about "I had a natural birth and it was easy but my friends ha epidurals and all tore" are, firstly, too anecdotal to mean anything but also overlook the fact that a woman may choose and epidural knowing it increases her risk of tearing and choose it anyway. That's informed choice. She may also rather manage the pain or discomfort of a tear than endure pain in labour. Surely we should trust a woman to know what is acceptable for her body and emotional wellbeing?

Apologies for typos and spelling mistakes

rosabud, you are really blowing things out of proportion a bit. Nobody here "dismissed" home-birthers as middle-class. I was just trying to point out that the mantra that a woman would always be more comfortable giving labouring and giving birth at home than the hospital is not always true. And yes, home births happen in all sorts of homes. But my I have a rather strong hunch that they happen more in bigger houses or simply better built houses/flats with thicker walls because many women like to have some privacy in labour.

I described my own experience of why I felt more comfortable in the hospital rather than in my own house. I have also seen similar experiences described here on other threads. Now that I have a house that affords me more privacy, I would like to try for a home-birth or at least longer home-labour for my next child.

Women who prefer hospitals are not always unenlightened. They may have very good reasons for their preferences. Take, for instance, the woman with four children who featured in one of the BBC "The Midwives" episodes. She very expressly wanted to be in the hospital rather that at home so she could be guaranteed some privacy and rest from the rest of her large family/other children and have time one-on-one with her newborn.

P.S. There is nothing wrong with being middle-class. I am middle-class and feel rather happy and fortunate about it.

Could I ask what is meant here by 1-1 midwife care? Does it mean always having at least one midwife with you during the whole of the labour/birth process or having one and the same midwife curate the whole process? If it's the latter, then it is not really available in home births either or at least not always. My impression is that home-birth midwives also work on a shift basis.

FrillyMilly, the latest episode of "The Midwives" mentioned that 40% of first-time mothers who have or rather attempt a home birth end up being transferred to a hospital. It's rather high. But I am sure it's much lower for subsequent births as they tend to be easier and perhaps more predictable.

Kellykettle "Reduce the epidural rate by giving women alternatives and reducing the number of epidurals requested not the number of epidurals allowed. "

This

I agree 100%. Then the onus is on the midwives to work with the mother to help her manage her pain relief. Hard to police. A MW under pressure might "pretend she didn't hear" a request, but still it shifts the responsibility to the MWs rather than making the mother have to put up with it because it doesn't suit someone else.

I don't know anyone who has had a successful home birth but the ones I've seen on tv the midwife is often at the kitchen table having a brew or writing up note. They only really step in to examine or near delivery which is the same as at hospital.

As a PO mentionedI think it would be great if they invested in alternatives such as more in depth parentcraft, more pools (there's one in our local hospital), tens machines to loan out for use in early labour, mobile epidurals. I'm sure there's much more but I've had two hour sleep. Without all this how can they lower the epidural rate.

Not the same midwife for whole of labour - mine was 2 days! - but having one midwife per labouring woman, not needing to wait when pressing call bell - midwife on mine popped in ever hour until it went wrong, but had 2 other women labouring at same time so when I was vomitting, panicking and having a hypo, I had a maternity support worker who, while lovely, couldn't do anything bar comfort which didn't help me at all.

Patron

My last post was not directed at you but to Lackingnamechange who followed my comments with a question as to whether I was going to give detached houses to all women who wanted home births. I don't think there is anything wrong with being middle class, that is my point. To dismiss those who want a natural birth as middle class seems to be implying that it is either a) a rather silly, frivolous obsession for women with large houses or b) something which only more privileged women have access to. I just wanted to make the point that both of those views are flawed.

This is the Doula UK response to the new guidance

Doulas are not there to 'push their agenda' nor are they (or should they be) natural birth zealots. Our role is to support the choices of our clients. We tend to be great believers in informed choice and informed consent, which doesn't always happen. We signpost research based evidence when asked, but again, as I said, our role is one of support whether our clients wants a homebirth or a hospital birth, epidurals or not.

With regards to feminism (and I've really only skimmed through this), surely we are all, or ought to all be, feminists. I don't think of it (personally) as an insult. I think of it as people loving women and that feminism brings us choice.