Monday, 11 October 2010

Causes of rising caearean rates?

I read an article on the BBC news site about ‘too posh to push’ being a total myth, and women overall are not demanding elective caesarean sections, but being advised to have a caesarean section when a pregnancy or labour deviates from normal, and yet the caesarean section rate is rising year on year. So, the question is, who decides what is normal and what is not? I think that there is a strong element of ‘if in doubt cut it out’ but women are not being given all the information to make a truly informed choice, and obstetricians are only too aware of litigation should a labour and birth not proceed as planned.
There is also the possibility of health professionals affecting how information is given to women during pregnancy and how that information is received- I remember a few years ago reading an article which discussed Queen Charlotte’s Professor Nicholas Fisk’s anonymous survey of 282 male and female obstetricians working in the NHS across London. Some 31 percent of female obstetricians and 8 percent of male obstetricians would request a caesarean section for themselves or their partners in the absence of any medical need. I think this is really sad as it shows that these professionals don’t have confidence in their own bodies to deal with a natural process. Some of their reasons for requesting caesarean section are cited as wishing to prevent perineal injury and stress incontinence, but they don’t consider the injury incurred by a caesarean section cutting through abdominal wall, muscle and uterus as potentially dangerous too. I have met women who still have stress incontinence even though their babies were born by caesarean section, so that argument doesn’t cut the mustard with me.
There is also the alarming increase in diabetes and obesity sweeping this country- I remember talking to a midwife who ran a clinic for diabetics- ten years ago she would see one or two clients a week, now she has whole clinics of twenty or more a couple of times a week. The ultimate result in this astronomical rise contributes heavily to the rising caesarean section rate.
Then, there is the spectre of thousands of job cuts within the NHS which were predicted earlier this year. The government promises that front line services will not be cut or affected, but, for example if you take away clerical support staff out of a ward, then the only people left to do the paperwork are nurses and midwives, and they are already drowning in a sea of paper and technology.
And then, only a few days ago several hospital trusts announced that maternity units were going to close- where will the women go who would have had their babies in these units? The answer is that they will have to go to larger hospitals where the staff are already hard pushed to provide a safe and adequate level of care.
There are many situations where, during labour or in the last weeks of pregnancy signs appear that all is not well, and the woman and her unborn baby will need extra monitoring. I suspect that in the light of further cuts to our NHS services, many of these women will be offered a caesarean section rather than the maternity unit facing an investigation into inadequate care after the event. Sadly I believe that our current overall statistic of 24% caesarean section rate will continue to rise, and the unusual birth experience will be that of normality.

So, what is the solution to the problem? I believe there is a multi faceted answer- firstly women must take responsibility for themselves, they must become healthier and eat a balanced diet, cut out alcohol and stop smoking all long before they decide to get pregnant, they should ensure that they are well informed about their pregnancy and birth by attending ante natal classes, and finding out as much information as they can through different media including the internet, joining discussion forums will help in broadening their views, and will lead to them being better prepared for labour and parenthood.
Our government must stick to its promises and save our NHS from any further cuts- yes there are ways of becoming more efficient but women will still need a good midwife to have a great birth experience. vaginal birth after caesarean gestational diabetes video

1 comment:

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