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.

http://www.telegraph.co.uk/health/healthnews/8052814/More-than-30-maternity-and-casualty-units-facing-the-axe.html

http://www.guardian.co.uk/society/2004/may/02/health.politics1

http://www.guardian.co.uk/uk/2002/apr/21/medicalscience.research

http://www.bbc.co.uk/news/health-11485987

http://www.mybirth.tv/video-play.cfm?id=73 vaginal birth after caesarean

http://www.mybirth.tv/video-play.cfm?id=146 gestational diabetes video

A clear view of birth

I haven't written my blog for sometime now and thought I ought to get on with it really! Last Monday I visited independent midwife Virginia Howes in order to film her Howes Birth Mirror http://www.kentmidwiferypractice.co.uk/2006/shop.htm
Virginia is entering a Barclays Bank competition to see if she can win the prize money in order to promote her product further afield. I think the mirror is a great invention as in the past I have filmed many waterbirths http://www.mybirth.tv/video-play.cfm?id=244 where midwives have used a conventional mirror- the downside of a conventional mirror is that it usually has an edge on it (perfect for bacteria to thrive) and is made of glass- probably something best avoided. Virginia's new mirror is made of polished steel- no sharp edges, unbreakable, and it can be sterilised in an autoclave. to view her product visit this link https://www.takeonesmallstep.co.uk/Entry/View/3043 I for one am backing it, as it is a fantastic, simple product and will be perfect for all those women wishing to get a clear view as their baby is being born.

Maternity Units ‘Shut to Mothers’

Okay, I just opened up my home page which is always set to the BBC news; I tend to watch very little news on TV these days and tend to find my information on the net. A headline caught my eye in the Health section: Maternity Units 'Shut to Mothers'. A précis of the article states that nearly half of 104 trusts responding to a recent survey by the Conservative party said that in the last year they shut their maternity units at least once and diverted women to other hospitals. The total of closures for 2008 was 553 compared to 402 in 2007. It didn't say if any women who were affected by these closures had untoward experiences or complications in their labours and births associated with these closures. I hope not but I suspect otherwise.

Now, I have been filming pregnancy and birth matters for many years and this particular scenario does seem to be happening with increasing regularity. A woman I spoke to only a couple of weeks ago said that she had been booked to have her baby at her local maternity unit in Brighton, the unit was closed to labouring women so she was asked to call the next maternity unit in Haywards Heath which was also closed, she eventually found a maternity unit to take her in Eastbourne. Fortunately she gave birth in the maternity unit and not in a car on the way there, which has happened to so many women over the last few years. This is not a local problem to Brighton, it is country wide as the Tories report shows and the main cause is increased birth rate coupled with decreased midwives and facilities. So, I then remembered an article that I had seen only a couple of days ago dated 6 th Feb: NHS facing £700 million negligence bill, The shocking fact is that more than half of the payouts are for maternity related cases Now,it doesn't take a genius to work out that maybe one is linked to the other? This figure is for 2010 alone. Surely it must be obvious that when you have shortages of midwives and maternity unit closures due to lack of funding the outcome is going to mean more mistakes being made by overstretched staff leading to more litigation?

So, more than £350 million has been set aside for next year's litigation budget for maternity services. Can you imagine what our consultant led maternity units, midwifery led units and homebirth midwives could do with that money?

If for example £100 million was put in to training and employing more midwives in the most overstretched units, how much could be saved from this horrendous litigation budget?

The Kings Fund has launched the Safer Births Initiative to improve safety in maternity services, it will be launched in October 2009 and I hope that when they have completed their research their recommendations will be implemented.

• National Patient Safety Agency


• Baby born on tube- link