Category: csections commentary

Hospitals remain under pressure to reduce their caesarean rate – despite recommendations to Inspectors to refrain from judging hospitals in this way. And where there are no targets in place, women can still face opposition from individual care givers.

This is why BirthRights – a UK information and advice centre – offer the option for 1:1 advice via their website.

They firmly believe in a woman’s right to an informed choice.

“Women have a right to make choices about the circumstances in which they give birth. This simple but powerful principle was established by the European Court of Human Rights in Ternovszky v Hungary (2010) under the right to private life in Article 8 of the European Convention which encompasses rights to physical autonomy and integrity. Article 8 is a ‘qualified right’ and so limitations on the right are permitted. The Ternovszky case concerned the right to give birth at home, but the principle applies equally to all choices that women make about childbirth. The decision represents a profound challenge to medical authority: if women have a legal right to make a choice, any limitation on that right must be justified. The decision-maker, whether a hospital or a doctor or midwife, must give proportionate reasons for their decision based on the individual circumstances of the woman and their reasons can be tested in court before a judge.”

To ask them a question click here.

Australian Birth site, Natural Parent Magazine, recently posted one of my articles. It is great to see more and more birth sites willing to talk about the possibility of a caesarean delivery. Knowledge is power!

“In reality a caesarean is an extraordinary addition to the tools available to those who help us with our births and it should be respected for the advantages if can bring to those who need it.”

Australian Birth site, BubHub, recently posted one of my articles. It is great to see more and more birth sites willing to talk about the possibility of a caesarean delivery. Knowledge is power.

“With knowledge, a caesarean can be a really powerful experience. One we can remember positively even if it was not the way we thought our birth would pan out…”

For years hospitals have been asked to record data about caesarean births. The results of a Freedom of Information request revealed that the way in which this information was recorded varied significantly from one hospital to another.

For example:

• Inconsistency in criteria used for recording whether a caesarean delivery was emergency or planned
• Inconsistency in criteria for recording a delivery as a maternal request or performed as a result of an obstetricians recommendation

It is easy to see that in reality reports about current rates face an impossible task – the truth is hard to discern. Despite this many hospitals faithfully report their figures and face judgement for their caesarean rates – some praised for low rates, some criticised for rates that are considered ‘too high’.

In fact the WHO retracted their recommendation for an ideal caesarean rate back in 2009 because there was insufficient evidence to define one.

Despite this, UK hospitals have continued to be scrutinised and judged according to their rates. Loaded statements by official bodies and the press have pushed many hospitals into defining, formally or otherwise, ideal targets for themselves. Stories of women requesting caesareans and being refused are all too common and maternity litigation claims in the UK are now thought to run to billions every year. The personal cost to families of these arbitrary targets can be shown to result in: “loss of life, life altering injuries as well as obvious psychological distress.”

Now, finally as the Sunday Times reports “Inspectors have been ordered to stop judging maternity units on their caesarean rates after the care watchdog accepted that it had sent the wrong message on normal birth.”

Heidi Smoult, deputy chief inspector of hospitals – commenting on the report by P Hull which led to this directive – stated that “medical intervention, while important “should never be at the expense of a woman’s or baby’s health.””

The Sundays Times speaking to Alison Wright, of the Royal College of Obstetricians and Gynaecologists, recorded the view that: “The need for a medical intervention can vary dramatically across services and regions, depending on the local demographics and the health needs of women. Therefore, we believe the approach should be more nuanced than promoting a particular maternity indicator, such as a caesarean birth rate.”

A step in the right direction. However, if you are trying to investigate your own birthing options, whether that is to have or avoid a caesarean be aware that internal politics within your hospital may be an additional factor to consider. Despite this new recommendation, it is worth finding out whether your hospital still refers to target levels for caesarean births.

For too long, healthcare providers have been concentrating on optimum caesarean rates, this despite the fact that nearly 10 years ago the World Health Organisation retracted their recommendations as there was “no empirical evidence for an optimum percentage”.

Now the Clinical Director for NHS England – Matthew Jolly – joined the fight by stating that caesarean rates should not have targets set as these can lead to “all sorts of unfortunate consequences.”

Attempting to artificially driving down the caesarean rate is dangerous. Over half the litigation costs in the NHS are still in obstetrics many of which relate to birth outcomes which could have been avoided if a woman’s concerns or wishes had been respected.

• 47% of maternity units set target rates
• 50%+ are graded on whether they encourage natural births

Cost is the major factor driving these targets and where cost is considered above a mother and/or baby’s safety, bad decision are going to be made and bad advice is going to be given to mothers.

NICE guidelines clearly state women should be able to make an informed choice about how they give birth. But targets like these are reducing options and we are regularly contacted by women at their wits end, wanting to know how they can challenge the advice given by their carers which they believe to be compromised.

But, is the tide turning? We are working with the Care Quality Commission to understand more about women’s caesarean experience, feeding into the development of this year’s Care survey. Watch this space to see whether such statements are actually reflecting a change in the behaviour of our Trusts.