Louise Nousratpour
Friday November 25, 2011
The Morning Star
New NHS guidelines on childbirth this week have reopened the debate around whether caesarean section on demand is simply about a woman's right to choose or whether it is a sinister sign of second-rate health care.
No one in their gender-right mind disputes the fact that women must have the ultimate say in how and where they give birth to their baby.
But to make an informed decision they must have access to the right care and professional advice at the point of need and free of charge.
However, government cuts to the NHS and the dangerous shortage of midwives has raised concerns that more women may choose elective c-sections for fear of being left "pushing alone" if they opt for vaginal birth.
An ongoing survey by WHO warns c-section rates have reached "epidemic proportions" in many parts of the world.
More than 24 per cent of women in England and 27 per cent in Wales have a caesarean while overall c-section rates in Scotland have risen from 8.6 per cent in 1976 to 25.4 per cent in 2010.
The WHO report warns that women undergoing c-sections that are not medically necessary are more likely to die or be admitted into intensive care units require blood transfusions or encounter complications that lead to hysterectomies.
The National Institute for Health and Clinical Excellence (Nice) insists that its updated guidelines aims to reduce the rate of elective c-section as it recommends that healthy women anxious about childbirth should be offered one-to-one professional help to allay their fears.
"The new recommendations mean that these fears will be taken seriously and women will be offered mental health support if they need it," Nice deputy chief executive Dr Gillian Leng explains.
She stresses that healthy women should only be granted c-section if proper counselling has failed to convince them otherwise.
Nice has also revised its guideline around pregnant women with HIV positive, recommending that they should now be advised to give vaginal birth in light of new evidence that the risk of transmitting the disease to their baby is, in some cases, the same as caesarean.
And it seeks to dispels the myth that "once a caesarean, always a caesarean" to encourage women who have had the surgery during previous deliveries to opt for normal birth.
Midwives and gynaecologists are confident that the right professional help and advice is key to cutting the number of elective c-sections.
But Cathy Warwick Royal College of Midwives (RCM) is concerned that the resources are not there for midwives to assure women that they will get the best quality and support if they deliver naturally.
This has left some women thinking that "the only way (they are) going to have good care is to have a major abdominal surgery," she adds.
Warwick is confident that if women are properly informed about their choices "very few" will opt for surgical childbirth.
"After a c-section you've got a major abdominal wound and you're asked to look after a baby - it's a bit like asking someone to go straight back to work after a major surgery," Warwick says.
National Childbirth Trust (NCT) chief executive Belinda Phipps warns midwifery numbers are well below the level required to guarantee safe and satisfying care.
"We hear from too many women who have found their experience traumatising in some way," Phipps says.
Veteran natural birth campaigner and gynaecologist Wendy Savage argues that the best way for healthy women to give birth is vaginal and the safest place to do it is at home with two midwives present as required by law.
"Hospital is associated with illness and death. A woman giving birth should not be treated like a sick patient," she says.
Nice guidelines from 2004 say women should be informed that booking for a home birth reduces the risk of having a c-section by 50 per cent.
But, although women have a legal right to choose where they give birth, the chronic shortage of midwives means home births are not being encouraged.
Latest official figures show a drop in the number of women choosing to have their baby at home - from 2.9 in 2008 to just 2.5 per cent last year.
Prime Minister David Cameron promised before the last general election that the Tories would increase the number of midwives by 3,000.
But latest NHS figures for England show the number has risen by just over 500 in the last year.
In a stark warning to Mr Cameron, Phipps said if caesarean rates increase after the change to the guidelines, "it will be evidence that women are not getting the quality of midwifery support they need to instil confidence and feelings of safety while giving birth."
Caesarean facts
- A total of 24.8 per cent of women (or 157,356) in England's NHS hospitals had a caesarean in 2009-10, compared to 24.6 per cent (154,814) in 2008-09. The figures do not include caesareans carried out in private hospitals
- In Ireland the c-section rate stands at 30 per cent
- In Scotland, normal vaginal deliveries have fallen steadily since 1976 from 75.8 per cent to 61.7 per cent in 2010 - while the overall caesarean section rate has risen from 8.6 per cent to 25.4 per cent.
- Caesarean section rate in Wales has gone up from 24 per cent in 2000-01
to 27 per cent in 2009-10.
- At 46 per cent, China has the highest rate of c-section in the
world - a quarter of them not medically necessary
- The US c-section rate is at an all-time high of 31 per cent.
- Caesarean dates back to the Roman times, but the earliest record of a mother surviving a c-section dates to 1500AD.
- The first modern Caesarean section was performed by German
gynaecologist Ferdinand Adolf Kehrer in 1881.
