Wednesday, 23 November 2011

Caesarean Section - A woman's right to choose

Today the headlines are screaming about new and controversial guidelines for England and Wales issued by NICE (National Institute of Health and Clinical Excellence), which state that pregnant women who request a Caesarean delivery should be allowed to have the operation, even without a persuasive medical requirement, provided that they are offered counselling and advised of the risks first.

I am not clear as to why such headlines are tagged as controversial.  Dig a little deeper and it is clear that these guidelines are in line with what is actually happening right now in hospitals.

The Deputy Chief Executive of NICE, Dr Gillian Leng has been quoted as saying:  “This guideline is not about offering free caesareans for all on the NHS.  It is about ensuring that women give birth in the way that is most appropriate for them and their babies.  Offering these women a planned caesarean section in these circumstances is a very long way from saying that caesarean section should automatically be offered to every woman.”

For the record, C-section figures have remained static for a number of years now, (although they had been steadily rising for many more) and it is anticipated that the rate will fall if the new guidelines are implemented.  Wendy Savage, a retired professor of obstetrics believes that the rise in C-sections was as a result of obstetricians being too keen to carry them out, rather than women themselves requesting the operation.

For me, the three main issues here, sidelined in the midst of hysteria about women being given a choice and misinterpretation of the facts, are as follows:-

a)      Many obstetricians are keen on C-sections because they have not been adequately trained on vaginal deliveries, according to Wendy Savage;
b)      There has existed a mentality of once a C-section, always a C-section and this should be challenged and;
c)      The inevitable costs issue.  Planned C-sections are more expensive than vaginal deliveries.

Many experts believe that equipped with the correct advice on the inherent risks associated with such a major operation and feeling confident in the support on offer during labour, most women would elect for a natural birth in any event. 

Speaking as a woman who gave birth by C-section, my only comment would be that women obviously need support – both medical and emotional - during their hours of labour and today’s story does not seem to take account of the desperate shortage of midwives.

I was lucky.  I greeted and bid farewell to a number of midwives during my lengthy labour and, after 48 hours of a stop/start labour, which failed to respond to chemical inducement, I was more than willing to sign the necessary paperwork in order to have the recommended C-section.  Let me tell you, after almost 48 hours with little sleep and a cocktail of drugs running through my veins, it is hard to judge whether or not I was capable of making this decision.  Certainly I was advised of the associated risks (possible damage to bowel amongst them), but all I knew was that my baby was too high, was not going to budge and I was way too tired to push any longer.  Also, my C-section was subsequently classified as an emergency caesarean as a result of the length of time I had been in labour. 

However, my post-operative recovery was swift.  Perhaps I was one of the lucky ones, but considering the operation is likened to a hysterectomy, I was up on my feet and taking regular walks within a fortnight, my scar healed well and I experienced no complications or associated discomfort aside from the obvious localised tenderness.

Surely, given the current shortage of midwives, it is better to offer women a choice, provided this is more than matched by the information and counselling on offer?  I recall constantly being asked about my birth plan by my midwife throughout my pregnancy and was dead set on a water birth.  The reality of the situation was altogether different.  My experience just demonstrated how a birth plan might be rendered null and void in an instant.

However, a choice must be balanced and fairly executed.  It is unethical surely to offer an informed choice on a planned C-section if the alternative (and allegedly the option most woman would opt for) is to have a vaginal delivery poorly executed by an untrained obstetrician.  I’m certain that the allegation of lack of training is perhaps not rife in the NHS, but if it is an issue at all, then it stands shoulder to shoulder with the shortage of midwives and serves as reason enough in my opinion, to allow women the freedom to choose how they give birth.

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