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.

Tuesday, 22 November 2011

Paperback vs Kindle

There is something that’s been bugging me recently and I need answers.  Perhaps you can help. Which is better at fulfilling our collective desire for a good yarn or lamp lit stolen moments of literary escapism – the paperback or the Kindle?  There’s only one way to find out.  Fight!!!

Full credit there to Harry Hill’s TV Burp, but seriously, how many of us now prefer to download our books rather than leafing through the trusty, but frankly old fashioned paperback?

As a staunch advocate of the paperback, this was not something I ever thought I would be deliberating over.  That’s not to say I am some technophobe who carries around loose change in case I need to use a phone box (in the misguided belief that a mobile phone will give me some terrible disease) or who refuses to hand over my credit card details to cyberspace.  (As an aside, my husband was a latecomer to the mobile phone owners’ club and as a result of my description of him a colleague once expressed his disappointment on finally meeting my husband, at the fact that he had not arrived on a Penny Farthing!)  No, for the record, I own a Blackberry, I’ve downloaded music, I’ve just completed two thirds of my Christmas shopping on line and if you were to ask my husband, he would definitely say that I am a Twitter addict. 

The last pocket of resistance in terms of my embracing the ever-changing world of technological advances in leisure pursuits is Kindle.  I am fully aware that Kindle downloads are cheaper and faster than having to fork out the full RRP and associated travel/postage costs in order to acquire the paperback.  But I like something tangible and until now, the prospect of reading a book – someone’s labour of love – in some cases, work of art – did not entice me.

My first book, Diary of a Sleep Deprived Mum has been published recently and, as is the current trend, has been converted to, and is now available on Kindle.  Thus, my curiosity has been aroused.  A first book is like a first baby - you don’t want to miss a thing - and so Kindle is now the missing piece of the jigsaw for me.  I have a paperback copy and I have the press coverage, but I have yet to read it on that lightweight tablet of electro-genius that is Kindle.

So, before I take the leap and purchase one for myself (the model I have in mind is the more expensive version with free WiFi and so not to be taken lightly), there are a few questions I have.  Thankfully, for the purposes of this blog, my long-term friend and self-confessed gadget freak, Neil, was on hand with his Kindle, to dispel some of the myths and counter my romantic attachment to the faithful, dog-eared paperback.

First up, eyestrain.  This is perhaps not the most obvious argument against Kindle, but nonetheless relevant to me as someone who spends much of her time in front of a screen.  According to my friend, eyestrain is all but eradicated on Kindle thanks to its amazing anti-glare screen which fools the reader into believing that their eyes are moving over paper.

I also understand that Kindle is very lightweight, unlike the book I am reading at the moment (Wild Swans), which is quite a tome.  But can you fold a Kindle in half when your head is resting on the pillow at night and flatten one half against the pillow, enabling you to read in a position just perfect to induce slumber?  No you cannot!

Ah, says Neil, but the Kindle will read to you if you’re too lazy/sleepy to read yourself, thereby lulling you to the land of nod.  You can’t argue with that, can you?

If I’m honest, the real sticking point for me is the fact that no matter what Kindle offers, it cannot replace the sheer tangibility of a paper copy.  Surely a screen encased in grey plastic is not something to cherish in the way that a book is, with the corners of the good and yellowing pages turned over – a snapshot in time of your passions and interests.  Books are for displaying on shelves; to be picked up again and again, loaned out, leafed through, and admired.  How can the smooth and glossy pink cover of Diary of a Sleep Deprived Mum, designed by my husband, be appreciated on a screen?  A Kindle lacks soul.

Maybe so, but at a fraction of the price of a normal paperback, says my trusty friend, one can afford to take a chance on those books by new, unknown, and as yet unrated authors (such as myself) which might otherwise be left in the book store.  And let’s not forget that it is possible to download newspapers and magazines to Kindle, thereby avoiding the mountain of recyclable paper cluttering up your living room.  I am still to be completely persuaded on this, but if there’s an argument to say that Kindle can help save the planet, then my eco-conscience will ensure that I invest in a Kindle and pronto.

One final point in favour of the Kindle is the battery life, which I am told is very good – up to three months on one charge.  And that for all you geeks out there is probably going to sell it to you.  A Kindle can go on and on, whereas sooner or later a book will succumb to discolouration and dust mites.

So, who wins the fight?  I’ll let you be the judge.  I shall closely monitor the download and paperback sales figures over the coming months.  For now, the jury’s out on this one.