The state of our countries NHS is in constant news at present with the proposed government changes to hours of work, forcing junior doctors to work hours they deem as unsafe and unfair. When I went to hospital to give birth to my son, due to the need to be induced then my son being poorly, I stayed in hospital for a week in total, and cannot fault the care both myself and my son received. All the staff were amazing, very caring – and the food wasn’t even that bad! But what was clear was that they were very short staffed for their demand, my experience on the delivery ward may have been improved and shortened had the ward been less busy, (the midwife admitted other people were taking precedent) or, they had more staff to deal with demand. In the post-delivery ward staff were very stretched, some mothers were waiting all day to be discharged as the midwife was just too busy, and one midwife was literally dashing from patient to patient.What is particularly topical at present is the NHS view on birth by caesarean section. The leader of the country’s obstetrician’s warns that there is an “incessant increase” of children being born by c-section. He believes some hospitals are carrying out far too many sections on first time mothers who have a normal, full term, head first baby – this leads to further issues through increasing the chance of their subsequent births also being by section. An issue due to costs of surgical teams, operating theatres, equipment, women having to stay in hospital longer – all cost pressures on an already stretched service.
Rates of sections have been rising, from around 10% of births 30 years ago to near 25% of births today. So why is this?
“Too Posh to Push”
Of the 646,904 deliveries on the NHS in 2014, 41,929 were by c- section, around 25%, and of that more than 10,000 were elective. The media have generated a “too posh to push” label on mothers who simple elect caesareans for reasons of vanity. Gail Johnson professional advisor for education and research at the Royal College of Midwives, urges a Caesarean is an emergency procedure only to be done when a normal birth (her phrasing) isn’t going to work – not a lifestyle choice. The World Health Organisation has said the procedure should not be carried out for personal preference because of the increased risk of causing disability or death, and it pulls resources away from other services.
Yet, to some, caesarean on demand still seems a good choice, it protects the vagina from painful rips and tears, it saves pelvic floor trauma leading to post birth and later life incontinence, prevents haemorrhoids from pushing, some women have experience worsened postnatal blues caused by the above.
Having a section is very convenient, it happens on a pre-arranged date so holiday and paternity time can be utilised incredibly efficiently. Other child care or pet care arrangements can be made in advance. It takes out the element of surprise so you can be more organised and have everything you need packed.
Some women have a fear of vaginal birth called tokophobia. Some of these women may have never had a baby, but others may have suffered a traumatic experience during an earlier delivery increasing their fear of history repeating with the next. For these women in particular they may put off getting pregnant, or when they do fall pregnant have nightmares, become extremely anxious about the forthcoming birth that is becomes all encompassing. Sometimes women are so terrified they want to end the pregnancy or feel opting for a c-section puts their mind at ease.
So, what are the current views of rules on Caesareans? Women may choose to have a caesarean, and it will be granted on the NHS. However, according to the NICE guidelines it will not be permitted until the request has been explored, discussed and recorded, through the following…
22.214.171.124 If a woman requests a CS when there is no other indication, discuss the overall risks and benefits of CS compared with vaginal birth and record that this discussion has taken place. Include a discussion with other members of the obstetric team (including the obstetrician, midwife and anaesthetist) if necessary to explore the reasons for the request, and ensure the woman has accurate information.
126.96.36.199 When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner. [new 2011]
188.8.131.52 Ensure the healthcare professional providing perinatal mental health support has access to the planned place of birth during the antenatal period in order to provide care. [new 2011]
184.108.40.206 For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS. [new 2011]
220.127.116.11 An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS
There is a lot of currently a lot support out there for women with tokophobia. These guidelines are set to be amended in September 2016.
Women are under educated on the downsides of the procedure
Some mothers simply aren’t warned of the potential risks of having major surgery which a caesarean is. Both to mother and baby. Mothers face the increased risk of infection to the womb or womb lining, which can cause fever, pain, bleeding, blood clots, excess bleeding, or damage to your bladder or ureter. Also risks of further complications, around 9 in every 1000 women need to be admitted into intensive care, hysterectomies are needed in about 8 in 1000 women, blood transfusions are also necessary for some women due to blood loss.
For babies, some have breathing problems being born in this manner and may need to be admitted into special care. Around 1 in 50 babies are accidentally hit by the doctor’s scalpel which may cause a slight head wound.
Post operation recovery may take longer than women who gave birth vaginally, tummy muscles will need longer to recover and may feel tender, driving is not recommended until 6 weeks after the surgery. No matter how you feel prior to the section, emotionally women may feel a little traumatised and have increased post-natal depression after the event, some women feel they haven’t given birth ‘properly’ or have difficulties breast feeding due to delayed skin to skin contact.
An increase in certain health issues may make birth by caesarean more likely, for instance;
- If the baby is in breech presentation – i.e, head up not down ready to transcend the birth canal.
- Multiple pregnancies, twins or more, there are increased risks for the second baby born therefore current practice is to offer a c-section.
- Preterm birth when birth is necessary and the baby has not yet reached full term.
- If baby is small for its gestational age, small babies are more at risk of mortality although sections still oughtn’t be offered as routine.
- Problems with the placenta, either being low lying or covering the cervix.
- Failure to progress – nearly a third of C-sections are performed due to failure to progress and subsequently labour being prolonged, causing exhaustion to the mother and trauma to the baby.
Birth by caesarean section is obviously a large procedure for both baby and mother and not something that should be entered into lightly by either the parent or the NHS. It seems rather a matter for concern that cost is an issue when it comes to health and safe delivery of a baby. It is perhaps a double edged sword that the chances of birth by emergency caesarean section are greater when one to one midwife to mother care aren’t available through the active stages of labour – this presumably occurs when cost pressures mean staff levels are too short to keep up with demand. Perhaps more money put into staffing on the labour ward could therefore reduce money spent on caesarean sections in the long term.