Dear Rena,

from the health-economist perspective I cant find a REAL evidence in
the review (2001) from Petrou et al. because of a lack of high-quality
papers and methods (Petrou stated this in his 
own conclusions, or is there a new report, I missed?). There is no
bottom-up costing or distinguishing between planned and unplanned
c-sections. So, your thoughts have to be kept in mind, I think!
In Germany, our health system is distinguishing plannend and unplanned
c-section in the DRG-System  since 2010. Because of calculating
costs-data from german hospitals they found a difference in costs. But
still, the cost data for planned c-sections are higher than for
uncomplicated vaginal births. The InEK-Insitute is doing a lot of
statistics for calculating the costs - so these data might be accurate
(means: hospital costs for vaginal births a lower than for planned
c-sections). But despite the correctness of theses data there is no
consideration of long-term effects and indirect costs. Moreover, the
potential of process optimation regarding planned c-section is not
considered!

Please apologize my English (but it takes so much time to spell and
write everything correctly and my thoughts are faster :))

Best regards
Nina


Nina Knape
Diplom-Kauffrau (FH)
Hochschule Osnabrück
- Verbund Hebammenforschung -
Postfach 1940
D-49009 Osnabrück
Tel. 0541/969- 3473
Fax 0541/ 969-3765 
[log in to unmask]


>>> Rena Papadopoulos <[log in to unmask]> 10/31/2011 11:52  >>>
I am not familiar with this study, and I totally agree that whoever
came up with this proposal are wrong. But when it comes to figures, we
all know how these can be manipulated to suit sinister plans.
rena

From: McCourt, Christine [mailto:[log in to unmask]] 
Sent: 31 October 2011 10:46
To: A forum for discussion on midwifery and reproductive health
research.; Rena Papadopoulos
Subject: [SPAM: 25.100] Re: c-section for all women who request it by
NICE?

Dear Rena

If so, they are misinformed. The review of evidence on costs undertaken
by Petrou et al showed that CS is more expensive.


On 31/10/2011 11:41, "Rena Papadopoulos" <[log in to unmask]>
wrote:
I cannot help thinking that this retrograde step is based on economics.
Is it possible that routine booked births via cs are cheaper (more
efficient use of staff) than the unpredictable natural start and length
of labour of normal births? Someone must have put forward such an
immoral argument which obviously has fallen on economically fertile
ears. Forgive me for putting a conspiracy theory forward but the cs
proposal is so bizarre....As far as I know the WHO is supporting natural
birth.
Regards,
rena


Irena Papadopoulos, PhD, MA, BA, DipNEd, DipN, RGN, RM, NDNCert, RNT,
FHEA,
Professor of Transcultural Health and Nursing,
School of Health and Social Sciences,
Middlesex University,
Archway Campus,
Highgate Hill, London N19 5LW.
Tel: 0208 411 6626
Fax: 0208 411 6106

To subscribe to our Transcultural mailing list send a message to:
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From: A forum for discussion on midwifery and reproductive health
research. [mailto:[log in to unmask]] On Behalf Of Soo
Downe
Sent: 30 October 2011 22:50
To: [log in to unmask] 
Subject: Re: c-section for all women who request it by NICE?


Just in case you cant download the information I have just sent:



Increased with CS

* Abdominal pain

* Bladder injury

* Ureteric injury

* Need for further surgery

* Hysterectomy

* Intensive therapy/high dependency unit

admission

* Thromboembolic disease

* Length of hospital stay

* Readmission to hospital

* Maternal death

* Antepartum stillbirth in future pregnancies

* Placenta praevia

* Uterine rupture

* Not having more children

* Neonatal respiratory morbidity



No difference after CS

* Haemorrhage

* Infection

* Genital tract injury

* Faecal incontinence

* Back pain

* Dyspareunia

* Postnatal depression

* Neonatal mortality

(except breech)

* Intracranial haemorrhage

* Brachial plexus



Reduced with CS

* Perineal pain

* Urinary incontinence

* Uterovaginal prolapse



All the best



Soo

________________________________

From: A forum for discussion on midwifery and reproductive health
research. [[log in to unmask]] on behalf of Soo Downe
[[log in to unmask]] 
Sent: Sunday, October 30, 2011 10:40 PM
To: [log in to unmask] 
Subject: Re: c-section for all women who request it by NICE?

Hmm - CS is now safe? Maybe it depends on what outcomes you look at:
These are the risks cited in the current NICE CS guidelines:



NICE 2004 Cesarean section: Quick reference guide. Available at:
http://www.nice.org.uk/nicemedia/live/10940/29333/29333.pdfdopwnloaded
on 6th Oct 2011
<http://www.nice.org.uk/nicemedia/live/10940/29333/29333.pdfdopwnloaded%20on%206th%20Oct%202011>











Longer term, CS has also been linked to type one diabetes in the
neonate, athsma, excema, and, most recently, multiple sclerosis:



Mult Scler. <http://www.ncbi.nlm.nih.gov/pubmed/21982872>  2011 Oct 7.
[Epub ahead of print]
Cesarean delivery may increase the risk of multiple sclerosis.
Maghzi AH
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Maghzi%20AH%22%5BAuthor%5D>
, Etemadifar M
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Etemadifar%20M%22%5BAuthor%5D>
, Heshmat-Ghahdarijani K
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Heshmat-Ghahdarijani%20K%22%5BAuthor%5D>
, Nonahal S
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nonahal%20S%22%5BAuthor%5D>
, Minagar A
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Minagar%20A%22%5BAuthor%5D>
, Moradi V
<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Moradi%20V%22%5BAuthor%5D>
.
Source
IRCOMS, Iran/Neuroimmunology Unit, Centre for Neuroscience & Trauma,
Blizard Inst. of Cell &Molecular Sci.,UK/Med. Schl, Isfahan Uni. of
Med.Sci, Iran.
Abstract
Background: Prenatal and perinatal factors are believed to contribute
to the risk of developing multiple sclerosis (MS). Objective: This study
was designed to evaluate whether mode of delivery (vaginal versus
cesarean section), as a perinatal factor, affects susceptibility to MS.
Methods: MS patients were recruited from the MS registry of Isfahan
Multiple Sclerosis Society (IMSS) and were compared with their healthy
siblings. Data regarding mode of delivery, birth order, and gestation
week of birth were obtained through a specially designed questionnaire.
Preterm or post term deliveries were excluded. We used conditional
logistic regression statistics and adjusted for gender and birth order.
Results: This study included 1349 participants (449 MS patients and 900
controls). Subjects who were born by cesarean sectionhad significant
risk of MS (odds ratio, OR = 2.51; 95% confidence interval, CI:
1.43-4.41; p = 0.001). There was significant MS risk for females who
were born by cesarean section (OR = 2.69, 95% CI: 1.30-5.58; p = 0.008),
but not for males (OR = 2.25, 95% CI: 0.90-5.63; p = 0.082). The mean
age at onset was lower in MS patients born by cesarean section (24.58 ±
6.33) compared with that of patients born by vaginal delivery (27.59 ±
7.97; p = 0.041). There was no significant difference between the two
groups for birth order (p = 0.417). Conclusion: Our results suggest that
those born by vaginal delivery are at a lower risk of subsequent MS.
These preliminary findings will need to be addressed in a much larger
and preferably prospective study.

PMID:
21982872
[PubMed - as supplied by publisher]

________________________________

From: A forum for discussion on midwifery and reproductive health
research. [[log in to unmask]] on behalf of Pamela
Harnden [[log in to unmask]] 
Sent: Sunday, October 30, 2011 10:25 PM
To: [log in to unmask] 
Subject: Re: c-section for all women who request it by NICE?

Dear Lucia,



The impression in Australia is that it is true and that the risks are
so small now because the obstetricians are so expert at it, the
suggestion is that it is actually safer than birthing normally!



Pam

On Mon, Oct 31, 2011 at 9:18 AM, LUCIA ROCCA <[log in to unmask]>
wrote:
Dear All,

I am sure this must be misinformation but I am a bit worried about the
news from Sky news:

http://news.sky.com/home/uk-news/article/16099301 

about NICE publishing a new report saying that women must have the
right to ask, at NHS expenses, a CS without medical indication.

could please somebody reassure me ( while I am on holiday...) that I
got it wrong?

Thanks

Lucia