Dear all
I think it is important not to trivialise the concerns of women though.
This was done by the media in the whole too posh to pushı episode which
followed Paterson-Brown et alıs survey of obstetricians preferences. We
undertook a systematic review to look at what the actual evidence was on
women electing for CS and the numbers were very small and seemed mainly
motivated by significant fear of the kind of level and type that could
constitute, arguably, a clinical need. The numbers are small, but the
whole media campaign and the talk from some professional quarters about
preferences driving the rising caesarean rate have quite possibly
contributed to normalising CS in public discourse - ironically.
Nonetheless, we know from research that service-led factors are driving
rising rates of CS beyond clinical need rather than womenıs preferences. I
would recommend all professionals to read the work of Belizan particularly
on this. How well are people being informed about the risks of CS? What
influences what we fear and what we donıt fear? But nonetheless, letıs not
forget that the small number of women who ask for CS are not the key
driver of rising CS rates and that professionals need to support and
inform women - not an easy thing in todayıs overstretched services Iım
sure.
On 08/06/2015 17:47, "Jenny Hall" <[log in to unmask]> wrote:
>In addition to this we have an 'instant access' generation of young women
>who expect everything to happen straight away... Putting up with pain,
>labour and everything else isn't part of this world view
>Jenny
>
>Sent from my iPhone
>
>On 8 Jun 2015, at 15:05, Louise Silverton
><[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>Thanks Mary. Nice to know that The work of Margaret Mead is alive and
>well!
>
>Clearly there is a lot here about fear of the unknown and the need to
>control that uncertainty. This is tied in with a societal (Men and women)
>lack of acceptance of pain in almost any circumstance. I have noticed
>that some of today's mothers seem to find the pain of even early labour
>hard to tolerate. I don't think that this was my experience years ago. I
>suggest that young women manage dysmenorrhea by liberal use of analgesics
>and/or oral contraceptives. If early labour and even Braxton Hicks elicit
>negative responses how much harder is it to encourage a woman to take
>labour as it comes and to see how she responds.
>
>Louise
>
>Louise Silverton
>Director For Midwifery
>Royal College of Midwives
>
>Sent from my iPad
>
>On 8 Jun 2015, at 08:45, Stewart Mary
><[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>This is, as Sheena pointed out, a great discussion!
>
>I have been struck by some of the comments about the need to address what
>seems to be some womenıs deep-rooted fear of childbirth. I wonder
>whether the issue begins even earlier (i.e. pre-pregnancy). Iım
>conscious of the fact that there is increasing cultural and social
>pressure on young women to sanitise, control and, in some ways,
>infantilise their bodies i.e. the seemingly intractable demandı that
>women remove most/all of their pubic hair, presenting themselves as
>pre-pubertal while overtly sexualised in other ways; the continuing taboo
>around leakyı bodies and the reality of bodily functions, including
>menstruation etc.
>
>A couple of years ago I was very struck by a conversation with a young
>friend in her early 20s the daughter of a good friend. I know that this
>young woman has been taught to feel comfortable with, and proud of her
>body without feeling the need to bow to social pressure. However, we had
>both read an article in the paper about labiaplasty and my young friend
>was wondering aloud whether this was something she neededı to have done.
> She knew, in her rational mind, that labiaplasty is madness and yet she
>felt there was something quite wrong with her own labia and that maybe
>she needed to get it fixed.
>
>If young women are absorbing such relentless messages about the
>unsatisfactory nature of their own bodies, then perhaps it isnıt
>surprising that they cannot face the prospect of subjecting that body to
>vaginal birth knowing that their body will be inspected by others and
>may be found wanting, and that the body they have spent so many years
>cultivating will be out of their control.
>
>Maybe as midwives/doulas/interested parties we need to start thinking
>about addressing some of these issues way before young women and men
>start thinking about pregnant and birth.
>
>Very best wishes
>
>Mary
>
>
>Consultant midwife - antenatal care
>Guy's and St Thomas' Hospital NHS Trust
>10th floor - North Wing
>St Thomas' Hospital
>London
>SE1 7EH
>
>Phone (internal): ext 55471
>External: 0207 188 7188 ext. 55471
>________________________________
>From: A forum for discussion on midwifery and reproductive health
>research. [mailto:[log in to unmask]] On Behalf Of Maggie
>Banks
>Sent: 07 June 2015 21:18
>To:
>[log in to unmask]<mailto:[log in to unmask]
>>
>Subject: Re: electivecesarean.com<http://electivecesarean.com> commented
>on "Hard evidence: who carries out the most caesarean sections?"
>
>It is interesting to see how low the maternal request for Caesarean
>section is in Sheenaıs link MailScanner has detected definite fraud in
>the website at "ow.ly". Do not trust this website:
>http://ow.ly/2btkjf<http://ow.ly/2btkjf> . Like Soo, I donıt believe
>women have a deep-seated fear of childbirth and it hasnıt been my
>experience that women want CS and I am talking about the many I have
>contact with beyond the homebirthers of my own practice.
>
>kind regards
>Maggie Banks
>PhD, RM, RGON
>
>15 Te Awa Road, RD 3, Hamilton 3283, New Zealand
>Phone 64 7 8564612; Email
>[log in to unmask]<mailto:[log in to unmask]>; Website
>www.birthspirit.co.nz<http://www.birthspirit.co.nz>
>
>Post-dates Pregnancy Workshop
>(Online)<http://www.birthspirit.co.nz/postdates-pregnancy-workshop-online/
>> 10 - 17 July 2015
>
>The Spirit of Birth: Nature, Nurture and the Evidence Workshop
>(Online)<http://www.birthspirit.co.nz/the-spirit-of-birth-nature-nurture-a
>nd-the-evidence-workshop-online/> 7 - 14 August 2015
>
>Water Birth Workshop
>(Online)<http://www.birthspirit.co.nz/water-birth-workshop-online/> 4-11
>September 2015
>
>next available Breech Birth Online
>Workshop<http://www.birthspirit.co.nz/breech-birth-online-workshop/> 2-22
>November 2015
>
>From: A forum for discussion on midwifery and reproductive health
>research. [mailto:[log in to unmask]] On Behalf Of SHEENA
>BYROM
>Sent: Monday, 8 June 2015 2:17 a.m.
>To:
>[log in to unmask]<mailto:[log in to unmask]
>>
>Subject: Re: electivecesarean.com<http://electivecesarean.com> commented
>on "Hard evidence: who carries out the most caesarean sections?"
>
>Hi everyone, great debate - thank you!
>
>Not sure if youıve seen this? Itıs causing a flurry of panic on Twitter,
>by some obs in US! MailScanner has detected definite fraud in the website
>at "ow.ly". Do not trust this website:
>http://ow.ly/2btkjf<http://ow.ly/2btkjf>
>
>
>
>With very best wishes
>
>Sheena
>
>sheenabyrom.com<http://sheenabyrom.com>
>
>Twitter: @SagefemmeSB<https://twitter.com/SagefemmeSB>
>
>On 6 Jun 2015, at 15:55, Nicky McGuinness
><[log in to unmask]<mailto:[log in to unmask]>> wrote:
>
>Hi all,
>
>Your comments about the impact of cultural conceptions of time and birth
>timings really struck a chord with me. I' ve just written a literature
>review on expected dates of delivery and its impact on womenıs
>experiences. The review was interested in looking at the psychological
>impact of the EDD on womenıs experience, and the wider implications for
>the usage of the EDD in antenatal care.
>
>I was only able to locate a couple of bits on the psychological impact of
>the EDD and the significance women attach to it. Van de Kooy (1994)
>reporting on her survey of midwives, describes how women felt upset and
>disappointed when their EDD was changed. Authors have also discussed how
>women can find it hard to tolerate waiting past their EDD and may expect
>IOL in order to end being in a time limboı, or even electı caesarean
>sections as they become anxious about the possible harm of too much
>pregnancy timeı.
>
>I reached the conclusion that normality of gestation length should be
>assessed in relation to the individual context, to the normal for herı,
>rather than exclusively to the population average. The importance of
>individual factors, or biologic variabilityı, needs to be considered in
>order to better calculate the EDD. In addition, the argument for moving
>to an expected due range rather than EDD, may well have positive outcomes
>for women in how they conceptualise and approach their gestation time.
>
>Anyway just thought I'd share....
>
>Best wishes,
>Nicky McGuinness
>(Student Midwife, former social researcher, including Birthrights Dignity
>in Childbirth survey)
>
>
>________________________________
>From: "Hall, Priscilla Joy" <[log in to unmask]<mailto:[log in to unmask]>>
>To:
>[log in to unmask]<mailto:[log in to unmask]
>>
>Sent: Friday, 5 June 2015, 16:37
>Subject: Re: FW: electivecesarean.com<http://electivecesarean.com>
>commented on "Hard evidence: who carries out the most caesarean sections?"
>
>I would like to chime in.
>
>It seems that we are having a conversation about whether women should
>have the right to choose and elective cesarean, when the real issues are
>further upstream, as some of you have pointed out.
>
>I wonder what would happen to requests for elective cesareans if we
>addressed women's fears about labor, if they felt more confident about
>their body's capacity for birth, and if they were able to experience
>greater agency during birth, so that they can shape the birth experience
>according to their own needs and wishes. I like your comment, Soo, about
>childbirth practices that make birth so frightening for women. We need
>to address that issue first, and then see what happens to elective
>cesarean requests. Then perhaps the elective cesarean problem will go
>away or nearly go away.
>
>I wonder if we need to study women's perceptions of the meaning of time
>in birth. The timing of birth is uncertain-the due date, the beginning,
>how long labor lasts but women are accustomed to having their life
>scheduled in discrete time slots. Physiologic labor doesn't fit in very
>well, and a scheduled cesarean is over in 45 minutes. There is no
>uncertainty.
>
>
>
>
>Priscilla Hall RN CNM PhD
>Emory University
>Nell Hodgson Woodruff School of Nursing
>1520 Clifton Road NE
>Atlanta, Georgia 30322
>224 805 8673
>
>________________________________
>From: Soo Downe [[log in to unmask]<mailto:[log in to unmask]>]
>Sent: Wednesday, June 03, 2015 4:24 AM
>Subject: Re: FW: electivecesarean.com<http://electivecesarean.com>
>commented on "Hard evidence: who carries out the most caesarean sections?"
>Nicky, I think this is a good reflection on the issues. And I think where
>there is genuine fear of childbirth, there are probably going to be more
>benefits than risks in a CS for a woman but maybe not for her baby. I
>also think (and I suspect you might agree?) that there is misinformation
>in the text you cite below, as, whatever prevailing medical/midwifery
>opinion is (and we have been wrong about so many things in the past
>twilight sleep, routine use of CTG, putting babies on their bellies to
>sleep) the evidence is clear elective CS for physically and
>psychological healthy women carries more risk for the baby with no
>associated benefits, and more risk of serious life-threatening events for
>the mother. This is even without putting into the mix the growing
>evidence on the microbiotic and epigenetic benefits of physiological
>labour and birth for the baby into its adulthood.
>
>If we have made childbirth so extremely frightening for women that they
>are willing to take these risks (and if they understand them fully) then
>yes, we as midwives do need to support individual women who choose CS in
>this situation. BUT - it then also becomes our absolute responsibility to
>resist/reverse childbirth practices/models/values and attitudes that
>render it so scary for such women.
>
>However, in my earlier email, I was really reacting to situations where
>women donıt really have a deep seated fear of childbirth, they just donıt
>fancy going through it, and they see it (due to media representation?) as
>just another option like a woman in the Trust I was working in some
>years ago who had a CS as she had pedigree dogs and wanted to show them
>at a particular show, so she wanted the baby out in time for her to be
>able to do this.
>
>Fascinating discussion!
>
>All the best
>
>Soo
>
>From: A forum for discussion on midwifery and reproductive health
>research. [mailto:[log in to unmask]] On Behalf Of Nicky
>Grace
>Sent: 03 June 2015 08:44
>To:
>[log in to unmask]<mailto:[log in to unmask]
>>
>Subject: Re: FW: electivecesarean.com<http://electivecesarean.com>
>commented on "Hard evidence: who carries out the most caesarean sections?"
>
>Please excuse me writing on my phone. This subject is close to my heart.
>I'm currently looking after a nulliparous woman who is planning a private
>el lscs through fear of birth basically. Thank you Alison for drawing our
>attention to this organisation. It seems to be the brainchild of one
>woman who has also written a book. Her philosophy is:
>
>'The risks involved with any surgery are very real and should not be
>underestimated, but neither should the risks inherent with pregnancy and
>childbirth in general. We want to highlight the growing medical opinion
>that elective cesarean risks are favourably comparable with vaginal
>delivery risks in healthy women. We do not suggest that every woman
>should consider elective surgery and fully support a woman's choice to
>give birth vaginally. We just ask that both choices are equally
>respected. Most of all, we want to help you make a more informed choice
>about elective cesarean birth, by providing you with data, research,
>interviews and opinion that you may not be aware of. You will still need
>to discuss your individual risks and benefits with your own physician,
>and we also suggest that you research other websites and books too. We
>welcome visitors from around the world, and wish you all the very best
>with the birth of your baby and look forward to hearing about your
>experiences in the near future.'
>Every instinct of mine rebels against el lscs but it isn't
>straightforward is it? As midwives we are duty-bound to support women's
>choices. If we believe they have the capacity to choose, for instance,
>VBAC or home birth when not entirely low risk, then it seems logical to
>accept their choices when they veer towards the more medicalised options
>such as elective induction or caesarean. If course it's not as simple as
>that because from a feminist perspective we could say that it is a matter
>for consciousness raising or in the case of fear, psychological and
>emotional support... Regarding Soo's point comparing the right to smoke -
>good point! I think you're right though it seems an extreme analogy. The
>difference must be in the acceptability of the issue culturally. Plus I
>guess there are are few positives to women smoking from a health
>perspective (though you could argue stress relief?) whereas there are
>arguably some health benefits to elective caesarean eg fewer vaginal
>lacerations? (albeit a very large abdominal laceration!)
>Just a few thoughts...
>--
>Sent from myMail app for Android
>Tuesday, 02 June 2015, 04:00pm +01:00 from "Macfarlane, Alison"
><[log in to unmask]<mailto:[log in to unmask]>>:
>In October 2013, I wrote an article on variations in caesarean section
>rates, based on data which had been published in May 2103 in the
>Euro-Peristat European
>Perinatal Health Report for The Conversation.
>http://theconversation.com/hard-evidence-who-carries-out-the-most-caesarea
>n-sections-19674 The Euro-Peristat Report, plus a more recent much more
>detailed article in BJOG on variations in mode of delivery can be found
>on our web sitewww.europeristat.com<http://www.europeristat.com/>
>Recently, the response below was posted on The Conversation by an
>organisation I hadnıt heard of previously,
>electivecesarean.com<http://electivecesarean.com>. The author says I
>should
>have been more positive about access to elective caesareans. I havenıt
>replied yet and if anyone else would like to do so, please go ahead. Is
>this a new organisation?
>Alison Macfarlane
>From: The Conversation [mailto:[log in to unmask]]
>Sent: 23 May 2015 05:40
>To: Macfarlane, Alison
>Subject: electivecesarean.com<http://electivecesarean.com> commented on
>"Hard evidence: who carries out the most caesarean sections?"
>electivecesarean.com<http://electivecesarean.com> commented:
>Re: "NHS maternity units in England should all follow a common set of
>guidelines published by the National Institute for Clinical Excellence
>(Nice), which stipulates among many other things, that
>women should not be automatically offered caesarean sections which are
>not clinically necessary."
>This statement appears to misrepresent the NICE Clinical Guideline CG132
>and subsequent June 2013 NICE QS32 publication. While NICE does not say
>'automatically offer' a caesarean, it does say that
>one should ultimately be offered if that is what the woman wants.
>The CG132 recommendations read:
>"Maternal request for CSWhen 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.
>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.
>An obstetrician unwilling to perform a CS should refer the woman to an
>obstetrician who will carry out the CS.
>NICE QS32 recommends offering a ³promptly arranged [discussion] following
>a request², ³consultant involvement in decision-making² and ³dedicated²
>lists that provide ³protected surgical and anaesthetic
>time and appropriate staffing² for planned caesareans.
>The author could and should have been much clearer on this point given
>some of the other information that is presented as part of the article.
>NICE is an evidence-based organisation and a significant
>number of organisation stakeholders were involved in writing the CG132
>guidance.
>To add your say go to
>http://theconversation.com/hard-evidence-who-carries-out-the-most-caesarea
>n-sections-19674
>If you don't want to receive notifications for this article, you can
>unsubscribe from notifications on this article .
>You can also unsubscribe from all comment notifications if you'd rather
>not receive them for any articles.
>
>
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