Re: c-section for all women who request it by NICE?
Sorry I didn’t notice the date! Don’t know where I was earlier as it didn’t catch my attention!
I was going to say, however, that we should also remember that there is very little solid evidence on women wanting CS for no reason. Studies suggest that only a small number of women do seek CS without medical recommendation and when they do, there is often a very good reason such as previous traumatic birth, particular personal or psychological reason for fears. Obviously the numbers may begin to increase in countries where is comes to be more normalised, with high rates of CS overall.
The critical review of literature we conducted – published in Birth in 2007 – examined these issues, and the follow up article, which looked at conceptual aspects, also examined the issues around medical birth being normalised and women in some settings getting very poor support in labour, combined with high risk of an unplanned CS because of prevailing high rates.
The role of the media does worry me though, as it gives the impression that there are hordes of women wanting (typically ‘demanding’) a CS and this in itself may work to normalise elective CS and to give the impression either that women are weak and silly (tone of some earlier media reports) or that CS is much easier than labour, whereas the evidence suggests that even elective CS can be a very difficult experience for women and very painful postnatally, aside from all the clinical evidence regarding risks, which should be available to women in an understandable form.
The refs were:
McCourt C, Beake S, Weaver J, Gamble J, Creedy D (2007) Elective Caesarean Section and Decision Making. A critical review of the literature. Birth, 34:1 March 2007 pp 65-79.
And
Gamble, Jenny RM, PhD; Creedy, Debra K. RN, PhD(Psych); McCourt, C BA, PhD; Weaver, Jane RM, PhD; Beake, Sarah RM, MA A Critique of the Literature on Women's Request for Cesarean Section. Birth. 34(4):331-340, December 2007
On 31/10/2011 11:56, "Carolyn Roth" <[log in to unmask]">[log in to unmask]> wrote:
http://guidance.nice.org.uk/CG/WaveR/97
If you look at this link it appears that the consultation period is actually long gone! This is now a prepublication period and from what the info suggests, not an opportunity to reopen the arguments. Where were we???
Carolyn Roth
LME & Director of Undergraduate Programmes
School of Nursing & Midwifery
Clinical Education Centre
Newcastle Road
ST4 6QG
Tel. 01782 679698
On 31/10/2011 09:04, LUCIA ROCCA wrote:
Yes, Please let's all send responses to NICE. Could please somebody forward the email address for NICE so we all responses to the same address?
Thanks
2011/10/31 McCourt, Christine <[log in to unmask]">[log in to unmask]>
With this in mind, all those who are concerned should send evidence and responses to NICE during the consultation period
On 31/10/2011 00:49, "Octavia Wiseman" <[log in to unmask]">[log in to unmask] <[log in to unmask]">http:[log in to unmask]> > wrote:
This is where the story came from – it’s still a draft report, subject to change:
http://news.sky.com/home/uk-news/article/16099301
From: LUCIA ROCCA <mailto:[log in to unmask]>
Sent: Sunday, October 30, 2011 11:05 PM
To: [log in to unmask]">[log in to unmask] <[log in to unmask]">http:[log in to unmask]>
Subject: Re: c-section for all women who request it by NICE?
Yes, and also in a bleak economic climate it seems quite wrong to increase expenses without reason.
Plastic surgery is getting safer and safer....
are we going to have cosmetic breasts inplans for free as well for all women who request it?
I am quite shocked if NICE publishes a report in support of free CS without medical indication and I think we should look into protesting against it.
Best wishes
Lucia
2011/10/30 Soo Downe <[log in to unmask]">[log in to unmask] <[log in to unmask]">http:[log in to unmask]> >
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]">[log in to unmask] <[log in to unmask]">http:[log in to unmask]> ] on behalf of Pamela Harnden [[log in to unmask]">[log in to unmask] <[log in to unmask]">http:[log in to unmask]> ]
Sent: Sunday, October 30, 2011 10:25 PM
To: [log in to unmask]">[log in to unmask] <[log in to unmask]">http:[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]">[log in to unmask] <[log in to unmask]">http:[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
--
Lucia Rocca-Ihenacho
Senior Midwife and Research Fellow
Barts and the London NHS Trust
07989 230313
--
Lucia Rocca-Ihenacho
Senior Midwife and Research Fellow
Barts and the London NHS Trust
07989 230313
