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 don’t really have a deep seated fear of childbirth, they just don’t 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

 

 

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]>:

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-caesarean-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 site www.europeristat.com
Recently, the response below was posted on The Conversation by an organisation I hadn’t heard of previously, electivecesarean.com. The author says I should
have been more positive about access to elective caesareans. I haven’t 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 commented on "Hard evidence: who carries out the most caesarean sections?"
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 “promptly arranged [discussion] following a request”, “consultant involvement in decision-making” and “dedicated” lists that provide “protected surgical and anaesthetic
time and appropriate staffing” 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-caesarean-sections-19674
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