Hi everyone,

Great thread, some really interesting discussion.

I would just like to add a couple of personal reflections

Firstly, is a concern that NICE policy (or any policy come to that)  is being represented, in some posts, as being somehow immune from the process of interpretation.  Surely policy should never be thought of as existing within a cultural vacuum, but instead is best understood as a process of interpretation in which the media will inevitably play a crucial role.  (I'm not talking about bias or anything like that here, simply the day to day operations of policy in practice.)

Secondly and in support of Rena's point, is my surprise at the grounds upon which the case for physiological birth is being defended; is financing really all that is at stake?  
To be the devil's advocate, if normal birth care did prove to be more expensive than c-section care, would this be considered to be justification for wholesale professional abandonment of our commitment to the preservation and facilitation of normal birth?  If not, why not?  Are these not the grounds upon which our defence should rest, despite current economic conditions?

Thanks again to everyone this is a really fascinating debate.


Mandie Scamell 
________________________________________
From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of LUCIA ROCCA [[log in to unmask]]
Sent: 31 October 2011 11:44
To: [log in to unmask]
Subject: Re: c-section for all women who request it by NICE?

My impression is that the new updated version of the guideline is going to be publishes in November 2011.

I am concerned not because of women who will expect an elective CS but all those women who will feel entitled in requesting it in grey areas, for instance after starting an IOL, which is taking time etc....in this case the real problem is the lack of one-to -one midwifery care these women get and lack of info, support and communication form the professional, but the result will be that women might request a cs, when in fact if they had more support they would have been able to go through events.
In addition NHS Trusts will not have the human resources in place for providing on-demand cs and it would be an increadible waste of resources.

I would consider more appropriate to invest in offering REAL one-to-one care to women first, before discussing anything else.


Best wishes

Lucia

2011/10/31 Macfarlane, Alison <[log in to unmask]<mailto:[log in to unmask]>>
Can I repeat Carolyn Roth’s advice. Don’t believe what you see on Sky News. Read the consultation documents on the proposed revision to the caesarean section guideline. The consultation closed in June.
http://www.nice.org.uk/guidance/index.jsp?action=folder&o=54526

The current guideline is here:
http://www.nice.org.uk/CG013

Alison Macfarlane

From: Rena Papadopoulos [mailto:[log in to unmask]<mailto:[log in to unmask]>]
Sent: 31 October 2011 10:52

To: [log in to unmask]<mailto:[log in to unmask]>
Subject: Re: c-section for all women who request it by NICE?

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]<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]<[log in to unmask]" target="_blank">http:[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: [log in to unmask]<[log in to unmask]" target="_blank">http:[log in to unmask]> with the command SUBSCRIBE TRANSCULTURAL-EUNET-L in the message body


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]<[log in to unmask]" target="_blank">http:[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]<[log in to unmask]" target="_blank">http:[log in to unmask]>] on behalf of Soo Downe [[log in to unmask]<[log in to unmask]" target="_blank">http:[log in to unmask]>]
Sent: Sunday, October 30, 2011 10:40 PM
To: [log in to unmask]<[log in to unmask]" target="_blank">http:[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]<[log in to unmask]" target="_blank">http:[log in to unmask]>] on behalf of Pamela Harnden [[log in to unmask]<[log in to unmask]" target="_blank">http:[log in to unmask]>]
Sent: Sunday, October 30, 2011 10:25 PM
To: [log in to unmask]<[log in to unmask]" target="_blank">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]" target="_blank">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