Interesting that a number of lay people who have seen the publicity have asked me if this is because of the shortage of midwives!! I explained that it would increase midwife's work as well as cost to the NHS overall.
Diane
Diane Fraser
Emeritus Professor of Midwifery
________________________________________
From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] On Behalf Of Ann Thomson [[log in to unmask]]
Sent: 31 October 2011 14:54
To: [log in to unmask]
Subject: Re: c-section for all women who request it by NICE?
My reading of the Independent newspaper today is that this proposal is only for women who have extreme fear of giving birth vaginally, not C/S on demand, and only after they have had appropriate counselling, but I have not read the original NICE document.
Ann
Ann M Thomson
Professor (Emerita) of Midwifery
University of Manchester
________________________________________
From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] on behalf of Andrew Symon [[log in to unmask]]
Sent: 31 October 2011 12:56
To: [log in to unmask]
Subject: Re: c-section for all women who request it by NICE?
A number of issues here.
Looking at the consultation document, I¡¦m inclined to agree with
Claire Feeley that this probably doesn¡¦t shift things that much from
what happens now ¡V but that shouldn¡¦t lead to any complacency.
Worst case scenario:
The Sky News interpretation of this story turns out to be true, and
women will more or less be able to demand a Caesarean.
In that event, they¡¦d still have to find an obstetrician who¡¦d
agree to do this on the NHS.
What are people¡¦s thoughts about how this would work in practice? Can
the NHS accommodate such extra demand?
I see that the consultation document goes on to note that FIGO¡¦s
Committee for the Ethical Aspects of Human Reproduction states that
¡§it is unethical to perform a CS without a medical reason because
of inadequate evidence to support a net benefit¡¨.
Perhaps we should be galvanising obstetric opposition to this.
Regards,
Andrew
Dr. Andrew Symon
Senior Lecturer
School of Nursing & Midwifery
University of Dundee
Scotland
+44 (0)1382 388553
http://dundee.academia.edu/AndrewSymon/
http://uk.linkedin.com/in/andrewsymon
MRes in Health & Social Care:
http://www.dundee.ac.uk/nursingmidwifery/postgraduate/
************************************************************
Please consider the environment. Do you really need to print this
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>>> Claire Feeley <[log in to unmask]> 31/10/2011 10:55 >>>
Looking at those links to NICE, the consultation deadline has now
passed (June 2011).
I think perhaps the news reports has blown it up (surprise surprise)
and the following guidelines aren't much different to what I have seen
in practice
Maternal request for CS
34
When a woman requests a CS explore, discuss and record the specific
reasons for the request. [new 2011]
5.9
35
If a woman requests a CS without a clinical indication, discuss the
overall risks and benefits of CS compared with vaginal birth (see tables
4.3 and 4.4) and record that this discussion has taken place. Include a
discussion with other members of the obstetric team (including the
obstetrician, midwife and anaesthetist) if necessary to explore the
reasons for the request, and to ensure the woman has accurate
information. [new 2011]
5.9
36
When a woman requests a CS because she has a fear of childbirth, offer
referral to a healthcare professional with expertise in providing
perinatal mental health support to help her address her fears in a
supportive manner. [new 2011]
5.9
37
Ensure the healthcare professional providing perinatal mental health
support has access to the planned place of birth in order to provide
care. [new 2011]
5.9
38
If after providing support, a vaginal birth is still not an acceptable
option to the woman, offer a planned CS. [new 2011]
5.9
39
An obstetrician has the right to decline a woman¡¦s request for a CS.
If this happens, they should refer the woman to an obstetrician who will
carry out the CS. [new 2011]
Best wishes
Claire Feeley (NQM)
________________________________
From: "McCourt, Christine" <[log in to unmask]>
To: [log in to unmask]
Sent: Monday, 31 October 2011, 10:46
Subject: Re: c-section for all women who request it by NICE?
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¡K.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] 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]
>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
sibl
ings. 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 ¡Ó 6.33) compared with that of patients born by
vaginal delivery (27.59 ¡Ó 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
>
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