“Caesareans for Everyone!”, say NICE guidelines

Cesarean Surgery

It’s not very often something makes me as cross as reading this article did this morning.

Apparently, NICE guidelines (one of the governing bodies of the UK’s National Health Service) have been changed to allow women to choose caesarean section to give birth, even if there is no medical indication.

NICE insist that this does not mean that caesareans will be dished out willy-nilly. Rather, this will make caesareans available for women who are suffering from psychological distress surrounding birth; women who may have been turned down previously by an unsympathetic doctor.

Let me just make one thing clear – I support women’s rights to give birth however and wherever they choose, and that includes caesareans. I think that a woman’s emotional distress is just as valid as a physical problem, and women who are suffering from emotional distress surrounding the birth of their baby should absolutely be able to opt for a caesarean if they so wish.

Caesareans are one of the miracles of modern medicine, and have saved the lives of millions of babies and mothers.  I am eternally grateful that they exist, and that they are available to those who need them.

What I am NOT happy about is footing the bill for expensive unnecessary surgeries for women who are NOT in emotional distress and who do NOT have any physical medical need for surgery.

In the current economic climate, where benefits for the needy and public service budgets are being cut left right and centre, how can changes such as these be implemented? How can the NHS spend their meagre budget on unnecessary surgeries? As a taxpayer, I will happily foot the bill if your surgery is necessary – for physical or emotional reasons – but I will not pay for surgery because you want to fit your birth into your busy schedule.

My husband needs an operation. His condition isn’t life threatening, but it is incredibly uncomfortable and impacts on his life on a daily basis. When he visited his doctor (and when he sought a second opinion), he was denied even a referral to a specialist, let alone an operation. His only options are an appeal (which would most likely get denied), or to simply wait until his condition worsens enough for them to give a crap. Only then will he get a referral to a specialist, and only then will he have a hope in hell of ending up on a waiting list for an operation.

And yet, women who have no physical or psychological need for surgery will be able to request it, and doctors will not be able to refuse?

Now, I am aware that most women would prefer to give birth vaginally. Even those of us who would have chosen a caesarean had we been given a choice often change our minds when we learn about the implications of the procedure in comparison to vaginal birth. But, when you consider that the cost of an uncomplicated caesarean to the NHS is £2500, in comparison to around £1500 for an uncomplicated vaginal birth, the cost will quickly add up even if only a small percentage of the population opt for their babies making their entrance via the sunroof.

Also, it’s worth taking into consideration that maternity services here in the UK are stretched to breaking point as it is. Although the caesarean rate rising isn’t necessarily a problem in and of itself, how are the maternity services going to cope with the extra workload? We already hear stories every day of women in postnatal wards across the UK who are left to their own devices following their caesareans because there simply aren’t enough nurses and midwives to go round. There are women everywhere who have felt abandoned after their caesarean births, laying in their beds unable to even lift their babies up by themselves.  What happens when the caesarean rates inevitably rise, putting more women in postnatal wards for longer periods of time, and requiring more care? How do NICE intend to ensure the NHS can provide enough staff to care for them?  It wasn’t long ago that myself and some other local mothers were campaigning to keep overnight stays available at our local NHS birth centre, and now the NHS are taking steps that will likely end up with MORE women needing overnight care for an extended period of time? It doesn’t make any sense.

And what about the human cost? What about the fact that caesarean section is four times more likely to lead to fatalities (according to a report in the British Medical Journal)? What about the fact that studies have suggested that babies born by caesarean are more likely to suffer respiratory distress? What about the fact that mothers who give birth by caesarean are statistically less likely to breastfeed, which could cause further health problems later down the line for baby and mum? What about the fact that women who have caesareans are more likely to suffer complications with healing after giving birth? Of course, these points are vastly outweighed by the benefit of a necessary caesarean section – but one with absolutely no medical indication, physically or otherwise? Seriously? Am I the only one here saying WTF?

Again, I support women’s rights to give birth however they choose. I just think that if women want to choose an expensive and unnecessary procedure with no medical indication, they should have to pay for it themselves. Give birth however you like – just don’t expect me to pay for your unnecessary surgery when there are people out there who are being denied treatment through lack of funding.

NICE should be focusing on improving support for pregnant families, and on developing a better system for the counselling offered to women who have suffered a birth trauma, or who have a phobia of giving birth.  These women should absolutely be able to choose to have a caesarean if they want to, but they deserve to have their issues addressed properly – throwing a caesarean at those issues is not good enough, not by a long shot.  Women deserve  better.

EDIT: I just want to clarify something again, as a few people have misunderstood my stance on this: I have nothing against caesareans or the women that choose them. I would feel the same way about this if it were a case of, say, NICE saying that doctors could no longer refuse patients drugs they wanted, regardless of whether or not they are necessary.  Patients should not be denied access to drugs they need, but they certainly shoudn’t be dished out in accordance to the patients whim.  Same goes for serious surgery like caesarean section.

IMAGE:  Santa Rosa OLD SKOOL @ flickr

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Comments

  1. I have to say I hear you! A friend of mine who is a surgeon in the UK told me this was going to happen a while ago and I was stunned.

    Yes, it should be a choice but choices which are more costly shouldn’t be provided for free.

    I know when I first got pregnant I was terrified about giving birth and said I WANTED a c-section – THEN my obgyn told me the reasons I didn’t want to have one unless medically necessary. At the end of the day it IS major surgery.

    I know a lot of first time mothers freak out about delivery – I am sure the stats are a LOT higher than in the article.

    • Absolutely! I know I’m going to get a lot of flack for this post but my issue really isn’t with people electing to have a c/s. Your body, your choice! My issue is with paying for other people’s unnecessary surgeries. If I had been given the choice with Monkey, I may well have chosen a caesarean – I was terrified of giving birth! Thank you for commenting!

  2. What I want to know is, when preparing for their c-section are they warned that there may not be a surgeon available at the right time and so they may need to have a natural birth after all? When you book a home birth in my area (and in many others), the midwife visits the expectant mum at her house around 37wks and tells her that there may not be a midwife available when she goes into labour and she may be required to go into hospital. Many of these mums may be in emotional distress at this news and even more so if they do call for a midwife whilst giving birth and are told there is no midwife available. Why is it OK to book people in for a c-section without a true medical/psychological reason that costs the NHS loads both straight away and potentially later on with long-term health issues and not to provide support for a home birth that has been proven to cost the NHS less?

  3. Hear, hear!

  4. I’m sorry, but this is going to be a bit of a rant……

    I disagree, I think there are lots of women who would prefer to have a CS, even with all the risks laid before them, rather than give birth vaginally. Many, like you say, have such an irrational fear of the birthing process and such little trust in their own bodies that they would prefer someone far more ‘competent’ than them to be in charge, and unfortunately, this is a myth that many doctors and even some midwives seem willing to perpetuate and encourage. What this bill means is a reinforcement of the undermining of women’s control over their own bodies, and their own abilities to give birth naturally and in their own time.

    When women succumb to the idea that birth is a medical process rather than a natural one, the system has won, because the fewer ‘crazy’ women choosing to ‘suffer’ with all the dangers of natural birthing, the better, in medical opinion…. when the alternative is to book you in next wednesday, cut the baby out in a specific time-frame, with all the benefits of modern technology. Certainly once you’re in hospital hands, in my experience, you are not expected to have any power of your own; everyone would prefer you to just play along with their rules.

    OK, I’m done. I should add all the usual of course, there are situations that warrant a CS, and many hospitals allow labouring women the dignity and support they deserve…. (just hasn’t been my experience) bla bla… but there are soooo many benefits to a vaginal delivery that women are rarely told.

    As usual you’re absolutely bang on, it makes my blood boil too! I hope your husband finds someone who’ll listen and help. Keep trying, persistence will pay eventually.

  5. They already do this here in the US… You see a lot of women hit 37 or 38 weeks, are sick and tired of being pregnant, and just ask their doctors to “get this baby out of me!” Twenty-five percent of all births are via cesarian these days, and while yes, it is every woman’s right to choose how she’d like to give birth, I think that’s a ridiculously high number for such a risky procedure. It’s major surgery, after all. Many doctors also push c-sections because of the convenience of scheduling them with no regards for the risks or the cost to the patient. The feeling here is that such a surgery is as normal and natural as vaginal birth. Yeah right. My due date is in less than 3 weeks and I’m nervous about being pushed into an unnecessary c-section. My guess is you’ll see a lot of this type of thing in the UK now given these new guidelines.

    • mmhmm, I wouldn’t be surprised at all if our c/s rate were to rise now. I can understand the logic used by NICE when making these changes, but unfortunately we don’t have enough NHS staff as it is to meet the needs of women. How they are going to provide enough staff to give the support they’ve promised is beyond me.

  6. I am a first time mum and a nurse in the nhs.

    i believe that its a mum’s choice to choose what her instincts lead her to.
    That said i feel that you choose based on the information to hand. i think that currently the nhs does not provide good enough education antenatally to mums for them to understand the benefits and risks and make an informed decision.
    afterall when we ask patients for consent for major abdominal surgery they have to be able to understand the risks and benefits.

    My delivery was a great experience, however due to a chronic medical condition of mine and also me being sick with infection i had a lot of intervention, from my waters being broken, syntocin, epidural, forceps. and all of these things had consequences, which i understood and therefore managed to have a good medicalised birth. if the forceps hadnt worked i would have needed a c section. how do i feel about this personally?
    i feel whatever was the safest way for me and my girl individually was the right decision for us. but i was lucky to be well educated thanks to the nct, and an nct teacher who went above and beyond for us all.

    with my mummy hat on i feel that a lot of women who would elect for a c section who would now get one that wouldn’t before could be in a vulnerable position, and i would expect them to be protected by legislation and not be put at risk.
    I’m interested at why NICE has made this recommendation and would like more information. does this reflect mother anxiety…releasing adrenaline and causing long unprogressing labours requiring a c section?

    or does NICE think that midwife time in a birthing centre is more expensive than a c section overall?

    i cant help but notice that my friends who had c sections when my daughter was born had extensive problems with breast feeding in particular supply…is this because a vaginal delivery releases hormones which start some of the physiological processes required for breastfeeing? is there less skin to skin contact with a c section as your baby requires more intervention such as suction of airways,at birth because it hasn’t had the required physiological process where the pushing through the birth canal clears their little lungs and airways? etc

    i know they suffered distress because of the feeding difficulties. i know the pain from the abdominal wound caused them problems with moving and holding their babies and going to the toilet.
    i had issues with my stitches in a similar way…but that was again a medical intervention…..
    my 4 caesarian friends all had distress with no official complications. they had no infection, or significant pain problems, or wound healing issues. just the expected.
    but they all had significant distress as they tried and tried to breastfeed and felt that they failed….which they did not as they nourished their babies with formula, which was their only option.

    however as mummies we know how easy it is to fall prey to baby blues and pnd. if we can make life easier for mummies and support them perhaps instead of offering c sections we should offer mummy support in the lead up to labour and birth and beyond, education and support. but perhaps NICE knows this is more expensive. (childcare, charity running costs, salaries etc)

    It is no conincedence that a lot of the costs post c section are the responsibility of the mother (as well as nhs costs), your ongoing pain relief is a prescription from your gp that costs you money. your formula as you anxiously top up your baby costs you money….etc. your pilates or exercise classes to regain your stomach muscles or bladder control cost you money.

    of my friends who had “natural” delivery, no medical intervention, no tears or episiotomies or stitches. their experience during labour and post labour as they became mummies with all the challenges that come with that, was very different and frankly seemed a lot better. why are we not trying to give all women this opportunity instead….i know i would have preferred this.

    i continue to wonder. i do know this, women previously could have a c section if they needed it, becuase of previous traumatic birth and fear and anxiety, because they had a breech baby, because of medical conditions in mum and baby, because of psychological need.
    so under this new concept who now gets a c section that didnt before? and are they better off?

    • Thanks so much for commenting, its great to hear from somebody who’s actually working within the NHS.

      This is exactly my point – under the previous rules, women who wanted a caesar because of their anxieties surrounding birth should have been getting one anyway – surely it would make a lot more sense to plow the extra money into creating a much better support system for these mums so that nobody ‘slips through the net’, as it were.

  7. I, personally, opted for a completely 100% natural birth & would do it again with any other child I have. However, as a young mom I’ve seen MANY other young moms here in the US have C-Sections for no apparent reason other than they didn’t want to feel pain and wanted “easy” labor (no anxiety involved). This irritates me to no end, if you don’t want to feel pain–don’t have a child. Kids will put you through much more pain than the physical day or two of labor for the rest of your life >.<

    Anxiety, I agree, IS a fair reason to opt out–but this younger generation has a motto of "Science offers it, so I must indulge!" Inductions are being handed out left & right as well because these younger moms "don't want to be pregnant anymore." Doctors are all TOO accommodating these indulgences in my opinion.

    –Kat,
    @ HippieMamaKat.blogspot.com

  8. Ditto on inductions being handed out like candy in the US. I had a neighbor brag on Facebook that her doctor scheduled her for an induction at 38 weeks because she was in “mental distress” about being pregnant still, even though they both knew she was just tired of it! I was floored that a doctor would essentially lie on medical records just so the mom could stop being pregnant when she wanted to be, instead of informing her of the health benefits to her child to wait until 40 weeks at least. But then, she’s not into this “alternative” birthing stuff, so she would not have been going to a doctor that was anyway.

  9. i was so enjoying your blog, but after a judgemental rant like this i won’t be coming back.

    • Judgemental? Seriously?

      Would you still think I was being judgemental if it were about the NHS handing out gastric surgery to anybody who asked for it, or if they suddenly said that patients could demand whatever drugs they want from their doctors regardless of whether or not they actually needed them?

      I have nothing against caesareans or the women that opt for them, as I have said a bajillion times. My issue is with the NHS using their meagre funding to pay for unnecessary surgery when people who actually NEED treatment aren’t getting it.

    • Did ^^^ that person even read the same article?? lol

  10. I disagree. You could just as easily argue that pregnancy is an elective medical condition. If people without children don’t want to pay for this unnecessary and undeniably expensive elective condition, should childbirth not be covered by health insurance?

    The reasons to choose elective c-section are varied and complicated. The woman who chooses to have surgery to fit childbirth into her schedule is extremely rare, but if laws “allowing” coverage only for certain types of c-section share your distaste for the scheduled birth, you endanger women like the one in the birth story on Navelgazing Midwife the other day- no medical indication, but a history of late pregnancy preeclampsia. Sure you can say OF COURSE she should be covered, but universal restrictions usually mean some people in that in between category get left out. That is not only unfair, it’s dangerous.

    The baby has to cone out one way or another, and it’s GOING to be expensive – it’s just a matter of degrees. I don’t like the idea of saying “this is a good enough reason to have a c-section, but THAT is not.” When you have universal health care, the act of having a child is one that places an unnecessary burden on the state. Would you want health coverage to cover children born under certain circumstances, but not children born to parent who already have two children, or parents who are unemployed or teenaged parents or parents with criminal records? Of course not. Outsiders have no place making these decisions.

    • I agree to an extent; although one could argue that those who choose not to have children, who then pay for maternity healthcare of others, are paying for their own future – the children whose births they’ve paid for will pay the taxes that will subsidise their own elderly care & pension.

  11. As a mom who had a c-section after a failed induction at 41 weeks, I could not agree with you more! Of course women should have the choice to deliver how they want, but choice comes with consequences. If you choose a more expensive procedure just for the sake of ease, the consequence should be paying for your choice. Optional surgery is vastly different than physically or emotionally necessary surgery. A perfect example would be breast implants. If you want implants to normalize after a mastectomy then of course insurance/whatever should pay for it (not that they necessarily will…but in a perfect world). If you want implants because you simply want more, then open up your pocketbook and pay. It’s the same procedure, but for extremely different reasons.

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