Is the National Institute for Clinical Excellence being very naive about Caesarean birth?
According to reports today NICE believes that its new guidelines allowing women to have free C/S for no medical reason – on demand, if you like – will result in fewer caesareans.
What??? Which planet is NICE on?
It also puts the cost of a Caesarean as £800 more than a normal vaginal birth. I am not sure how this figure is arrived at but a quick headcount of the 12+ people present in an operating theatre compared with the 2 midwives and a dad normally supporting a vaginal birth makes me wonder. Previous estimates of the real cost to an NHS Trust of a C/S are nearer the £4,000 range and if you have one at a private London hospital you won’t get much change out of £10,000 – or so I’m told.
On the Today prog on Radio 4 I’ve just heard Cathy Warwick from the RCM, followed by Prof Wendy Savage, point out that a Caesarean is major abdominal surgery, and having one before looking after a newborn is like having such surgery – a hysterectomy for example – and going straight back to work the next day.
Warwick also stressed that as long as we give women the care they deserve” women don’t choose Caesareans. Well, that begs the question of how the NHS can provide that care when more and more of the budget is going to be swallowed up by major abdominal surgery.
I have a terrible sense of foreboding about these new guidelines. The way they have been reported gives the impression of a “cuts for all” culture yet NICE is “only” trying to bring their guidelines closer to what hospitals do – a dodgy way of doing things in any case. What women will “hear”, boosted by some ignorant reporting and even more ignorant commentating, is: “forget about all that horrid natural birth stuff and just have a nice tidy scheduled operation.” They will NOT hear – because it’s never reported – that the very same guidelines also say that home birth should be offered and available for ALL low risk mothers.
And what I never hear is anyone prepared to say “giving birth naturally is the most wonderful experience ever”. Which was how I felt each time I did it.
If Trusts were to invest in more midwives, promote one to one care and allow women to choose where to give birth once they are in labour, we might see more women having the kind of empowered, natural experience my clients instinctively long for. But they won’t be able to.
The guidelines also advise “counselling” for women who say they are afraid of labour: the best counselling they could have already exists: HypnoBirthing in particular tackles head-on the fear of childbirth. As a HypnoBirthing practitioner I devote a lot of time to unhooking the chain of myth and fear which leads straight to a bad birth experience.