Every woman and newborn should have the safest birth given their particular circumstances – and the NHS’s decision to remove the cesarean rate cap will help achieve that.
For centuries, cesarean section has been used as an alternative to ‘natural’ vaginal delivery.
I have witnessed many lives of infants, and sometimes their mothers, be saved thanks to C-sections.
It is a safe and well-established procedure, and notably a survey of female obstetricians, published in the journal The Lancet in 1996, famously found that one-third will choose cesarean section over natural birth.
Indeed, I myself have had two C-sections for medical reasons.
Every woman and baby should have the safest birth given their particular circumstances – and the NHS’s decision to remove the cesarean rate cap will help achieve that.
But for years, the NHS has set targets to keep the number of cesarean deliveries, particularly urgent ones, at around 20% – amid concerns that a vaginal birth would be better. as they are ‘natural’ and safer as they do not involve invasiveness. medical intervention.
Maternity units that exceed that quota are considered underperforming, assuming they let women have cesarean deliveries when they don’t need them.
It’s true that cesarean delivery comes with risks that women need to be warned about. This is a major surgery, with risks of bleeding, infection, scar tissue, bladder damage and blood clots, and others often take longer to recover from a cesarean section.
However, if you have a complicated vaginal birth or a long labor, there is also a risk of bleeding, blood clots, and infection. The delivery can lead to tearing and bowel problems that last for months, and in some cases even longer.
But penalizing maternity units for having too high a C-section rate can have consequences. It puts pressure on medical teams to have a ‘preferred’ natural birth over a form of birth suitable for each woman.
In recent years, there have been a number of high NHS cases leading to the inevitable deaths of mothers and babies.
In some cases, these are attributed to maternity units encouraging the mother to continue with natural labor despite indications that a cesarean section is safer.
This was exemplified in the NHS Trust case of Shrewsbury and Telford Hospitals, at the center of the biggest maternity scandal in NHS history.
The trust had the highest rate of natural births – and the lowest rates of cesarean deliveries – in the UK for five of the eight years from 2010 to 2018, when it also had an unusually high rate of premature births.
The trust’s caesarean section rate is between 15 and 22 percent of births, compared with the national rate of 25 to 30 percent.
A report on poor care at the trust, including dozens of infant deaths, will be released soon.
(This is not a common problem in NHS maternity units: some hospitals have very low rates of cesarean deliveries because staff are well-trained and they provide dedicated care to women when they are pregnant.) labor.)
In last year’s UK Maternity Service Safety report, the Commons Health and Social Care Committee described fines hospitals for high rates of cesarean deliveries as ‘deeply disturbing’, and recommends ‘immediately end the use of total cesarean percentages. as a measure for maternity services’.
In response, NHS England has now written to all maternity units asking them to stop using targets that may be ‘clinically inappropriate and unsafe in individual circumstances’.
So now, instead of targeting a specific birth, we offer the safest birth for that mother and baby. And the type of birth will vary between women.
For most women, this decision will make no difference to the care they receive. For example, at the top private hospital in London, where I specialize in obstetrics, half of the women have had a cesarean section and they can choose their own.
There are also senior obstetricians delivering deliveries – a move now more widely adopted by the NHS.
As a result, the rate of risky emergency cesarean deliveries in hospitals is lower than the national average.
But I also think the decision will have little impact on my busy NHS hospital, where we deliver between 5,500 and 6,000 babies a year. We have a consultant in the wards 14 hours a day, seven days a week, and as a result, decisions about deliveries are made at the top level much more often than in the past.
What this goal decision hopes to do is prevent any hospital from attempting a natural birth at all costs.
It’s about stepping in and performing a caesarean section when appropriate – at a time when both mother and baby are healthy – rather than continuing with a vaginal birth at all costs.
Caesarean section is not failure.
shaziamalik.co.uk
INTERVIEW WITH RACHEL ELLIS
Source: | This article originally belonged to dailymail.co.uk
