Membership of The White Ribbon Alliance

My organisation, electivecesarean.com, has joined The White Ribbon Alliance For safe Motherhood, whose Mission, Vision and Principles include working to create a world where:

*It is a woman's basic human right to achieve optimal health care throughout pregnancy and childbirth for herself and her newborns.

*Women are empowered to demand quality, safe and respectful motherhood services and to help other women to do the same.

*Women and newborns have access to essential and life-saving motherhood services and information.

*Governments set policies in collaboration with women, their communities and other stakeholders to implement programs in support of safe motherhood.
*The White Ribbon Alliance respects, protects and encourages individual, gender, cultural and social diversity.

Turkish doctor's perspective on c-section rates

A very interesting interview with Professor Atıl Yüksel, head of the Istanbul branch of the Turkish Society of Obstetrics and Gynecology, was reported by journalist Barçın Yinanç this week, in the Hürriyet Daily News. Well worth a read if you've been following cesarean developments in Turkey recently.

He gives answers to questions such as:

"Is there a problem with the high number of births by Caesarean section in Turkey?
Why is the rate of Caesarean births so high in Turkey?
Is Turkey’s new law regulating Caesarean sections a first in the world?"

£2.25m settlement for devastating birth injuries

Mother: “I begged, pleaded and cried for the Caesarian, thinking it was meant to be the mother’s choice, but it just fell on deaf ears”...

Reporter Hannah Upton, writing in the West Morland Gazette, describes how Mrs Hall, mother of Zak, who is now five-years-old, had "asked for a planned Caesarian for Zak’s birth when scans showed he could be as big as 12lb by his due date."

"She had already been through a difficult labour with daughter Ashleigh eight years earlier, and was keen to avoid a similar situation."
 However, Mrs Hall was induced instead, and following "a series of mistakes" at The University Hospitals of Morecambe Bay NHS Trust, Zak was stillborn. He was resuscitated, but brain damage had already occurred.

Cesarean live online chat transcript now available

Last Thursday 12 July, Dr. Murphy and I were invited to answer questions during a live online chat. The Canada.com chat was moderated by Ruth Dunley (left) of Postmedia Digital, and you can now scroll through and read the entire Q&A transcript of "Should caesarian sections be more widely available?"

Is Turkey law playing chicken with doctors?

I've been researching the cesarean situation in Turkey for some time now, and this latest news about the government introducing legislation in order to reduce its countries high rates has really captured the attention of the media. This is the comment I've just posted on this Guardian article:

1. One other likely factor that is driving Turkey's comparably high cesarean rates is the country's efforts to continue improvements in its maternal and neonatal mortality rates (i.e. its efforts to save the lives of mothers and babies).

2. The article states that the "optimal caesarean rate given by the World Health Organisation is 15% to 18%" but in fact the WHO updated its statement on cesarean thresholds in 2009, admitting that the optimum rate is unknown.

3. A causal link between cesarean birth and babies being "more prone to obesity" has not been confirmed.

4. Turkish doctors are not alone in "presenting C-section delivery as a normal alternative to natural birth", and while it is imperative that Turkish women who would prefer a natural birth are supported in this birth choice, women who prefer a cesarean birth (at 39+ gestational weeks and planning a small family) should continue to be supported in their choice too.

5. It is my understanding that tokophobia (fear of birth) is to remain a 'medical indication' under Turkish law, which is a good thing, and certainly in line with last year's NICE recommendations here. It will be interesting to see whether rates of tokophobia in Turkey begin to increase at all now...

Doctor: Offer cesarean to women 40 years +

Photo: University of Alberta

In a letter to the editor published in June's J Obstet Gynaecol Can, Dr. Venu Jain argues that with the increasing numbers of women giving birth at older ages, and the fact that they are more likely to experience obstetric problems, doctors should consider discussing and offering them an elective cesarean birth.

In 'Elective Caesarean Section for the Mature Nullipara', Jain concludes: "The foregoing discussion leads to the question: in nulliparous women aged 40 and over, given the risks associated with a trial of vaginal delivery, should an elective Caesarean section be offered?4 On the basis of current evidence, it appears that not only may the risk of intrapartum/ postpartum maternal (and neonatal) complications be lower but also that such an approach has the potential to reduce the long-term maternal morbidity related to obstetric trauma such as urinary incontinence and pelvic organ prolapse. If elective Caesarean is not offered, would informed consent for trial of a vaginal delivery be prudent in the current medico-legal milieu?"

If you're an older mum, and haven't yet decided on your birth plan, you might want to read Dr. Jain's letter in full here.

Centralised maternity care - but who's it for??

The Press Association, Guardian and Telegraph have reported today on the president of the Royal College of Obstetricians and Gynaecologist's strategy for the future of maternity care. But while the focus has been on Dr. Falconer's idea to centralize care into fewer and larger obstetric units - giving rise to concerns about the distance women might need to travel to hospital, - an even more important issue is being missed.

The government, the RCOG and the RCM are yet to confirm or deny whether women with "low risk" pregnancies will even be allowed to give birth in these centralised hospitals. Or whether they will in fact be "encouraged" (or forced) to give birth in midwife-led birth units.

The PA article reads, "Around 94% of births currently take place at hospitals, but he said the number could be reduced through the expansion of home births and midwife-led birthing units based at or near hospitals. This would also lessen the need for so many obstetric units."

And the RCM's new president has sugeested that it's time midwifery led care became "the default path for healthy women".

No thank you. Even if I'd never chosen a cesarean birth, I would still have wanted to be in a hopsital with emergency obstetric and other specialist care immediately available (i.e. without transfer).
This was my comment on each article: "What readers need to be made aware

Worrying statement by RCM's new President

Photo: rcm.org.uk

"...midwifery led care is safe and is associated with a lower intervention rate and is more cost effective than care by a team of doctors and midwives gives an impetus to developing more midwifery led care including out of hospital care. Perhaps it is time for this to be the default path for healthy women."

This is an extract from a statement by Professor Lesley Page (my bold), who is the new President of the Royal College of Midwives.

Readers of this blog will know that I am deeply concerned about the push for all women with 'low risk' pregnancies to be 'encouraged' to give birth in midwife-led birth centres, and the presentation of homebirth as being of equal risk to birth in hospital.

I support birth choices, and the RCM press office assures me that that it supports choice too (including maternal request cesareans), but it makes me very uncomfortable (as did a number of quotes from RCM members during recent obesity link articles) to read something so prescriptive as a "default path for healthy women". What about healthy women who would prefer obstetrician-led (or at least obstetrician-present-on-the-ward) care? Or women who want a cesarean? What does this statement say to them?

You may or may not share my concerns, but to help you make up your own mind, here is the link to Lesley's statement in full: "Midwives hold the future"

Did the cesarean section originate with Caesar?

Photo: Beaute de Maman

I don't usually post information on 'cesarean history' articles, but when I came across this one earlier in the week - "DID THE CESAREAN SECTION ORIGINATE WITH CAESAR?????", written by Dr. Michele Brown OB/GYN - I made a note to blog about it because I think it provides a very interesting and easy-to-read historical overview.

Take a look and see what you think.

Canadian mother files 'denied cesarean' case

Photo: istockphotos.com

If you haven't read this blog yet, it's a must. On July 4, 2012, Mrs W, who lives in Victoria BC (Canada) posted: Filed. Let the legal process begin.

It reads, "As of this morning - I filed my case regarding the denial of my maternal request c-section in July 2010. The legal process begins...may it result in a recognition of a woman's legitimate right to informed consent and to choose between planned vaginal delivery and planned caesarean delivery in Canada - and may it prevent other women from unnecessarily having similar experiences. Right now I hope to be granted the strength and courage to survive the process - and hope that doing this puts "IT" to rest."

"Awaiting Juno" describes itself as "A brave blog that strives to seek the truth and support women's rights to quality care, informed choice and timely access to medical care during labour and delivery... Healthy Mom, Healthy Baby should be the non-negotiable starting point."

I think Mrs W. deserves every success in this claim, and if you read her story, I'm sure you'll agree.

Do C-sections "cause" childhood asthma?

Photo: wales.nhs.uk

In her blog today, "Do C-sections "cause" childhood asthma?", the Skeptical OB discusses the importance of understanding that in scientific studies, cause and correlation are two very different things. It's a very interesting post on this topic, and well worth a read. I commented:

"Great post on this topic. While it's possible that incontrovertible evidence of a causal link between asthma and c-sections may be found one day, we are not there yet. Also, many of the studies published to date contain mixed cesarean data, yet we need to separate the associated risk of babies born via emergency cs, elective cs at various gestational ages, and elective cs for various medical and/or obstetrical indications.

I'd also agree with some of the posters here that even if a causal link IS proven, the risk of asthma for their child will still be assessed alongside other serious intrapartum risks with a trial of labor. The asthma debate is very similar to the one about whether c-sections increase your child's risk of obesity."

Maternal mortality rates are in sharp decline

Charis Gresser, writing in the Financial Times' Care: Maternal mortality rates are in sharp decline (July 7, 2012), reports that around 287,000 women die each year "because of complications from pregnancy or birth", but although this marks an improvement, Gresser reports that nearly two million babies still die every year "either during labour or shortly thereafter".
 

The article is certainly worth reading as it outlines what's working well and discusses how further improvements could be made.

Two babies die - but 'normal birth' is achieved

This week, two separate stories appeared in the news describing the devastating loss of babies and their parents' anger at the maternity care they received. An inquest recalled a verdict of natural causes in the first report (below) and an investigation is pending in the second, but I think it's fair to say that both examples demonstrate that no matter how 'low risk' a pregnancy first seems, all pregnancies and births are inherently risky, and a mothers' instinct that her risk has escalated deserves due attention.

(July 3, 2012 Kingston News) Heartbroken mother whose baby died at Kingston Hospital 'denied Caesarean section'

"Baby Tallula Braithwaite, who was 11 days overdue, died after a 36-minute resuscitation attempt by doctors at Kingston Hospital... Days before, mother Amanda Braithwaite... had pleaded with doctors for a Caesarean after she felt something was wrong and feared for her baby’s health."
"...Coroner doctor Sean Cummings recorded a verdict of natural causes after hearing how the baby, assessed as low risk, may have died due to an amniotic fluid infection in the womb or even oxygen deprivation during childbirth, the inquest heard.

(July 5, 2012 Daily Mail) Devastated couple blame NHS budget cuts for death of their baby boy after doctors refused to deliver him on the weekend
"Scan revealed problem with blood supply between mother and unborn son"
"Couple say doctors told them they didn't induce babies on the weekend"
"Miss Hurley then had to return to the hospital where she gave birth to her stillborn son..."

Live Chat: Should C-sections be optional?

Next Thursday, July 12, Canada.com is hosting a live online chat with my co-author Dr.Magnus Murphy and me. It begins at 8pm UK-time (3pm Eastern, 12pm Pacific), and asks, Should C-sections be optional?

"Canadian doctor Magnus Murphy says Caesarean sections should be a "respected and available" delivery option for women. Dr. Murphy, a University of Calgary clinical assistant professor in the department of obstetrics and gynecology, has written a book with Pauline McDonagh Hull, Choosing Caesarean: A natural birth plan, that rejects many of the traditional arguments against C-sections. "We're not saying that women should choose," he has said. "We're saying there should be a choice." What do you think? Should Caesarean births be an option available to all Canadian women? Tell us about your experience in the delivery room, ask questions and be part of the conversation — join our live chat with Dr. Murphy and Pauline McDonagh Hull, Thursday, July 12 at 3 p.m. ET, 1 p.m. MT and noon PT."

Montreal radio interview today

Earlier this evening I was interviewed about our book by Suzanne Desautels, a presenter on CJAD 800 AM's The Ric & Suzanne Show, and you can listen to the Podast here.

Suzanne told me she'd had three vaginal births and was completely non-judgemental about women who choose surgery instead. Definitely one of the most open-minded and honest interviewers I've experienced.

Also worth a listen if you get chance is Dr. Murphy's interview on CBC's Calgary Eyeopener radio show, which also aired today. Podcast here.

Doctor advocates informed choice for mothers

Photo: The Calgary Herald

An interview with my co-author Dr. Magnus Murphy appears in the Calgary Herald today, and here are some examples of what he says:

"We're not saying what women should choose," he said. "We're saying there should be a choice."

Murphy, whose urogynecology practice deals with these issues, said pelvic floor injuries include serious vaginal prolapse, urinary and stool incontinence and sexual dysfunction. "I have many patients who wish they did have a caesarean. Some of my patients are pelvic cripples at a young age because of damage sustained during childbirth."