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Hospitals offered cash in big push to reduce Caesarean births
Sophie Goodchild and Ellen Widdup05.06.09
Health bosses have launched an "unprecedented" attempt to reduce the number of Caesarean sections - leading to accusations they are "rationing" the births.
Primary care trusts are offering cash incentives to hospitals as they try to end the rapid growth in the number of mothers giving birth surgically.
Clinics are targeting women who have already had Caesareans to encourage them to opt for a natural birth.
The move has been prompted by a dramatic increase in the number of non-emergency Caesareans in the past year. One in four London births are carried out surgically, despite warnings that they are major operations that can put babies' health at risk.
Excessive medical intervention by doctors has been blamed for the rise, as well as middle-class mothers opting for a C-section.
However, maternity support groups claim "rationing" could result in the NHS paying out thousands in therapy for traumatised mothers. They say some women would rather have abortions than be forced into natural birth.
The measures have been introduced by primary care trusts - which pay hospitals to provide services - under a scheme called Commissioning for Quality and Innovation.
Figures from 17 of London's hospital trusts which responded to a Freedom of Information request show there were 6,276 elective Caesareans, compared with 5,923 the previous year - an increase of six per cent.
Newham and Guy's and St Thomas' are among hospitals which have signed up to this scheme. Guy's said managers and senior clinical staff were drafting an action plan to reduce its C-section rate to below 27 per cent of births.
The hospital will receive an extra £200,000 for meeting targets, including reducing C-sections.
Newham was told it would only get full funding if it cut its emergency C-section rate by one per cent. It said it planned to do this by auditing C-sections case by case and reviewing the care offered to women.
Imperial College Healthcare NHS Trust is one of at least six hospitals setting up a clinic staffed by midwives to encourage natural births. A spokeswoman said: "We are setting up a birth choices clinic for women who have had one previous Caesarean section to promote attempting a vaginal birth."
The Royal College of Midwives welcomed moves to reduce C-sections. Cathy Warwick, its general secretary, said: "Caesarean section is a major medical intervention, and we welcome measures by trusts to reduce them because the current rates are known to be too high. But for some women it will of course be appropriate to plan one or have one in an emergency.
"There is evidence that if women get one-to-one support in labour then the rates will be reduced, and the RCM believes that among other initiatives trusts should ensure they have the appropriate staffing levels to support this."
But Maureen Treadwell from the Birth Trauma Association said "rationing" was dangerous and wrong, especially when considering mothers who found giving birth traumatic.
She said: "It's deeply disturbing if some PCTs are rationing Caesareans. In a humane society, this is profoundly wrong. The current policy of promoting vaginal birth after Caesarean section is flawed."
The natural way: A woman's body is built to give birth'
Cynthia Wey was determined to give birth naturally.
Mother to Ethan, two and a half, and Micah, seven months, the 33-year-old from Bow used an NHS birthing centre for each labour.
"With the birth of both my children, I placed a huge emphasis on everything being as natural as possible," she said. "Birthing centres have birthing pools for each room and other equipment on hand such as gym balls, birthing stools and essential oil burners. Fathers can stay overnight.
"I had no intention of having an epidural because I thought drugs might pass to baby and make it harder for them to feed and bond with me.
"I looked into natural forms of pain relief and went to National Childbirth antenatal classes and yoga. Yoga helped me with posture during pregnancy as well as relaxation techniques for labour.
"With both children it went according to plan. The water in the birthing pool was a great relief for pain but I also think learning breathing and relaxation techniques was beneficial because I had something to concentrate on.
"I felt reassured - it encourages you to focus and take control during the contractions. I knew that whenever there was pain, there was something to get me through it.
"A woman's body is built to be able to give birth so medical intervention is not always required."
Choice: Louisa Butters struggled having Cecilia
The surgical option: It's silly to be a martyr to pain'
Louisa Butters wanted to have a natural birth when she found out she was pregnant with Cecilia, now eight months.
But the 29-year-old from Pimlico suffered complications when her waters started leaking at 35 weeks. She was admitted to Chelsea and Westminster Hospital to be induced at 39 weeks, but suffered so much pain she opted for a Caesarean section.
“I am fairly pragmatic about the whole thing,” she said. “Things don't always go according to plan and I think it is silly to be a martyr to pain when you don't need to be.” Mrs Butters said she would opt for a Caesarean again, even if doctors suggested she give birth naturally. “Every birth and every baby is different,” she said. “But I already have a scar and know what would happen with a Caesarean. I think it would be better for me.”
She said her attempt at a natural delivery left her feeling traumatised and frightened. “Being induced was a horrific and intrusive process,” she said. “I knew we weren't getting anywhere. Cecilia just didn't want to come out. I elected to have a Caesarean.
“It was absolutely brilliant. I was out of hospital within three days and back on my feet in a week. A Caesarean was definitely the right thing for me.”
Reader views (12)
It is wrong to accuse all mothers who have c-sections, nor is it right to demonise those to opt for natural birth at the other end of the spectrum. Giving birth and becoming a mother is a highly emotive experience and everyone has a valid story to tell.
However IT IS TRUE that labour and birth have been unnecessarily medicalised by some people and there is ample research to back up the fact the for those women who are healthy, remain active and have exercise during their pregnancy are mostly able to give birth naturally, sometimes with non-medical pain relief such as TENS machine, gas and air (laughing gas) and water therapy (birthing pool).
There is good research to support the fact that when possible, babies born through the birth canal (vagina) have better resistance to germs, the act of compression of their lungs through the birth canal naturally helps them towards their first breath. Additionally, the absence of medication for pain relief in the mother (that is partially passed through the baby) helps maintain the baby's alertness in the first few moments of life - very important in establishing good breastfeeding when the mother's breast needs the initial stimulation for milk ducts to start producing milk.
So in an ideal situation, natural birth is a good idea for both mother and baby. What we need is more information out there for mothers-to-be to make an informed choice about their birth options. C-section can save lives and is needed in some cases too.
- Cynthia Wei, London
Based on my own experience; I agree that the current rate of Caesarean sections are far too high.
3 years ago I gave birth to an heathy girl by natural birth but this almost didn't happen. Why? At 38 weeks, during routine check, my urine test showed that I had pre eclampsia, instead of going to a beach that day, I was checked into one of the top NHS hospitals in central London on a Friday afternoon. Within half an hour of being allocated a bed in the delivery unit, a male consultant came in advising that given the preeclampsia and the high blood pressure, for the safety of my baby and myself, he would strongly recommend C-section. I protested that I would like the chance to try for natural birth. I was almost overruled, when by chance, due to change of shift, the consultant on duty for the night shift happened to be one of the ante-natal consultnats I had seen earlier in my pregnancy. She said that she would give me a chance to try natural birth and that the electronic blood presure machine had not been working well during the day and directed the manual machine be brought in to measure my blood pressure. Indeed it turned out that my blood pressure was in fact much lower than the level given out by the electronic machine and the other machine was indeed faulty. A midwife was assigned to me to monitor my progress and she was excellent, professional and caring. By 11 am next morning, my healthy daughter was born. Limited space does not permit me to provide details
- Alana Lau, london, greater london UK
To state that women who have c-sections are 'too posh to push' is ridiculous! After a 4 day labour, I was exhausted and my baby was stuck. If my mother had not seen his heart rate drop on the monitor, then the midwife, who was elsewhere, may not have seen it until it was too late. Signing a consent form and being rushed into theatre for an emergency c-section was the most terrifying thing that has ever happened to me, but my son lived as did I. If c-sections are rationed, then I may have been forced to keep pushing for even longer than the 2 hours that I'd already tried and my son may have died.
The 8 inch scar is a permanent reminder as to how lucky we were to have a healthy son and I'm grateful that I was given this life saving surgery when I needed it without beaureucrats checking and filling out forms to decide if I was 'entitled'.
Next time round, I will have an elective c-section as the thought of going through that emergency scenario again terrifies me. If I am pushed into saying that I'll go for a VBAC then I'll change hospital until I find someone prepared to put my fears and needs, rather than the hospital's need to provide the necessary statistics, first.
- Mawgan, London
Darius Midwinter, it must be wonderful to be so perfect. Basically you seem to despise anyone who isn't you - ie those who dare to get ill or who want to have families. Take a chill pill, live and let live and stop getting so angry - you'll enjoy life a lot more. Also - have you ever reflected on who is going to pay your pension and wipe your bottom when you're dribbling in the nursing home? Today's children - that's who. I'm sick of the attitude that prevails in British society that people who have children are somehow selfish. If it wasn't for us, the country would collapse. Stay childless if you want, just don't think it makes you a better person.
- J Rogers, London
Caesareans save lives. Just ask anyone who has been through a nightmare 'natural' delivery or the (astonishingly high) numbers of women who have had to watch their babies die because they were told to just get on with it, rather than offered a Caesarean in time. Many women who have been lucky enough to have had a relatively straightforward delivery think it's that way for everyone. It's not, and demonising those of us who have to have Caesareans (and make no mistake - for most of us it is not a selfish lifestyle choice, but a vital intervention - helps nobody). My daughter almost died because doctors failed to predict how big she was and did not perform a Caesarean in time. They had to break her collarbone in order to deliver her the 'natural' way (and only just did so in time). A few more minutes and she could have been brain damaged or dead. That's the reality, Dave from London. There's lots of self-righteous guff being spouted on this site by ill-informed, prejudiced (and probably misogynist) people too lazy to look behind the 'too posh to push' tabloid headlines. If they did, they would find the majority of women just want their babies, and themselves, to get through the whole thing safely (and alive).
- Lindsay, London
Don't even get me started, Jessica: it's like those lazy lay-abouts who have heart by-passes because they're too posh to pump - I mean, HELLO?!
Who do these people think they are, wasting money on pointless operations? A cesarean costs around £2000 (being abroad I had to pay for my 2, so I know). Clearly these women should learn to keep their legs together and then the money could be better spent on giving Jessica free visits to the GP whenever she has "Flu" or some other vital medical problem which renders her too posh to go to work. The only sensible way forward is for women like me and Posh, who started out a size 6 and had huge babies (9lbs for mine) either to be prevented from breeding or to be left to die in childbirth along with the baby when it won't (sorry to be vulgar) come out, as would have happened a couple of generations ago. *Tsh!* Some people are SOOOOO selfish it's unreal. AND they stay slim - the Witches!
Having started out like Cynthia Wey, progressed like Louisa Butters and wound up castigated like Posh with moronic choruses of 'OOOOH TOO POSH TO PUSH?!' whenever I went near sanctimonious Brits, I'm pretty glad I wasn't left to the mercy of the NHS. This issue is purely and simply about rationing money, not the best needs of the patients - and there's no softer target than a post-operative woman with a 11cms of stapled gash and a screaming newborn to look after.
- Roz, France
I just wish 'British' mothers would ration their pregnancies and think of others for a change.
- Dave, London
Nu Labor go away!!
- Georgie, Islington, London
This infuriates me, whether a caesarean is carried out should be for reasons individual to the woman and baby concerned. I was in labour for 4 days with my daughter with contractions every 5 minutes from the beginning, I had an emergency c-section after labour failed to progress and she became distressed - I will not be pressured into putting my future children through such trauma and will opt for an elective. Clearly the best option is a natural birth, but the worst is an emergency section. I will hedge my bets and have an elective caesarean - this is not too posh to push and probably cheaper than dealing with what (God forbid) could have happened last time. It would be great if people who chose to comment did so from a vaguely educated standpoint rather than making stupid glib remarks.
- Sarah, London
Well balanced article but as I am quoted may I just clarify the position of the Birth Trauma Association. It is true that we do not believe vaginal birth after caesarean (VBAC) should be promoted but neither do we believe elective repeat caesarean should be. Women should get accurate information and be free to make a choice; there are pluses and minuses on both sides.
- Maureen Treadwell, Stockbridge
A simple way to prevent rationing would be to split the NHS into two - a National sickness service for unintentioned illness and non "lifestyle choice" treatment, funded of course by the taxpayer, and a National Childbirth Service, first child free (to the non taxpayer), the rest funded privately.
This would concentrate the minds of those wanting large families at the taxpayers expense, give superior care and choice (yes - even birthing pools) to those who wish to take advantage of it.
Everyone except of course the feckless and benefit multi - breeder wins.
- Darius Midwinter, London UK
Blame the likes of Victoria Beckham. 2 posh 2 push
- Jessica, London
