Wednesday, 23 November 2011

Caesareans on demand. ‘Nice’ to have but not need to have?

The National Institute of Health and Clinical excellence (NICE) has issued some new guidelines advising that pregnant women should be allowed  to choose caesarean delivery, paid for the NHS, even if there ‘is no medical need’

As always, I am writing this post with all hats on – mother, clinically trained, healthcare manager and commentator. Let’s start with the mother bit first. Childbirth, like so many other experiences, can be dramatically influenced by perception. My mother, bless her, told me that giving birth was ‘easy as falling off a log’. A strange saying as I don’t know anyone who has actually fallen off a log, but I guess that if you chose to do such a foolish thing – it would be easy. I was very fortunate to produce a tiny baby who was in a hurry to be born so it was just as dear Mama said – a doddle. But I won’t deny that it was a painful doddle.

I would not for one moment belittle anyone who has fears or concerns about natural labour. Neither would I dispute that C sections can be life saving and vital in some cases. But to choose to have surgery simply because you can, really isn’t good enough. Pregnancy is usually an active choice. Even unplanned reproduction is often a result of a choice not to be more careful! With choice comes responsibility. We are already very fortunate in the UK to have access to free maternity services. Those free services, up till now, included the reassurance that either a planned, medically necessary or unplanned emergency Caesarean would be offered. So prior to these new guidelines, mothers being cared for within the NHS would expect to have to go through natural labour unless sound medical reasons existed.

NICE recommends that mother’s considering to opt for a C section should receive counselling from a midwife. That seems sensible until you look at resources currently available. Just two months ago, the Royal College of Midwives warned that some areas of the country face ‘dangerous shortages’ as the number of trained professionals has not kept pace with the rising birth rate.

This is where all my other hats kick in. Yes – in a perfect world patient choice would be absolute, although the wisdom of choosing major abdominal surgery when not essential could be questioned.  But we don’t live in a perfect world. Especially in the land of healthcare. Midwifery resources are already stretched, so how can this counselling realistically be offered? NHS Hospitals are severely stretched so how can it be sensible to offer a potentially huge number of extra surgical interventions with the resulting increase in bed occupancy and procedural   costs?

Every treatment option must be considered in the context of medical inflation and the dire financial straits of the NHS. It isn’t helpful to those trying to balance the books when an official body eases open a potential floodgate of cost and resource pressure.

As the NHS faces it’s most drastic reform and cost cutting measures, all agencies must try to work within the context of this reality.

We don’t just need joined up care – we need joined up thinking.


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