BTA go to the Equality and Human Rights Commission on epidural denial

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The Birth Trauma Association has approached the Equality and Human Rights Commission to investigate whether Trusts who permit denial of pain relief to women in labour are breaching equality legislation. There certainly appears to be a case to answer as there is no other field of medical practice where individuals are denied access to pain relief for prolonged periods. The case has now been ‘under consideration’ by the EHCR for six months and is proving ‘controversial’

Epidural analgesia does have some risks; dural tap can cause severe headache in around 1 in a hundred cases but all forms of anaesthesia carry risks and balanced against the likelihood of the very severe pain of labour, these risks are for the mother and the mother alone to evaluate.

Unfortunately, the existing cultural attitudes to pain relief such as those expressed by Dr Denis Walsh still prevail. This has resulted in very little research into improving pain relief for labouring women and eliminating the small risks that currently exist. There is already scope for improving the placement of anaesthetics into the epidural space but very few UK trusts have invested in these technologies; the severe and sometimes traumatising pain caused to women in labour is still considered ‘normal’ and therefore unimportant. Until this is changed, “we [the BTA] believe those Trusts denying women pain relief are guilty of unacceptable and quite blatant discrimination”.

Antenatal advice ‘perpetuates C-section myths’

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Leigh East has written an article for BBC Health discussing the impact of inadequate antenatal education on women’s birth expectations and their increased likelihood of birth trauma as a result.

“With over half of UK births involving intervention, women need to know more about their options so they can assess the risks for themselves.”

“But all too often the risks of vaginal birth are significantly downplayed while caesareans are portrayed as an intervention to avoid wherever possible, with those planning a Caesarean labelled selfish or “too posh to push”.”

“…the majority of women still understand so little about C-sections that it should come as no surprise to find that many find their experience, if they have one, extremely traumatic, so severe in fact that some go on to develop post-traumatic stress disorder, while those who want or need to plan a Caesarean are left totally unaware of the opportunities for making their birth feel special and personal.”

“Unfortunately the toxic combination of out of date or inadequate information and biased advice means that women will continue to face their birth with huge gaps in their knowledge leading to unnecessary trauma.”

Maternal requests should be supported within the NHS

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NICE have issued (subject to typos) the new version of the Caesarean Section Guideline. There have been a number of significant steps forward in this version. In particular the following:

  • Recommendation 38: For all women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.”
  • Recommendation 39: An obstetrican has the right to decline a woman’s request for a CS. If this happens, they should refer the woman to an NHS obstetrician in the same unit who will carry out the CS.” pg 12
  • NICE “agreed that it is important that women are presented with evidence based information in order that they are able to make an informed decision. The reported benefits and harms can then be discussed with each individual woman to help her make decisions based on the relative trade off between the two modes of birth interpreted in light of her own circumstances.” pg 63
  • NICE “agreed that when discussing the risks and benefits outlined in the table, the healthcare professional and woman also need to consider the woman‟s individual circumstances which affect the risks associated with vaginal birth and CS such as previous abdominal or pelvic surgery, impaired mobility from pelvic girdle pain, or care of other children. It is also important to discuss the number of future babies that the woman and her partner are planning as some risks such as placenta praevia increase with an increasing number of CS.” pg 63

NICE Caesarean Section guideline reviewed

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Our members have actively participated as ‘stakeholders’ in the review of the NICE Caesarean Section guideline. This new version will be an update to the 2004 guideline and as such will be tackling only specific topics namely:

  • the diagnosis and management of morbidly adherent placenta
  • the care of women with HIV
  • the appropriate decision-to-delivery interval for unplanned CS
  • the timing of antibiotic prophylaxis provision
  • the risks and benefits of CS and vaginal birth
  • the risks and benefits of vaginal birth following a previous CS
  • and the appropriate care pathway for women requesting a CS in the absence of an obstetric or medical indication.

“There is no target for the rate of caesarean sections in England”

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The Department of Health today confirmed to Leigh East Editor of csections.org that “there is no target for the rate of caesarean sections in England.” This follows a week where statements have been made by various health professionals using the old recommendation from the World Health Organisation (15%-a figure retracted in 2009) to boost their argument that maternal request planned caesareans without medical grounds should be banned.

WHO retracted their 15% caesarean rate target 2 years ago!

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Two years ago we called for the retraction of the World Health Organisation’s recommendation that the caesarean rate should not exceed 15%.  Press coverage at the time highlighted this change (BBC) (Medical News Today)

The WHO’s ‘Monitoring Emergency Obstetric Care: a handbook’ now states that there is “no empirical evidence for an optimum percentage”, an “optimum rate is unknown,” and world regions may now “set their own standards”.