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Demand for Caesareans is Fuelled by the Fear Caused by NHS Cutbacks

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I am a lay member of the Association of Radical Midwives (ARM). I agree that women should have choice in how they have their baby, and for a very few women, that may mean choosing a caesarean. Some women are so afraid of losing control during birth that they would rather hand over control to a surgeon than risk needing an emergency caesarean. Has NICE considered why women are asking for elective caesareans? Could it be because the NHS factory system of birth is traumatising too many women? Women are scared stiff of birth and the NHS emphasis on risk only fuels the flames of fear.

ARM would prefer that women were able to opt for low tech solutions to the problem of traumatic childbirth. Three such solutions spring instantly to mind: firstly, birth centres where midwives look after you during labour and birth; secondly, water birth - labouring in water goes a long way towards reducing the stress of labour, and thirdly having your own known midwife from the early days of pregnancy through birth and during the early days of parenthood.

NHS cutbacks have closed birth centres - birth centre midwives are pulled in to labour ward when it is short staffed. (This is a bit like calling in GPs to work in hospitals and shutting the local surgery.) Waterbirth is discouraged because it ties up one midwife with one woman throughout labour and in large obstetric units midwives are running around in ever-increasing circles trying to look after three or more women in labour at a time. Wherever caseload midwifery has been tried, women have loved it and midwives jump at the chance to work that way. (The next issue of Midwifery Matters, ARM's magazine, will tell of the rise and fall of one-to-one midwifery in Sheffield.)

But caseload midwifery is considered elitist and, to be honest, the hospitals might not like midwives having that much autonomy. It can make both the women and the midwives bolshie - they may choose to follow NICE guidelines instead of hospital guidelines, they may even choose to decline medical intervention. Hospitals may prefer to have women - mothers and midwives - under their control. Guess what: women lacking control have more pain during labour and overworked midwives lacking control have more days off sick with stress - and so the cycle goes on - fewer midwives spread ever more thinly until the maternity services are at breaking point and the mortality rates go up.

Am I being cynical when I say I think NICE is allowing elective caesareans for maternal request because the lawyers prefer it? I can think of only one case where a woman has won a law suit for having a caesarean against her will. It is more usual for lawyers to win cases by arguing that a caesarean would have prevented brain damage. The cut and repair of a caesarean wound (often followed by infection and sometimes by infertility) is not considered as damage to the mother.

And are women going to be warned how much pain to expect after the operation? It's not easy caring for a newborn baby while recovering from major surgery. Are elective caesarean mothers going to be warned that their babies are more likely to suffer respiratory distress and need time in SCBU and are less likely to be successful breastfeeders? Who will be counting the cost of the harm done to mothers and their babies?

If the NHS has £800 to spare for each birth, the money would be better spent on keeping local birth centres open and enabling mothers to have their own local midwife.

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