This week’s blog reports on the controversial news that mothers may soon be able to choose their mode of birth delivery as the caesarean may become available for all mothers rather than just when it is medically needed.
What is a caesarean?
A caesarean, or c-section, is an unnatural procedure for giving birth, which is performed under a regional anaesthetic, called an epidural, which numbs the lower part of the body but allows the mother to be awake during the operation. The procedure usually lasts 30-45 minutes, however an emergency caesarean can be performed in 30 minutes. The baby is delivered by making 2 main incisions; one horizontal incision in the lower abdomen and another horizontal incision in the wall of the womb. In 2 out of 100 cases, the baby’s skin is cut when the womb opening is made. Recovery after a c-section often takes longer than a natural birth, and there may be after-effects such as infection.
Currently women cannot choose to have a caesarean, but the decision is made for them by Doctors for medical reasons. Factors which effect whether a c-section is necessary include the size of the baby’s head, the shape or size of the pelvis, the positioning of the placenta, whether twins or triplets are expected, the baby’s positioning, whether the baby becomes distressed or mother’s illness e.g. high blood pressure (1). However, this may be about to change next month in the news that NICE are making plans to make c-sections an open option available for healthy mothers at their own choice.
Arguments for the change
The change will come with great controversy. Among those for the availability of c-sections is Dr Bryan Beattie, who helped write the existing c-section guidelines. He states that the move to open c-section availability is a “huge development in terms of allowing women to make an informed choice”. Other similar arguments say that living in the 21st century means women have the right to choose their mode of baby delivery.
Despite the caesarean being major abdominal surgery, C-sections are reported to be now safer than ever, as they are performed more commonly. Nowadays complications affect less than 20 in 10,000 babies (2).
Arguments against the change
However, there is fierce opposition from midwives and natural birth campaigners. Some people believe that the NHS should not fund the extra costs for a procedure that is medically unnecessary. Caesareans are £800 more expensive than natural births, and therefore when the demand rises, the NHS will be faced with an added financial burden which no one knows if they can actually afford. Caesareans have boomed in popularity and are now performed in just under a ¼ of deliveries, compared to 9% back in the 1970’s. It has been suggested that this could be partly due to the rising ages at which mothers give birth and rising obesity levels among pregnant women.
It has been calculated that reducing the number of caesareans a year by 1% could save the NHS £5.6 million a year. Can the NHS afford to lose this money and what will suffer in its place?
Unsurprisingly, not all Doctors will agree to performing caesareans without need, due to the problems associated with it. These include that women need to stay longer in hospital, there are higher readmission rates and more abdominal pain. Those Doctors that oppose the operation will be able to refer patients to other Doctors.
The National Institute for Health and Clinical Excellence is due to publish the new guidelines next month. Let us wait and see the controversy unfold in front of us.