Kate Chapman: Is it time to see sense about C-sections?

Kate ChapmanThe UK’s caesarean section rates have risen massively, almost doubling in the past 20 years, so it was with interest that I heard the news that 4 PCT’s in southern England are to stop paying for caesarean sections above the national average rate of 23%.

Each caesarean section costs £800 more than a vaginal birth, so the hospitals stand to lose a lot of money unless they bring the number of sections they do down. 

The implication is, of course, that the rate is high not because of increasing numbers of pregnant women who are old, obese, or have complications.  No, the idea here is to force hospitals to cut down on caesarean sections which are down to maternal choice rather than clinical indication. 

7% of caesarean sections are recorded in patient notes as “maternal request,” but the real figure is probably much higher as clinicians can just stretch the truth and put it down to something else in the notes to avoid having to explain themselves later. 

NICE is toughening up too. It’s currently in the process of updating its caesarean section guidelines, and under new draft proposals, women who are too scared to give birth naturally will be referred for psychiatric counselling to try and change their minds.  In addition, obstetricians who are presented with a woman who won’t even consider a natural birth will be able to refuse to treat them and refer them on. 

So is this just a cynical scheme to deny women a choice and save some cash? Not really. Yes, it will probably save trusts money, but it will also save worried mothers-to-be from undergoing serious surgery for no reason. First time mums who have been told horrifying tales of women having traumatic births may just need some facts, a bit of reassurance, and some time to rethink, which is what they are being offered.

Of course if the changes to the guidelines go through it will be controversial. The UK’s childbearing women seem to have split into two camps. While one side favours the natural approach, with hypnobirthing, doulas, and a paddling pool all that’s required, the other side does not.  There are increasing numbers of caesarean converts singing the virtues of the elective section… Many women now feel that they should have the right to choose how their baby is delivered, and if it’s good enough for Posh Spice…

I’ll finish with a quote from Mumsnet, the home of all considered and reasonable discussion, on the subject of getting an elective section.  “If they keep saying no, “says one Mumsnet user, “then start speculating about the legal consequences of their decision… guaranteed to get a consultant’s attention.”

Kate Chapman is a Clegg scholar, BMJ