Unnecaesarean

I must confess that I “borrowed” this clever title from a blog written by a group of mothers who are birth activists and one Obestetrician Gynaecologist in the USA. The Unnecesarean is full of birth stories and information on how to avoid unnecessary caesareans (Americans leave the ‘a’ out of caesarean). But don’t worry, just like that site doesn’t, I’m not about to start ranting about why people should never have caesareans.

I’ll even mention a couple of really good reasons why people SHOULD have caesareans; for example, when there is fetal distress (that’s when the baby’s heart rate drops), or there is a maternal complications (such as, unstable blood pressure or an epileptic fit etc.), or labour has been going for too long with no progress, or when there has been significant complications from perineal trauma from a previous birth (such as incontinence or fistula). Like I said, I’m not against caesareans.

BUT… And it’s a big but, there are many many risks that I don’t think people really take seriously enough. Just some of the risks for the mother include excessive blood loss, infection either in the uterus (in severe cases can cause infertility problems) or in the scar itself and in future pregnancies the placenta is more likely to imbed over the cervix (called placenta praevia). Not to mention the longer hospital stay and recovery time. There are also some serious risks to the baby, including respiratory distress, low apgar scores and the need for additional resuscitation methods (especially when mums need a general anaesthetic), sometimes forceps are needed to deliver the head and the doctor can sometimes accidentally “nick” the baby with the scalpel. Not to mention that in some hospitals there will be a prolonged time prior to initiation of breastfeeding and “skin to skin” time is difficult and awkward in theatre.

So, knowing that I didn’t write to give you all a lecture, the reason I did decide to write on this topic is to share my excitement about a document that the NSW Department of Health released in June last year, entitled “Towards Normal Birth“. This document arose out of concern regarding The Mother’s and Babies Report, 2006, that stated that the caesarean rate in NSW hospitals had risen by a staggering 10% from 1998 to 2006. The increase is such a concern because there is more and more evidence of increasing maternal mortality and morbidity associated with caesarean birth. Normal vaginal birth is much safer (and significantly cheaper) for mothers and babies.

I just wanted to highlight some of my favourite points in the “Towards Normal Birth” document. Under the heading “Purpose of the Action Plan” there were 7 points. Two of which particularly stood out to me:

  • reduce the use of interventions that women experience in labour, particularly augmentation of labour, analgesia and electronic fetal monitoring
  • reduce unnecessary interventions

Yay! Hopefully this means we will be working towards NOT doing continuous CTG’s(strap on baby monitor that means you can’t move further than the 1 meter cord or use shower or bath for pain relief) on such a huge number of women. The second point makes me a bit sad… shouldn’t we already be doing this? There should never be unnecessary intervention!

The document also highlights an implementation process with 10 steps to providing woman centred labour and birth care. Here are  a few of the Area Health Service requirements for adoption and implementation of the 10 steps, that I am particularly excited about:

Within Step 3

  • plan and implement strategies to enable women the option of a program of care so that the woman has known midwives providing her individualised care. Collaborative midwifery/medical programs of care, with obstetric/GP obstetric and midwifery support and leadership should be available in labour wards appropriate for the role level of the maternity service.
  • ensure midwives have opportunities to work in continuity of carer programs and provide access to professional development and skill development where needed (Excellent! More caseload programs, with more training courses to make us feel confident in our skills, ie. suturing, cannulation)

Within Step 4

  • provide women desiring a vaginal breech birth access to clinicians that will support this choice. (Yay! See my post about vaginal breech)

Within Step 5

  • develop written policy on pain relief in labour that includes: providing a leaflet for women talking positively about the use of water for pain relief and citing the evidence; encouraging women to move around and adopt positions of choice; the use of water immersion in labour and birth. (Yay! Finally there will be a written policy encouraging midwives to encourage women into water… no more being “not comfortable” with waterbirth!)

Within Step 8

  • provide access to vaginal breech and vaginal twin birth services (Yay! No longer will a woman have to fight to get the chance to birth naturally)
  • provision of training packages and networked support for obstetricians, obstetric registrars and midwives
  • provide access to opportunities for observation and clinical training in these two areas (Yay! We won’t have to be unfamiliar and scared of these variations on normal because we will be trained and supported)

All of Step 9 (massive WOO to the whole lot!)

  • change maternity unit physical environments to facilitate electronic point of care documentation – this can reduce the time that midwives spend away from women and permit accurate, timely information to be recorded
  • keep a woman’s medical record with her throughout her intrapartum care
  • implement local guidelines/protocols that discourage activities that separate midwives from the woman in labour. This includes the use of centralised monitoring systems as they discourage midwives from being with the woman in the labour room (the use of use of CTG /EFM should be in accordance with Safety Notice 004/07)

So as you can tell I’m pretty excited! Because there is a mandatory compliance requirement by 2015, I know that things are looking more positive and will definitely improve for normal birth within NSW hospitals! Good luck and let’s stay motivated!

 

 

 

 

 

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