Belinda Phipps 

Women need choice, not caesareans

Belinda Phipps: Figures show the NHS's Maternity Matters programme is failing. Empowered mothers would choose fewer medicalised births
  
  


The latest maternity figures released yesterday for England are very concerning. Reduced spontaneous deliveries, increased medical interventions and high caesarean section rates mean that women are not getting the type of birth they want and many are not getting the safest birth.

There's a 4% increase in the number of births in consultant wards and a decrease in birth in NHS midwifery facilities. This is exactly the opposite direction to that intended in the government policy, Maternity Matters, which includes the government's promise to allow women in England to choose where they give birth.

These new figures demonstrate the effect of the lack of progress highlighted in the National Childbirth Trust's Location, Location, Location report released this week. Large numbers of women do not have a realistic possibility of choosing between a birth centre run by midwives, a consultant unit or a home birth.

If women did have choice, we would be expecting to see a falling caesarean section rate, far fewer women choosing obstetric units, a network of birth centres being used by 20-40% of women and a home birth rate approaching 30%. When healthy women can choose care at home or in a unit run by midwives, they are more likely to have straightforward births that are a safe and positive experience.

Worryingly, England's caesarean section rate is at 24.6%, well beyond the World Health Organisation's recommendation of 10-15%. Obstetric units are there for women and babies with medical problems. It is quite wrong to fill them with healthy women who, given the option, would not choose them.

If the government were serious about Maternity Matters they would believe the data in our recent report and the data released today, which backs up our claim that the policy is blocked.

Careful analysis of the financial rules that drive the way the NHS measures itself reveals that they make it financial suicide for a hospital to reduce its caesarean rate or to open birth centres. This could be resolved by the wave of a pen, with no cost to the NHS.

What we need are managers, politicians and civil servants to make the system changes so the clinicians, working to a great set of maternity policies, can get on and provide the choice that women and families deserve.

 

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