PCTs impose restrictions on caesarean sections

I agree with Paul Armstrong. I chose to have two caesarian sections after witnessing the brutality of "normal vaginal deliveries" that are the culture of the NHS.

At the time, the hospital was a training hospital for midwives. If they hadn't done a certain number of episiotomies by the end of their labour placement they had to repeat it and get left behind compared to their colleagues.

The rule was, if a woman had not had an episiotomy, she needed one. If she had not had an episiotomy she needed one. No escape.

These episiotomies were sometimes done with local but frequently they were not. The idea was that at the height of a contraction the woman didn't feel it.

From the screaming and jumping about the bed, and from direct questionning of these poor women, it was obvious that they suffered up to three hacks with scissors and this was extremely painful. Some midwives refused to accept this but others did.

I was sick of seeing well motivated, brave women completely lose it in the second stage of labour due to the pain and anxiety involved.

Midwives shouted at women to push as if it was a football match.

Forceps deliveries are brutal and not without risk to the baby and the woman's perineum.

I also did a neonatal paediatrics. I would go along and ask who was in labour and I would take note of the room numbers were difficult deliveries were anticipated. When my bleep went off I would go straight to the problem room. Sometimes the birth had not happened, sometimes the baby was out fine. More frequently it was "Mrs Normal" whose birth had gone badly and I needed to resuscitate a floppy, navy blue baby.

It is a medical joke that the first three minutes of your life comes only second to the last three minutes when danger is concerned.

If these babies get brain damage their entire lives and that of their parents is severely blighted.

I want to see caesarian sections on request for everyone.

Women need to know the risks and what can go wrong at sections and for other types of delivery. By word of mouth from other mothers they should be able to find out which hospitals practice humanely and those that don't.

There is a conspiracy of silence in the NHS about the bad and brutal practices that go on in labour wards.

Women are not being provided with balanced information about the risks and benefits of different birth plan. Instead, planned cesarean risks are all too often over-exaggerated, while planned vaginal birth risks are under-estimated or even ignored altogether.

We need to let women know the true facts (without ideological bias - without assuming that all women want the same thing - and without fearing what might happen to the cesarean rate if we do), and after a balanced, individualized consultation, let them decide on their preferred birth plan.

In terms of cost, there is actually evidence that a planned cesarean is no more costly than a planned vaginal birth - when comparisons include costs beyond the immediate intrapartum period (e.g. treating infant and maternal birth injuries, and also litigation costs). The figures being quoted in the media this week are completely erroneous, and add little to this controversial debate. Comparing the cost of spontaneous vaginal births with cesarean births ignores the fact that a significant proportion of women will NOT have a spontaneous vaginal birth outcome - even if they want one - and for those that don't, their birth carries a greater cost psychologically, physically AND financially (compared with a maternal request cesarean).

Here are some example NHS stats for England:
(2009-10)
Emergency cesarean 15%
Episiotomy 15%
Instrumental 12%
(2007-08)
Perineal laceration 36.6%
Fetal distress 21.5%
Long labour 10.5%

Many doctors are making the decision to avoid the unpredictability of labor and elect to have a cesarean (with no indication); it is therefore only right that lay women be allowed access to this legitimate birth choice too.

Finally, I'd like to share details of my blog (cesareandebate.blogspot.com), my website (electivecesarean.com) and my latest youtube video (http://www.youtube.com/watch?v=8XMKMUegtjo).

I trust that this is acceptable.