‘Planned home birth reduces likelihood of caesarean section’

Abstract

Last month’s ‘Hot Topic’ focused on the recent guideline on caesarean section published by the National Institute for Health and Clinical Excellence (NICE) (2011). It compared the sensational headlines generated by the guideline, e.g. ‘Women promised caesarean section on demand!’, with the reality of the actual content of the guideline which is more broad and complex than such headlines would suggest. However, members of the public do not, on the whole, access the whole guideline, and often believe the newspaper headlines. Many midwives in clinical practice have noticed and commented on the reaction of pregnant women and their partners to the newspaper coverage of the guideline. An increase in request for elective caesarean has been widely noted, with women expressing relief that they believed they could now opt for a caesarean section. These requests have not, in the main, come from women who have serious fears or a phobia about birth; rather they reflect the current crisis in women’s confidence in their ability to give birth, and the rising anxiety levels of partners and members of their families and communities. This is a major challenge to us as midwives. Rebuilding women’s confidence is absolutely key to helping them rediscover their ability to labour and to birth their babies, without surgical intervention. There are other elements of the NICE guideline which could, potentially, be equally ‘headline-grabbing’. Two of these elements (which were also contained in the 2004 NICE guideline on caesarean section) are concerned with place of birth and support in labour. So one headline could read: ‘Planned home birth reduces caesarean section rates!’ Both the 2004 and draft 2011 guidance documents advise that healthy pregnant women with ‘anticipated uncomplicated pregnancy’ should be informed that: ‘Planning a home birth reduces the likelihood of CS’ (NICE, 2011: 7).