Caesareans and pain relief for mothers giving birth 'should be cut to save the NHS money'
01:00 GMT, 31 August 2012
Family doctors are being told to try to talk women out of having Caesareans and very strong painkillers during birth to save the NHS money.
New guidelines drawn up for GPs urge them to encourage women to have natural labours with as little medical help as possible.
They also remind doctors to tell women to consider having their babies outside hospital in midwife-run units or in their own homes.
Pain relief: Plans to ration epidurals have met with criticism from senior doctors
Caesareans cost the NHS around 1,200 a time while epidurals – anaesthetic injections into the spine – are around 200.
The guidelines state that, as well as
being expensive, they both slow down a mother’s recovery after labour
and impede breastfeeding.
The advice does not suggest women should not be given any painkillers, such as gas and air which are commonly used.
However, it specifically tells
doctors to try to reduce the numbers given epidurals and other
anaesthetic injections into the spine.
The advice – drawn up by the Royal
College of Obstetricians and Gynaecologists, the Royal College of
Midwives and the National Childbirth Trust – has enraged campaigners and
some senior doctors.
Felicity Plaat, consultant
anaesthetist at Queen Charlotte’s Hospital, London, said: ‘In the 21st
century, where the resources are available, it’s unacceptable and
unethical to withhold effective pain relief from women who require it.
‘Furthermore, only the woman in pain can decide whether and what analgesia, or pain relief, she needs.’
Deborah Morgan, of Perinatal Illness
UK, a charity which supports women with post-natal depression, said:
‘The physical and mental health of women and the lives of babies are now
being compartmentalised to fit a system.
‘It is not really in their interests, and instead is all about saving money – bottom line.
Warning: Professor Philip Steer, editor-in-chief of the British Journal of Obstetrics and Gynaecology, said that the move would reduce choice without any guarantee of an improved outcome
‘Under the guise of “choice”, women are being covertly pushed into accepting a supposedly cheap option.’
Professor Philip Steer,
editor-in-chief of the British Journal of Obstetrics and Gynaecology,
said: ‘To try to achieve increased rates of uncomplicated births – by
reducing the availability of induction, epidural anaesthesia and
Caesarean section for informed women who request them – reduces choice
without any guarantee of an improved outcome.’
The advice has been sent out to the
new groups of GPs – clinical commissioning groups – which are replacing
primary care trusts under NHS reforms.
It tells GPs to think of midwife-led centres as the ‘default’ option, rather than hospitals.
Although the majority of women have
their babies in hospital, most are perfectly capable of giving birth at
home or in such centres, it points out.
These clinics aim to help women to give birth naturally without epidurals, anaesthetics or the help of doctors.
GPs are also told to discourage women
from having Caesareans, particularly if they had one for their first
birth and are convinced they are unable to have their second baby
But the advice conflicts with
guidelines from the National Institute of Health and Clinical
Excellence, which states that women should be offered Caesareans if they
were very worried about giving birth.
Earlier this year NICE relaxed its
rules and stated that those who had a particular phobia of birth should
be allowed the operations.
The RCOG has removed the guidelines
from its website although they have already been read by a number of
doctors and health professionals.
It will hold a meeting next week to discuss if they should be rewritten.
Expensive: Caesareans cost the NHS about 1,200 a time while epidurals – anaesthetic injections into the spine – are about 200