Mothers could be denied painkillers when giving birth in NHS cutbacks
Guidelines also suggest denying women caesareans and encouraging mothers-to-be to give birth at homeTop doctors say plans will reduce choice without any guarantee of a better outcome



16:32 GMT, 30 August 2012

Women should be denied caesareans or refused painkillers during labour to save the NHS money, according to guidelines.

They should also be encouraged to give birth at home or in centres run by midwifes – rather than in hospital.

Controversial advice sent round to GPs urges them to try and increase the numbers of women giving birth naturally, without c-sections, epidurals or other strong painkillers.

Plans to ration epidurals have met with criticism from senior doctors

Pain relief: Plans to ration epidurals have met with criticism from senior doctors

C-sections cost the NHS around 1,200 a time while epidurals – aesthetic injections into the spine – are around 200.

As well as being expensive, the guidelines state that they slow-down a mother’s recovery after labour, and impede breastfeeding.

But the advice – drawn up jointly by the Royal College of Obstetricians and Gynaecologists, the Royal College of Midwives and the National Childbirth Trust – has enraged campaigners and senior doctors.

Felicity Plaat, Consultant anaesthetist at Queen Charlotte’s Hospital, London: ‘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 the charity Perinatal Illness-UK, which supports women with postnatal 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.

‘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 and achieve increased rates of uncomplicated births by reducing the availability of labour 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 the Government’s NHS reforms.

It tells family doctors to think of midwife-led centres as the ‘default’ option for labour, rather than hospitals.

Although most women currently 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 encourage women to give birth entirely 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 naturally.

But the advice contracts new guidelines from the health watchdog NICE which states that women should be offered c-sections if they were very worried about giving birth.

Earlier this year the National Institute of Health and Clinical Excellence relaxed its rules and stated that those who had a particular phobia of birth should be allowed the operations.

The RCOG has since removed the document from its website although it has already been read by a number of doctors and health professionals.

It will hold a meeting next week to discuss whether they should be re-written.