Tuesday, 12 March 2013

I'm Too Posh to Push - The Telegraph has Proof!


I've been AWOL from here for a while, small kids, very busy blah blah blah, but if one thing was going to get me back to the blog it would be shoddy journalism about C-sections. So, thank you The Telegraph, you've got me back in the saddle:

Here's the story: "Caesarian rates support 'too posh to push' theory". To summarise: Chelsea and Westminster hospital has a C-section rate of 33%, at King George hospital in East London it's 8%. Lots of posh people live in Chelsea, lots of poor people live in the east end, therefore the 33% are too posh to push. Also, C-sections cost the NHS "several times more than a natural birth" and mean the mother is "three times more likely to need a hysterectomy after their next pregnancy" while the baby is at increased risk of "death, blood clots and breathing problems".

On the face of it it's pretty damning. Posh women in Chelsea are risking the lives of their infants and draining NHS resources because they just can't be bothered to pop their babies out properly. 

Except that's utter rubbish, and here's why:

Firstly it assumes that everyone in Chelsea is "posh". Certainly there are a lot of wealthy people there, the cheapest house currently for sale in the area is a 2 bedroom cottage going for £1,150,000. But there are plenty of  "poor" people too, in council flats etc, London is just like that- who do you think is more likely to use an NHS hospital for the birth of their child?*

Secondly, 33% is the overall C-section rate, i.e. it includes emergency C-sections. I had an emergency C-section, after 34 hours of unremitting contractions - was I too posh to push then? Even after an hour and a half of, well, pushing? Ok, the writer also points out the the hospital has the highest rate of elective caesareans, with "16 percent of births performed by choice rather than as an emergency". But this is also misleading. There are only two types of c-section, emergency and elective. So those that take place because of e.g. a transverse baby that could not be delivered vaginally, or a severe heart condition in the mother that means she could well die in labour, are still "elective" although there is very little choice in the matter. The Chelsea and Westminster hospital has a high risk maternity unit, women with exactly these kinds of issues are referred there so it's hardly surprising that they have a higher than average C-section rate.

But what of the cost to the poor old NHS of all these C-sections? Well the Daily Mail re-hashed the Telegraph piece and tells us: "caesarean section costs the NHS about £2,600, more than double the £1,200 cost of a natural birth" Not exactly "several times more" and we're not told where those figures come from either. The only ones I've seen in the past put the cost of a C-section higher, but importantly don't include the costs of treatment and surgery for women who suffered damage during a vaginal birth, or the astronomical costs of a lifetime of care for those (thankfully rare) cases where a child suffers permanent brain damage after eg. shoulder dystocia leads to them being deprived of oxygen during a "normal" birth.

Ah - but C-sections are more dangerous for everyone we're told. I have no idea where the three times more likely to need a hysterectomy figure comes from, guess what - no reference! But even assuming it's true, it's still meaningless. Does it mean 60% of C-section mums need their womb whipped out compared to 20% of those who did it properly? It could equally be 0.0000003% v 0.0000001%. Show me the stats! 



What's more important? A Natural birth or a healthy baby?

Where the baby is concerned, my consultant agreed that there is indeed an increased risk of breathing problems. But if the baby is delivered after 39 weeks (as is standard if there is no good reason to do it earlier), then that risk becomes negligible. And yes, more do die after a c-section, but not because of the c-section. The vast majority of those poor babies had developed serious problems before or during birth, they were delivered surgically as it was the best hope of saving them. They would not have survived a vaginal birth either but their mothers were brave enough to endure major surgery in the hope of saving them. 

How dare anyone label those women too posh to push?

But finally, what about those brave, poverty stricken women in East London, delivering their babies by the Telegraph approved method? Well after five minutes on Google I discovered that the King George hospital maternity services are about to be shut down. The unit currently only accepts low risk women with everyone else going to the Queen's hospital, ten minutes away in Romford. No one choosing, or even needing a c-section would be sent to King George's, even women in labour there who need one unexpectedly are likely to be ambulanced to Queen's instead. To use their 8% C-section rate as a yet another slap in the face to C-section mothers is either lazy, callous or both. 

This matters because the vast majority of women who have had C-sections didn't want them. They, we, endured major surgery because we genuinely believed it was the safest thing for our babies and for ourselves as the mothers who would care for them. Comparing the stats from different hospitals is meaningless to the unique situation of any individual mother and if those numbers are deliberately (or just lazily) fiddled, to produce clich├ęd headlines then they are not only meaningless, they are also deeply offensive. 


SBxxx
PS. C-section mum Kirstie Allsopp responded to this piece too, you can read her letter to the Telegraph here
PPS. Neither the Telegraph or the Mail state where the figures come from, my best guess is here

*The hospital does have a private maternity service, but the article doesn't state if this was included in the figures, or if so, what proportion of the c-sections it accounted for.

17 comments:

  1. Hear hear! Three medically necessary c-sections and not feeling anything but relief that we're living in a country which provides this kind of life saving operation for its citizens.

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    1. Indeed, in another time or place a lot of us (and our children) wouldn't have made it, the NHS is highly flawed, but thank heavens we have it!

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  2. I had an elective c section for the birth of my second daughter. The first birth ripped my pelvic floor muscles to shreds and my baby was in distress because she was stuck. Rather than being too posh to push, I put the life of my second child and myself first by having an elective c section. It is not an easy option to have major abdominal surgery so perhaps the ones who think it is should wind their necks in. For the absolute minority of ladies who think a c section is an easy option, I urge you to think again. If you watched a c section being performed it would terrify the living daylights out of you. Why do you think they have a green curtain between you and your nether regions? However it is a safer option in some circumstances and thank God for that.

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    1. similar story here, emergency c-section first time after the baby got stuck, elective second time as I wanted the safest possible option. I'm also yet to see one of these articles where they actually have a mother who wanted a C-section for no good reason!I can't imagine there are many women that foolish.

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  3. Great blog post. There are also all the elective c-sections for ID twins that are at the consultants insistence not the mothers. This type of journalistic hype seems to be the fashion at the moment. Long gone are the days of well written and researched articles. Part of the reason why I don't read newspapers anymore

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    1. gah - my own blog isn't allowing me to reply to your comment! I'll try again..

      Thank you! I'm sure most "elective" c-sections are really done for reasons like that, I guess "mum does best thing for her kids" just isn't very sensational.

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  4. Woah! Good stuff. Never read so much sense written about this issue, unless you count Kirstie Allsopp's response to the Telegraph piece and this http://www.telegraph.co.uk/health/women_shealth/9922563/Were-not-too-posh-to-push-idiots-off-cliffs.html by the Telegraphs journalist Bryony Gordon.
    I had twins. My main concern was getting two healthy babies. By the time it transpired at 34weeks that the slowing growth rate of my son and my rocketing risk of pre-eclampsia was putting that aim in danger I just needed to get them born. But because there was an 18hr gap between my consultant saying 'we need to get those babies out in the next 24 hours' and my actual Csection, it counted as elective. Too posh to push really winds me up!!!

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    1. Ooh I can see how that must be especially annoying to you Fee! Why should mothers be criticised for doing the best thing for their baby? I hope you and the twins were fine, thank heavens the c-section option exists for us in the UK.

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  5. Great post. When I read The Telegraph's article I just felt depressed-here we go again. I had an elective c-section for my second child because of complications arising from my first pregnancy and birth. I didn't make the decision lightly and was supported throughout by the brilliant medical teams. I wasn't able to breast feed my first child either for medical reasons, so I fit all sorts of stereotypes. Shoddy journalism, snap judgements-get it all the time.

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    1. Thank you! How sad that there even is a stereotype for that, surely it's just Mum doing her best?

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  6. Quite right! I had an EMCS and I don't think anyone who's had one of those did so because they were 'too posh' to have the baby naturally, that's why it's an emergency!! Why on earth would your choice of how to give birth be down to your class or social status anyway? Do rich people like having surgery?? Typical papers looking to annoy people...

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    1. Agreed! I doubt many women, if they had any idea of what's involved would choose surgery

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  7. Fantastic post! The media is always looking for ways to belittle mums for some reason or other, as if mums don't feel guilty enough about everything as it is. I agree that the stats have been totally massaged to suit the article. Must be a slow news week if they've resorted to insulting mums again.

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  8. Thanks! The laziness and predictability of these pieces would be shocking if it weren't so common!

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  9. Thanks for this, you inspired me to write my own response here, http://www.rrgwebdesign.com/why-articles-about-caesareans-make-me-so-mad/

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  10. Might as well rename Romford's Queen's Hospital as The East London General Hospital.

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  11. I know this is an old-ish article, but I have just come across it during my research around how I will deliver my baby. Being 12 weeks pregnant, I am already being pushed to have a vaginal delivery, with midwives refusing to talk about risks of natural birth (inc. perineal tears) and happy to talk horrors about c-sections. Having looked at the new NICE guidelines, the reality is that c-sections and natural deliveries both have associated risks. The choice is about which risks you are willing to face, including for your baby. I am in no way ashamed of having a C-section, especially after looking at NICE risks and statistics. People should get better informed. Tks for the article, I really appreciated your inputs and found this really interesting!

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