In November of 2011 the Royal College of Midwives reported that in the last 10 years the birth rate in the UK has increased by 22% while medical services suffered a shortfall of approximately 5,000 midwives. The Royal College of Midwives points this out as having serious ramifications regarding patient safety especially in the context of new NHS guidelines. However, in from the point of view of hospital administrators of trying to implement policies without resources to do so safely may increase exposure to claims of medical negligence.
The National Institute for Clinical Excellence (NICE) is informing NHS policy regarding child birth that seeks to educate expectant mothers about the necessarily serious nature of caesarean births. The hope is that though a discussion of the risk involved the number caesarean births as patients opt for “safer options” (i.e. natural delivery). About 25% of all births in the UK are done via caesarean section versus about 14% in Nordic countries, and NICE view this disparity as having largely to do with “myths” having to do with both vaginal and caesarean births.
However, the shortage of trained midwives calls into question the practicality of implementing such a policy. Natural births taking place without the support of a midwife have been shown to contribute to traumatic deliveries that can injure both mother and infant—as well as causing undue distress to the mother. This is significant to the NICE guidelines in that women who have experienced traumatic births in the past are susceptible to developing an unreasonable fear of vaginal birth (tokophobia). Indeed, Malcolm Griffiths, a consultant obstetrician and gynaecologist who chaired the NICE guidelines committee agrees that appropriately attended births were critical in reducing caesarean rates, and that it was not uncommon for women having had a previous traumatic birth to be so emotionally distressed by the incident that they then considered abortion. Nina Khazaezadeh, a consultant midwife added that, following traumatic births, women tended to put off future pregnancies.
The chief executive of National Childbirth Trust, Belinda Phipps, warns that if caesarean rates go up after these guidelines it speaks to the UK failing to provide safe and supportive midwife care. Though, if these guidelines are to be adopted safely at all then a much larger pool of midwives is necessary so as to ensure adequate care for both mother and baby. If this need is not met then poor outcomes in terms of patient care are going to become more common along with the cases of medical negligence.
