Sunday, April 08, 2007

I love LUSCS?

Doctors told to reduce caesarean births
The New South Wales Health Department has issued a new directive aimed at trying to reduce the number of unnecessary caesarean deliveries in state public hospitals.

The new policy says a request from a mother to have a caesarean section is no longer a justifiable reason for performing the procedure, if there is no medical reason.

Dr Andrew Child from the Health Department says under the changes a doctor must fully explain to a woman all of the risks associated with a caesarean section before one can be performed.

"It will change the attitude of the staff," he said.

"At the moment the staff are tending to just give it a quick tick whereas this will enforce the need to make sure that all the risks and dangers are very clearly put on the table."

Firstly, does the NSW Department of Health seriously believe that anybody performs Caesarean Sections on a whim, without due consideration for the indication, benefits and risks? Or that women agree to a Caesarean Section without appropriate consultation, advice and consideration?

Secondly, like any surgical procedure, it is normal practise to explain to the patient the risks associated with the procedure that is planned. The only exception to this rule is where the patient is incapacitated (and therefore the explanation goes to the person who is most responsible for the patient), or in the setting of a life or limb-threatening emergency where the patient is unable to understand or comprehend the situation, or time is so critical that there is no option (these usually all happen together). Though obviously in the Health Minister's mind, a Caesarean Section is not like any other operation. Perhaps the only "change in attitude" should start at the top. A Caesarean Section is an operation. A Caesarean Section is an operation. A Caesarean Section is an operation...

Lastly, perhaps there should be a similar edict warning mothers of the risks of not proceeding with a Caesarean Section when recommended, the risks or home birthing, or the risks of getting pregnant in the first place!

Perhaps it might have kept this poor couple out of trouble: Twins' home birth risk 'downplayed'

I am sure that Dr Crippen would have plenty to say, given his Campaign Against Reckless Midwives (or "Madwives", as he prefers). Perhaps we are inevitably heading towards the NHS model of perinatal care - though not if this article from The Times has anything to do about it.

Personally, having just been through the whole business recently, we had a fantastic obstetrician and some excellent midwives in the delivery suite, though once we left for the post-natal ward the quality and empathy of the ward midwives left a great deal to be desired. You get the whole range from the uncaring to the overbearing. Nevertheless, we have each other. And now two little boys.


Dr Michelle Tempest said...

Congrats on the two little fellas. This sounds like a policy which has no bearing on what happens at the grass routes level. Take care over the long weekend.

Sheepish said...

Thankyou for your wishes. As in any industry, there is a lot that happens amongst the grass roots that government bureaucrats do not understand.