Too-posh-to-push women 'should pay for their own caesareans'
Last Updated: 12:01am GMT 09/01/2007 Women who have caesareans as a "lifestyle choice" rather than for medical reasons should have to pay for their treatment, a leading public health expert said yesterday. NHS money would be better spent on expensive cancer treatments than on mothers who choose the procedure because they are afraid of the pain of labour, Dr Tim Crayford, president of the Association of Director of Public Health, said. The caesarean rate has risen from nine per cent of all births in 1980 to almost 23 per cent in 2004-05. There has been growing concern over the phenomenon of so-called mothers-to-be who are "too posh to push". Recent surveys have shown rates vary across the country, from about 20 per cent in the North East to almost a quarter in London. According to the World Health Organisation (WHO), the proportion of mothers that need caesareans for medical reasons should be 10-15 per cent. Dr Crayford, who is also director of public health at Croydon primary care trust, said: "If we have to choose between caesareans for those who are 'too posh to push' and money for cancer drugs like Herceptin then I'd say give the money to Herceptin, no question. This is an ideal opportunity for the NHS to review what is does. I would prefer that every £1 spent on health care delivers the most benefit for the population. "When the NHS is not spending money on really important public health measures but spending it on what people want, then this is a debate we should have." A caesarean costs the NHS an average of £1,000 more than a natural birth. If the WHO is right that about 60,000 "unnecessary" caesareans are being carried out in England and Wales per year, the extra cost to the NHS is approximately £60 million. Most caesareans are carried out because of medical complications, a slow progressing labour or the mother having had the surgery during a previous birth. The proportion performed as a result of a request by the mother is about 1.5 per cent of all births. In 2004 doctors were told by the National Institute for Clinical Excellence (Nice) and the National Collaborating Centre for Women's and Children's Health that they should not automatically arrange caesareans on request without legitimate medical reasons. Nice also said caesareans made it less likely for women to go on to have further babies, had a higher incidence of certain birth complications and were more likely to lead to subsequent stillbirth. Dr Crayford also said money could be saved by removing fewer tonsils and performing fewer hysterectomies. "Tonsillectomies do benefit some individuals but it is a very small number," he said. "Many haven't had a sore throat for six to nine months but, because they've been on a waiting list, they still have the operation." About 50,000 tonsillectomies are carried out in England every year, costing the NHS £40 million. Dr Crayford questioned why a hysterectomy costing £2,800 is sometimes carried out to prevent heavy menstrual bleeding when a coil costing £100 can do the same thing without surgery. Best Regards, Kelly Zantey Creator, <http://www.bellybelly.com.au> BellyBelly.com.au Conception, Pregnancy, Birth and Baby <http://www.bellybelly.com.au/birth-support> BellyBelly Birth Support
