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Elective caesarean now available for all mums-to-be

A caesarean delivery will be offered to all pregnant women who ask for one, even if there's no medical need, according to new NICE guidelines

Posted: 23 November 2011
by Lara Brunt
Pregnant woman with doctor
NICE insists the new guideline "is not about offering free caesareans for all on the NHS"

Women should have the right to a caesarean, even if they have no physical or mental health need, according to guidelines published today.

The revised guidelines from the National Institute of Health and Clinical Excellence (NICE) say that women requesting a caesarean because of anxiety about childbirth should first be offered counselling.

NICE states: "If after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS [caesarean section]."

The revised guidelines say that women should be told of the risks of a c-section, however, ultimately the decision rests with the mum-to-be.

Dr Gillian Leng, NICE Deputy Chief Executive, said: “This guideline is not about offering free caesareans for all on the NHS; it is about ensuring that women give birth in the way that is most appropriate for them and their babies."

Tokophobia, or fear of childbirth, is thought to affect 6% to 10% of women.

Cathy Warwick, Chief Executive of the Royal College of Midwives, said she was pleased to see the recommendation that women with a fear of childbirth be referred for counselling.

"We know that when such individualised support is offered, for example in consultant midwives' clinics, these anxieties can be allayed for many women, and they can go on to have a normal vaginal birth," she said.

The NICE panel emphasised that only a very small proportion of women who don't have a physical or psychological need actually end up choosing a caesarean.

Malcolm Griffiths, consultant obstetrician and gynaecologist at Luton and Dunstable hospital, who chaired the guideline development group, said: ”Caesarean section is major surgery which most pregnant women want to avoid if they can. We want women who do not need to have a CS to be able to avoid such surgery."

Other changes to the guidelines include offering Vaginal birth after caesarean (VBAC) to women who had undergone up to four previous caesareans.

Mr Griffiths said: "The guideline also dispels the myth that ‘once a caesarean, always a caesarean’ because the evidence shows that for women who have had up to and including four previous CS, the risk of fever, bladder injuries and surgical injuries is the same with a planned CS as it is with a planned vaginal delivery, and the risk of the uterus rupturing is rare."

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