Women could be given right to choose Caesarean birth

A Caeserean section taking place A Caeserean section can be necessary for medical reasons

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The NHS watchdog for England is considering giving all women the option to have a Caesarean delivery even if there is no medical need.

Currently women do not have an automatic right to choose a C-section.

The change has been suggested in a draft of a report to be published by the National Institute for Clinical Excellence later this year.

Obstetricians say this is welcome and will "formalise" what many hospitals are doing already.

The C-section rate in England has remained approximately static at about one in every four births or 25%.

Guidelines by the National Institute for Health and Clinical Excellence currently state: "Maternal request is not on its own an indication for Caesarean section" and that: "An individual clinician has the right to decline a request for Caesarean section in the absence of an identifiable reason."

It recommends that women should be offered counselling if they are afraid of childbirth.

Start Quote

It is formalising what was informally happening in most hospitals”

End Quote Consultant obstetrician Patrick O'Brien

NICE is drawing up new guidelines for all aspects of c-section to take account of the latest medical developments.

In the latest draft, it no longer says maternal request is not a justification: "For all women requesting a Caesarean section, if after discussion and offer of support, a vaginal birth is still not an acceptable option, offer a planned Caesarean section."

The finalised guidelines are not due until the end of November. The process is in the stage known as "pre-publication" and it is often the case that even significant details can change before the final report is published.

Patrick O'Brien, consultant obstetrician working in London, said: "It's laudable what they've done, I'll support it.

"I don't think it changes practice a whole lot. It is formalising what was informally happening in most hospitals."

Reasons given for non-medical C-sections

  • Fear of labour or pain
  • Fear of pelvic floor damage
  • Previous bad experience of vaginal delivery
  • A personal assessment of the benefits and risks of a vaginal delivery versus an emergency Caesarean
  • Concern about the impact of vaginal delivery on sex life
  • Viewing a Caesarean as more modern
  • Needing to co-ordinate the birth with a busy or difficult lifestyle

Source: North Yorkshire and York Primary Care Trust

He said that at the moment: "If patients want a Caesarean section, it is generally agreed and if an obstetrician really disagrees the patient is referred."

However, some primary care trusts have recently announced that they are no longer offering C-sections for non-medical reasons.

When North Yorkshire and York Primary Care Trust made the announcement last month, its medical director Dr David Geddes, said where a woman was requesting to have a C-section with no medical reason, the PCT "shouldn't be supporting that" because the procedure was more dangerous than natural childbirth.

Caesareans do come at a higher cost. The NICE report estimates a normal birth costs an average of £1,512, planned Caesareans cost £2,369 and emergency C-sections cost £3,042.

Pauline McDonagh Hull, editor of the electivecesarean.com website, said: "I am very pleased that NICE is recognising and supporting informed women who choose a Caesarean birth plan.

"This is important and most welcome progress."

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