Women can choose Caesarean birth

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

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Pregnant women who ask for a Caesarean delivery should be allowed to have the operation, even if there is no medical need, according to new guidelines for England and Wales.

The National Institute of Health and Clinical Excellence (NICE) states that women should be offered counselling and told of the risks first.

Ultimately, however, the decision would be made by the mother-to-be, it said.

NICE said this was "a very long way" from offering all women surgery.

The last set of NICE guidelines, which were published in 2004, clearly stated that "maternal request is not on its own an indication for Caesarean section" and that clinicians could decline the procedure "in the absence of an identifiable reason".

The rules on requesting a C-section have been revised. Clinicians say this is to bring the instructions into line with what is already taking place in hospitals.

Birth fear

Start Quote

It's not a major operation that most pregnant women are interested in or want to have”

End Quote Malcolm Griffiths Consultant obstetrician and gynaecologist

The 2011 guidelines say that women requesting a C-section because of anxiety should be offered mental health support. A phobia of childbirth is thought to affect 6% to 10% of women.

Nina Khazaezadeh, a consultant midwife at St Thomas' Hospital, says she often meets patients who want a Caesarean due to a "perceived lack of control, fears of inadequate care provision and lack of support during labour and delivery".

"But, after a discussion of all the pros and cons of both types of birth, and having been assured of one-to-one midwifery support and an individualised birth plan, they will choose to try for a vaginal birth."

The updated guidelines state that if such women still wanted a C-section, they should get one.

Women with no medical need can also ask for a Caesarean section. The guidance states that they should be told of the risks and discuss their request with a clinician, but their request cannot be denied.

Malcolm Griffiths, a consultant obstetrician and gynaecologist who led the development of the guidelines, said: "Caesarean section is a major operation, it's about as major as a hysterectomy.

"It's not a major operation that most pregnant women are interested in or want to have."

Dr Gillian Leng, deputy chief executive of NICE, 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.

"Offering these women a planned Caesarean section in these circumstances is a very long way from saying that Caesarean section should automatically be offered to every woman."

New rules

The risks

Planned Caesarean section may reduce the risk of the following in women:

  • pain during birth and for the next three days
  • injury to vagina
  • haemorrhage
  • shock

Planned Caesarean section may increase the risk of the following in babies:

  • intensive care admission

Planned Caesarean section may increase the risk of the following in women:

  • longer hospital stay
  • hysterectomy
  • cardiac arrest

Source: NICE

There will be wider changes to clinical practice.

Being HIV positive will no longer be treated as grounds for an automatic C-section. Improvements in anti-retroviral therapies mean it is now safe for some woman with HIV to deliver vaginally.

There will also be changes to break the mentality of "once a Caesarean, always a Caesarean".

The latest evidence suggests that even for women who had up to four previous C-sections, that the risks of fever, bladder injuries and surgical injuries were the same for planned vaginal and planned Caesarean deliveries.

Also it had been thought that giving women antibiotics to protect against infection during surgery could be damaging to the baby. NICE says medical evidence says this is not the case and that women should now be given antibiotics before going under the knife.

In the UK, about one in four births is by Caesarean section. The rate has been roughly static for the past four years following years of increases. Across Europe figures vary widely from about 14% in Nordic countries to 40% in Italy.

Graph showing rise in C-section rate

NICE believes that overall, the rate could fall after the introduction of the new guidelines.

Wendy Savage, a retired professor of obstetrics, said women requesting a C-section were not responsible for the rise rather "it is obstetricians that are too keen to do it".

On vaginal births she said: "They don't know how to do it most of them now because they haven't been trained how to do it.

"It is up to us to put our house in order and stop doing Caesareans too easily.

"We're doing too many first Caesars and secondly we're doing too few vaginal births after Caesarean section."

Cathy Warwick from the Royal College of Midwives: 'It doesn't differ from the current practice going on in many maternity units'

The changes will come at a cost to the NHS of around £0.5m, largely from the cost of mental health services for women with anxiety.

The cost of a planned Caesarean section was estimated at £2,369, with a planned vaginal birth costing £1,665.

Maureen Treadwell, co-founder of the Birth Trauma Association, said: "We are delighted that this updated guideline recognises the terrible impact that fear of childbirth can have on women and their families."

Cathy Warwick, chief executive of the Royal College of Midwives, said: "If midwives are able to help women to understand what their choices mean for them and their baby and feel they will be supported in labour then very few women will want an elective Caesarean section.

"They will be making decisions from a fully informed position and from a position of trust in maternity services, not one based simply on hearsay."


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  • rate this

    Comment number 102.

    Should not the headline be ConDems admit they consider women in labour as bed blockers?!

  • rate this

    Comment number 101.

    For people saying about emergency Caesarean.. this is totally different to a planned section - a lot more traumatic.

  • rate this

    Comment number 100.

    Personally I don't understand why a woman would choose to have a C - section which is MAJOR surgery! I had to have major surgery 2 weeks after giving birth natutally for somthing un-related to having a baby to save my life, it was an emergency operation that I would never choose to have if i had the choice.

  • rate this

    Comment number 99.

    I had my three children by c-section,the first because of foetal distress during labour,the second due to a botched induction,and for the third no choice.Although my eldest child is now forty one I still feel robbed of the experience of normal childbirth.Having a c-section is no picnic as all the pain comes after !

  • rate this

    Comment number 98.

    For those who are wondering the term is nothing to do with Casear but with the latin word "caesus" meaning (having been) cut.

  • rate this

    Comment number 97.

    having had an emergency section with my first child and a 'natural' delivery with my second, i fail to comprehend why anyone would chose to have a major operation without a medical reason for doing so. The 6 week recovery time and trying to look after a newborn is extremely tiring. I also found it very painful to even pick my baby up.

  • rate this

    Comment number 96.

    I think it's a waste of medical resorces and cost to allow this, we are at a time when cuts need to be made and this is not a necessary a c section is not just a another method for birth but a major op too. Woman with this phobia of childbirth clearly need extra support talking about it to over come it child birth hurts been there done it twice & one very differcult birth but you get over it.

  • rate this

    Comment number 95.

    Contrary to popular belief Caesarian has never been available as choice on the NHS.I asked for one; I have a pre-existing medical condition which can make end stage labour difficult & was concerned for my unborn child. I was told no but given the utmost assurance they'd intervene quickly if I had difficulties. It was all I needed to hear - all went well. Most women just need reassurance.

  • rate this

    Comment number 94.

    Whilst I don't think this idea should go ahead, C Secs should be reserved for those in medical need, as a bloke I am appalled at the under current of misogony running through many of the comments on this thread.....once again large nos of blokes think they have a right to make women's choices for them......

  • rate this

    Comment number 93.

    I had an emergency c-section with my son in 2006, it was not a very pleasant experience at all. I too felt cheated that my body hadn't performed the way it is designed. I was encouraged with my second to have a natural birth, it was hassel free and I was home less than 48 hours later, freeing up a bed for someone else. Its a no brainer, natural is safer in most cases and cheaper!

  • rate this

    Comment number 92.

    I had a Caesarean (not out of choice) 21 years ago with my 1st child and then gave birth naturally to my 2nd three years later. I wouldn't have had a Caesarean out of choice, but this was advised by the doctors and midwives who were attending me at the time. I think women should not make this decision lightly. I got over the second birth a lot quicker even though I had another child to care for

  • rate this

    Comment number 91.

    Ha! hundreds of thousands of years of 'natural' birth, all of a sudden some women are too posh to push. As if they're the first to face the prospect of giving birth.
    As with most things; unles it's medically necessary, let nature take its course, otherwise you pay for it

  • rate this

    Comment number 90.


  • rate this

    Comment number 89.

    As far as I am aware one adverse effect (not mentioned in the above article) is that the natural birth triggers the production of breast milk, but a cesarian delivery does not. My two younger children were home births by choice. Not a choice that would suit everyone. It's as close as a man can come to understanding the birth process.

  • rate this

    Comment number 88.

    I find it astonishing that C sections are now being offered regardless of medical need, when my wife cannot get the drug she needs, because there is a cheaper alternative, which is much less effective. It has been suggested that she buy the current drug privately, at a cost of £60 per month.

  • rate this

    Comment number 87.

    Why is childbirth the only medical process where some believe that pain relief & medical intervention are bad? Still am annoyed that I had to go through so much pain during 3 days for my 'natural' birth when it could have been prevented by a c-section once it was obvious things were not moving quickly & I became exhausted by the pain.

  • rate this

    Comment number 86.

    Birthing methods, together with ALL other issues concerning a woman's decisions about her body, are not a matter for anyone except that person herself (with medical advice on choices, of course). Anything else violates her Human Rights - and, try as the present government might, we have not yet allowed them to repeal that act.

  • rate this

    Comment number 85.

    This is madness. The money for the NHS is very constrained and many diseases do not get properly treated because of lack of funds. Birth is not a disease. Why on earth should other people subsidise women who have lifestyles that are two busy to allow a natural birth.

  • Comment number 84.

    All this user's posts have been removed.Why?

  • rate this

    Comment number 83.

    It's funny how when it comes to choices that only a woman can make, there are always people yelling at them that "it's not natural" and "we've got this far without it". Yet despite it not being 'natural' and not being used hundreds of years ago, no one has ever told me I shouldn't have the metal plate in my leg after I broke it!

    My body, my choice. I'll listen to the experts, then I'll chose.


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