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NICE backs women's right to elective caesareans

Women should be allowed to choose to have an elected caesarean regardless of whether they have a physical or mental health reason to do so.

The new guidelines from the National Institute for Clinical Excellence (NICE) are expected to result in an increase of half a million pounds in NHS costs.

It is hoped the recommendations will ensure women's fears and anxieties around childbirth are taken seriously.

Women requesting a caesarean should be offered counselling and told of the risks involved but the ultimate decision lies firmly with the mother-to-be.

The provision of such mental health support is set to cost the NHS a further £1.1m.

NICE said recent media speculation has been wrong to suggest the revised guidelines could open the doors to the possibility of all pregnant women being offered the option of an elective caesarean section.

It claimed the move could actually lead to fewer women having emergency caesareans.

"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," said Dr Gillian Leng, Deputy Chief Exceutive for NICE.

"For women who ask for a CS in the absence of any clinical indication, physical or mental, the guideline says they should be asked why they are requesting the operation, and be provided with full information about the risks and benefits. They should also be offered the opportunity to discuss the procedure with other members of the obstetric team. If, after this, they still want to have a CS, they should be allowed to have one.

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

For the first time, women who are HIV positive and can prove they are taking their medication will be allowed to opt for a natural birth, leading to an expected saving of £600,000.

Scores of women who have previously had a caesarean will also be eligible to give birth naturally for subsequent pregnancies as the NICE guidelines rubbish the old saying 'once a caesarean, always a caesarean'.

Evidence shows the risk of fever, bladder injuries and surgical injuries is the same with a planned caesarean as it is with a planned vaginal delivery for those women who have had up to and including four previous caesareans.

A spokesperson from NICE told NiP the overall number of caesarean sections is not expected to increase or decrease significantly because of a change in practice resulting from the new recommendations.

She said any changes "are difficult to quantify with certainty and are likely to vary widely around the country".

"The Royal College of Midwives believes that 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," said Cathy Warwick, Chief Executive of the RCM.

"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."

"Around 10% of planned vaginal births end up with an emergency caesarean, which is, on average, more expensive than either vaginal birth or planned caesarean. But, on average, a planned caesarean costs around £700 more than a vaginal birth," said the NICE spokesperson.  

"This guideline does not seek to define an acceptable rate of caesarean. Rather the purpose is to allow appropriate decision-making for individual women, with women and their families having a key role in the decision-making process." 

The World Health Organisation dropped its caesarean limit of 15% last year and no longer advises on an optimal caesarean rate. 


Do you think women should be granted the right to choose to have an elective caesarean?
Your comments
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"If a woman can show she understands the risks and benefits of LSCS in discussion with senior obstetric and midwifery staff, then this request should be granted." - Justine Nichol, Newcastle


"In section 13 of the full Guideline, the cost of CS is found to be similar to natural birth because of the inclusion of the cost of stress urinary incontinence, estimated as follows:
Diagnosis: £150 x 0.61 = £92 Surgery: £6,202 x 0.182 = £1,129 Total = £6,810, averaging at £541 per natural birth.
Surely it would be better to put this value into incontinence prevention (free pilates classes?) rather than funding unnecessary CS surgery? In addition, this valuation also assumes that the status quo of surgery for Stress Incontinence is the best treatment option." - Andrew Brown, UK


“I think that all women should have right to choose their way of delivering. We are living in the 21st century, there shouldn't be an obligation for natural birth because some women cannot cope with that and all the time they are worried about the process. This solution can help women to be calm during pregnancy and about delivering their baby.” - Neda, Doncaster