The new guidelines on caesarean section were published last week by the National Institute of Health and Clinical Excellence (NICE). From now on pregnant women can choose to have a caesarean section, even in the absence of obvious clinical need.
This announcement has been highly criticised by the national me- dia, predominantly arguing the point that a caesarean section is £800 more expensive than a natural vagi- nal delivery. It has also been esti- mated that a 1% increase in the c- section rate could lead to an extra £5.6 million annual cost to an al- ready cash strapped NHS.
However, an analysis of current research data suggests that many negative outcomes of vaginal deliv- ery were simply not recorded, po- tentially invalidating the cost- effectiveness argument that many journalists reported.
Furthermore, the actual propor- tion of women requesting a caesar- ean section for social reasons is very small (6-8%) compared to those choosing a natural vaginal delivery, despite the fact that obstetricians agreed to perform c-sections in half of those cases. Clearly, this small group of women is not the cause of the rising c-section rate in the UK, which is currently about 25%.
The truth is that this new guide- line has been widely misrepresented in the media. Although the guideline does propose that every woman should have an ultimate right to choose a caesarean section; accord- ing to NICE, it ‘is a very long way’ from offering surgery to every preg- nant woman.
Dr Gillian Leng, deputy chief executive of NICE, said ‘it is about ensuring that women give birth in the way that is most appropriate for them and their babies’.
The new guideline states that the main priorities are the ‘woman’s birth experience’ and her mental health. According to research, the former is significantly better in women, who have had a c-section, whereas refusing a caesarean sec- tion, can lead to potentially signifi- cant psychological damage to both mother and baby.
It has been found that many women request a caesarean section, because they believe it to be the saf- est option for their baby. A small proportion of pregnant women expe- rience a morbid fear of childbirth.
NICE recommends obstetricians and midwives to enquire into the specific reasons behind each request for caesarean section. Such a discus- sion, in addition to explaining the potential risks and benefits of a c- section, may help to alleviate the woman’s anxieties, correct any mis- conceptions and encourage natural childbirth.
However, if a vaginal delivery is still not acceptable, even after men- tal health counselling, then an elec- tive c-section under epidural should be planned.
Women requesting a c-section, should consider the following risks and benefits, because it is a major operation.