Women should be offered caesarean sections more freely on the NHS according to the latest guidance from the National Institute for Health and Clinical Excellence.
If mothers-to-be are anxious about childbirth or have suffered a previous traumatic birth they should be able to request a caesarean section, the NHS guidelines state.
And if a woman has anxieties about the birth, then those fears should be “taken seriously” and she should be offered mental health support.
If, after being offered counselling and weighing up the relative risks of the operation, she wants to go ahead with a c-section then NICE recommends she should be granted one.
Even those without a medical or mental health reason who request the procedure should be allowed it. But NICE adds that women should be given all the risk information and access to the obstetrics team to discuss it.
In the UK, currently just less than one in four births are carried out by caesarean section and up to two-thirds of these are done in emergency situations where there has been a problem during natural delivery. The remainder are planned.
Women planning a c-section may do so because of known complications such as a low-lying placenta or breech position, but the majority are because the mother has had a previous caesarean section.
However, the NICE guidelines also state that women who have previously been advised to have a c-section may be able to avoid unnecessary surgery.
For instance, women who have had a previous c-section or are HIV positive have previously been recommended against having a vaginal delivery. NICE says these women should be offered a vaginal birth following new evidence that the risk of HIV transmission is the same with a c-section as natural birth.
The updated guideline dispels the myth that “once a caesarean, always a caesarean” as the risk of fever, bladder injuries and surgical injuries in women who have had up to and including four caesarean sections is the same for a vaginal birth as it is for a caesarean section.
New mums talk to Myleene Klass about important decisions made regarding birth.
Caesarean rates vary across the world. In Italy, the rate can be higher than 40%, while in Nordic countries it can be as low as 14%.
Malcolm Griffiths, consultant obstetrician at Luton and Dunstable hospital and chair of the new guidelines, said one of the key differences between countries with low and high Caesarean rates was one-to-one support for women in labour from health professionals and a supportive family.