New c-section guideline

The release comes after months of speculation and claims across the media that all women will be asked if they’d like the procedure.

The new guideline for England and Wales states that women requesting a c-section because of anxiety should be offered mental health support.

If, after talking to a health professional, they still feel they need a caesarean, then this should be offered to them.   

A phobia of childbirth is thought to affect 6% to 10% of women.

Cathy Warwick, RCM chief executive, said: ‘The RCM is pleased to see the recommendation that women who have anxiety about birth “be referred to a health professional with expertise in providing perinatal mental health support”.

‘We know that when such individualised support is offered, for example in consultant midwives' clinics, these anxieties can be allayed for many women, and they can go on to have a normal vaginal birth.’

The guidance states that women with no medical need can also ask for a caesarean section.

The document says these women should be told of the risks and discuss their request with a clinician, but their request cannot be denied.

This has led to speculation and fears that women who are able to have a vaginal birth, will push for a caesarean section.

But Cathy said that, with the support of midwives, few women will elect to have the procedure.   

‘Midwives need to be able to give time to women to really discuss what they want, and then be able to fully support and advise women towards this,’ she said.

‘One-to-one care in labour from a midwife a woman ideally knows and certainly trusts is particularly important.

‘The RCM 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 CS.

‘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.’

In the UK about one in four births is by caesarean section and NICE believes this rate could fall on the back of the introduction of the new guideline.

Dr Gillian Leng, NICE deputy chief executive, 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. 

‘For a very small number of women, their anxiety about childbirth will lead them to ask for a CS. 

‘The new recommendations in this guideline mean that these fears will be taken seriously and women will be offered mental health support if they need it. 

‘If the woman’s anxiety is not allayed by this support, then she should be offered a planned CS. 

‘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.’