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Midwives back moves to increase availability of caesarean sections

Caesarean sections will be available to pregnant women on the NHS regardless of whether there is a medical need for the procedure, a new report has revealed.

Until now, the operation was only open to women who had a medical reason why they should not give birth naturally, but this is all set to change according to a draft report by the National Institute for Health and Clinical Excellence (NICE).

The reason for the change is that the procedure is now much safer than it used to be years ago, meaning healthy women can opt to undergo the operation.

The move has been supported by the Royal College of Midwives (RCM), which has welcomed a thorough discussion of the evidence on the different ways to give birth and the risks and implications associated with them.

General secretary of the RCM, Cathy Warwick, said: “We are pleased to see the focus on a good discussion of the evidence that includes the risks of caesarean section and the implication for future pregnancies and we are confident that when women are fully aware of the evidence they will not be asking for inappropriate caesarean sections.

“We agree with the NICE suggestion that ‘if after proper counselling’ a ‘vaginal birth is still not acceptable’ then the option of caesarean section should still be possible.

“Women who fit into this category are usually women who have had a very difficult previous birth.

“We are pleased to see the recommendation for women who have such 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 in consultant midwives’ clinics, these anxieties can be allayed for many women.

“The RCM is concerned that the complexity of this discussion and decision making should not be underestimated.”

Readers' comments (2)

  • Why exactly? Surely the fact that the procedure is safer is not the only reason???

    Obviously I am an adult Nurse, not a Midwife so am no expert on this, and I may be getting this wrong (I have only read limited information on the new guidance, this limited piece being one of them) but am I right in thinking that women will simply be allowed to ask for a C section and get it, even if it would have been considered 'inappropriate' under the old guidance? I do not agree with this move at all. If a caesarean is done or offered for CLINICAL reasons, as per the guidance in the past, then that is absolutely the best thing to do for that patient and there is no question of that, but having it as a simple choice, being just another way to have a child I think is wrong and will bring with it a whole host of other problems. Plus there is also the financial considerations for unnecessary procedures on the NHS.

    Increasing the level of support for those with anxiety, great. Increasing perinatal MH support services, brilliant. But this is a step too far I think.

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  • Andrew Kingsley

    There are risks and benefits to both methods of birthing. However from a purely infection control perspective there is benefit to the health of the baby by birthing through the canal followed by breast feeding. This process initiates the process of colonising the skin with what will turn out to be a protective commensal flora and then through breast feeding add to the building of immunity.
    Caesarian wounds are not without risk of post operative infection, so in order to give any prospective mother informed consent on birthing choices every hospital will need to undertake regular surveillance of C section infection rates. Interestingly pilot studies under the Health protection Agency's SSISS (Surgical Site Infection Surveillance System) have been run recently though as yet there has been no indication that they will be made mandatory.
    When choices are offered I hope relevant information will be provided including infection control.

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