Mothers-to-be who request a Caesarean birth should be referred for counselling before it is granted to curb rising demand for the operation, an NHS watchdog has recommended.

Caesareans cost £800 more than vaginal births and increasing numbers of women are requesting them despite there being no medical reasons for doing so in most cases, according to the National Institute for Clinical Excellence (NICE).

NICE issued a new guidance yesterday that says care in childbirth should "take account of women's needs and preferences". But it notes that the caesarean rate has almost doubled from 13 per cent in 1992 to 23 per cent in 2008-09. The guidance says when a woman requests a caesarean her obstetrician and other medical professionals should discuss the risks and benefits with her.

If she has a fear of childbirth, she should be offered a referral to a "healthcare professional with expertise in providing perinatal mental-health support to help her address her fears in a supportive manner". Only if a vaginal birth is still "not an acceptable option" should her request for a caesarean be granted.

Christine Carson, the programme director at NICE, said: "Recent evidence shows that a caesarean section is not necessarily the best course of action in some cases." Research shows that women having a caesarean spend longer in hospital. The draft guidance is open for consultation until 20 June.