Women to gain right to have planned Caesareans on NHS

Changes could lead to large and costly rise in numbers of women demanding the procedure
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Indy Lifestyle Online

Women will have the right to give birth by Caesarean section without a medical reason if new guidelines for the NHS are adopted.

The draft guidelines from the National Institute for Health and Clinical Excellence (Nice) will allow women with a "fear of childbirth", but no medical reason for avoiding natural birth, to have a planned Caesarean section on the National Health Service.

The only requirement will be for the patient first to be referred to an experienced practitioner "to help her address her fears in a supportive manner". After that, the woman will be entitled to proceed with a planned Caesarean, no longer seen as a riskier alternative to a natural birth.

Maureen Treadwell, co-founder of the Birth Trauma Association, said the proposed changes were "to be welcomed". "It's long overdue," she said.

"Childbirth can be very traumatic, and women should have rights over what happens to their body."

Under current guidelines, doctors have the right to decline requests for Caesarean sections when no medical reason exists. When requests are declined, women are offered a referral for a second opinion. While Caesareans are sometimes performed for non-medical reasons, these are the exception rather than the rule.

Cathy Warwick, general secretary of the Royal College of Midwives, said the proposed changes were not markedly different from the status quo, in which most doctors strongly encouraged natural birth, but patients could get Caesareans for non-medical reasons "if the woman [was] really adamant".

However, the new guidelines "could change expectations" for women, making them feel entitled to demand an NHS-funded Caesarean section. "That could encourage more women to ask for them," she said.

Those expectations would be "very difficult for professionals to resist," particularly when they were overworked. The changes were "unhelpful" at a time "when we're trying very hard to reduce the number of Caesarean sections," she said.

"We're all trying to promote women having as little intervention as necessary because there are still risks with intervention. There are increased hospital stays, more abdominal pain."

Caesarean sections cost about £800 more than a natural delivery, and some estimates have suggested that reducing the rate of Caesarean sections by one percentage point could save the NHS £5.6m a year.

The estimates do not take into account the costs of injuries caused during natural birth. Caesarean section rates in the UK have more than doubled from 12 per cent in 1990. In 12 per cent of cases, women who opt for a natural birth end up having a Caesarean, due to complications. Ms Treadwell said she hoped that the draft guidelines would not be changed before the final publication late next month.

A Nice spokesman said he would not comment until the new guidelines were published. "This is a draft report and is due for publication next month after consultation. As a result the report could change."