Women have the right to choose a Caesarean

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The Independent Online

The medicalisation of childbirth is one of the great social changes of our times. "Normal" childbirth, achieved without medical intervention, is already a minority activity in Britain with just 45 per cent of new mothers in 2001-02 enjoying a spontaneous labour and delivery unassisted by medical science.

The medicalisation of childbirth is one of the great social changes of our times. Where once most babies were born at home, with the assistance of a midwife, now most are born in hospital with all the technological wizardry of modern medicine. "Normal" childbirth, achieved without medical intervention, is already a minority activity in Britain with just 45 per cent of new mothers in 2001-02 enjoying a spontaneous labour and delivery unassisted by medical science.

The biggest single change of the past 20 years has been the doubling of the Caesarean rate, driven by fears of litigation and a culture of increasing medical intervention. If a baby's heart is monitored through labour, the very fact of observing it makes it more likely that the baby will ultimately be delivered by Caesarean.

Yesterday, the National Institute for Clinical Excellence (Nice) issued guidelines that aim to curb the soaring Caesarean rate by implementing a series of checks and balances designed to make obstetricians think twice before reaching for the scalpel. These guidelines are thoughtful and sensible, but in one respect run counter to the Government's choice agenda for the public services.

Around 9,000 women a year request a Caesarean because it is more convenient, or they think it will be less painful or damaging than a vaginal delivery. Nice says that these requests should be resisted - although it stops short of saying that they should be refused altogether. But even this is perverse, since it runs counter to commitments made over the past decade to increase choice in childbirth.

If women choose to have more, rather than less, technological intervention, their wishes should be respected. They should be fully informed about the risks, but given that these are evenly balanced for a Caesarean and a vaginal birth, ultimately it should be up to any patient to decide which risks they wish to avoid. The cost to the NHS is not excessive, given the small numbers likely to opt for major surgery not deemed medically necessary.

To survive in the modern world the NHS has to be responsive to what patients want - as well as to what doctors think they need.

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