The rules on requesting a c-section have been revised, with guidelines published today recommending that women should have the right to a caesarean, even if they have no physical or mental health need.
The revised guidelines from the National Institute of Health and Clinical Excellence (NICE) say that women requesting a c-section because of anxiety about childbirth should be offered counselling.
Tokophobia, or fear of childbirth, is thought to affect 6% to 10% of women.
The guidelines go on to state: “If after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS [caesarean section].”
NICE states that women should be told of the risks and benefits first, however ultimately the decision would be made by the mum-to-be.
“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,” said Dr Gillian Leng, NICE Deputy Chief Executive.
However, the last set of NICE guidelines, which were published in 2004, stated that “maternal request is not on its own an indication for caesarean section” and that doctors could decline the procedure “in the absence of an identifiable reason”.
Other changes to the guidelines include offering vaginal birth after caesarean (VBAC) to women who had undergone up to four previous caesareans.
Dr Gillian said the revised guidelines largely reflect current practice, and she doesn’t believe they will make a big difference to the caesarean rate.
Malcolm Griffiths, a consultant obstetrician and gynaecologist at Luton and Dunstable Hospital, who chaired the guidelines development group, said most women were not interested in having a caesarean.
“My obstetric case load is about 500-600 cases a year. I have had two c-section requests this year. One was due to vague medical issues and the second was a woman with tokophobia,” he said.
Around 25% of births in Britain are now by caesarean. The rates in Nordic countries are much lower, at about 14%, while over 40% of births in Italy are by c-section.
“I think probably key to the difference is support during labour, with one-to-one midwifery care and support in Nordic countries,” said Malcolm.
“There is very clear evidence that one-to-one support in labour reduces caesarean rates,” said Cathy Warwick, chief executive of the Royal College of Midwives (RCM).
However, Cathy welcomed the new NICE guidelines, saying it was “absolutely acceptable” that a woman who feared childbirth should be offered a caesarean.