Last updated at 12:46 AM on 31st October 2011
Surgical birth: The procedure rate is soaring
All women are to have the right to request a caesarean on the NHS in a potentially hugely-expensive move.
Draft guidelines to be finalised next month by the National Institute for Clinical Excellence make it clear all women who do not want to give birth naturally will be allowed to have the procedure – even if there is no medical reason for one.
Despite the move, NHS hospitals are still trying to curb the soaring rate of c-sections, which cost around £800 more than a natural birth, and experts say it is likely women in some areas may still be refused on cost grounds.
The watchdog’s decision amounts to a U-turn as it overrules the previous guidance which recommended that only expectant mothers with certain medical conditions or a phobia of childbirth were offered caesareans.
Some hospitals responded by banning women from having one unless they were likely to have a high-risk complicated birth such as twins. Now NICE will announce that c-sections have become so safe that women should be given the choice of giving birth naturally or surgically.
Dr Bryan Beattie, an obstetrician who helped draw up the existing guidelines, said: ‘It is a huge development in terms of allowing women to make an informed choice.
‘Ten or 15 years ago there may have been a better argument for saying no. But caesarean sections have become much safer. We have closed the gap to the extent that you really do have to bring in maternal choice as part of the decision-making process.’
Cost of living: Caesareans cost around £800 more than natural births, but are growing in popularity
However some believe the NHS should not fund the extra cost.
Cathy Warwick, a professor at the Royal College of Midwives said c-sections for non-medical reasons were ‘inappropriate’.
Caesareans have become increasingly popular, now accounting for just under a quarter of all deliveries – compared with just nine per cent in the 1970s. Economists have calculated that reducing uptake by one percentage point could save the NHS £5.6million a year, although this figure does not include the cost of injuries during natural birth.
Dr Mark Porter, a consultant obstetric
anaesthetist, said obligating the NHS to perform a c-section on any woman was
‘potentially quite expensive and hugely controversial’.
He said: ‘The problem is that we have got so good at doing c-sections, and we do so many of them, that the evidence has genuinely shifted.’
Women who request a c-section will be urged to discuss the decision with doctors and midwives.
Decision: Pregnant women will be given the choice of whether they want to have a caesarean birth under new proposals
It is understood doctors who are uncomfortable with performing the procedure in cases where there is no medical need will have to refer women to another surgeon willing to perform it.
The Royal College of Obstetricians and Gynaecologists says that 12 per cent of women who opt to have a natural birth will end up having an emergency c-section.
The ruling is likely to trigger more debate about use of NHS resources. A year ago, NICE reversed a ban on three drugs which were denied to those in the early stages of Alzheimer’s, following a campaign by the Daily Mail.
Aricept, Exelon and Reminyl cost only £2.50 a day, but the watchdog ruled in 2007 that they could only be used for moderate – not early – stages of the disease leaving patients waiting for their condition to deteriorate.
Nexavar, a drug for advanced liver cancer was banned in 2009 on cost grounds although it had been shown to extend life by an average of seven months – double the normal life expectancy.