National Institute for Health and Clinical Excellence (NICE)
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Helping women make informed choices about caesarean births

NICE's new quality standard on caesarean section aims to ensure pregnant women can make an informed decision about their planned mode of birth.

While many women plan a vaginal birth, the number of women having caesarean sections, including planned caesarean sections, has been rising.

In 1980, fewer than one in 10 women had the procedure. Now, up to a quarter of births are carried out by caesarean section. Reasons for this include concerns among certain women that they will not receive adequate care and support during labour and delivery.

The NICE quality standard on caesarean section contains nine measures that together aim to improve the care of women who may need, request or have had the procedure.

These include a measure that pregnant woman should have a documented discussion with members of the maternity team about the risks and benefits of caesarean section compared with vaginal birth.

NICE's rationale for this is that she should be able to talk to the most relevant member of the maternity team depending on her question or concern at any time during her pregnancy, and that this discussion should be arranged promptly following a request.

A further quality standard statement is about pregnant women who request a caesarean section because of anxiety about childbirth, and are offered a referral to a healthcare professional with expertise in perinatal support.

NICE says that if women are given the opportunity to discuss their anxiety about childbirth with someone who can answer their questions and understand their concerns in a supportive manner, these anxieties can often be reduced to the point where the woman is able to choose a planned vaginal birth.

This discussion is an important part of the decision-making process and should happen before a decision on caesarean section is made with the maternity team

In addition, the quality standard contains two statements which say that a consultant should be involved in decisions surrounding both planned and unplanned caesarean sections. This is because they are best placed to advise about the potential benefits and risks. This involvement should ensure the best possible outcomes for mother and baby.

After the caesarean section, the women and her partner should be able to discuss the implications for future pregnancies so they are able to make more informed decisions about planning their family.

Dr Gillian Leng, Deputy Chief Executive and Director of Health and Social Care at NICE said: "NICE has developed this standard because up to a quarter of women are now having caesarean sections, and we want to ensure that women who may need or may have had a caesarean section, or are simply asking about them as an option for delivering their baby, have the most up-to-date information about the quality of care they should receive."

She added: “Taken as a whole, these quality statements will contribute to improving the effectiveness, safety and experience of women who may need, request or have a caesarean section.”

Pippa Nightingale, Head of Midwifery, Imperial NHS Trust and member of the topic expert group said: "As a midwife working in a busy London hospital, I know that some women request a planned caesarean section because of fears that their care will not be good enough and concern that they will not receive enough support during labour and delivery.

"However, after a discussion of all the pros and cons of both types of birth, and having been assured of one to one midwifery support and a personal birth plan, many will often choose to try a vaginal birth.

She added: "Ensuring women are fully informed about their birth options is important, and I am sure this quality standard will be a helpful tool for all involved."

Christine Johnson, a mother with experience of caesarean section and member of the topic expert group which developed the quality standard, said: "It's really important for all pregnant women to receive clear information, both verbally and on paper, so they can choose the right birth plan for them.

"This quality standard will help to improve many mothers' experience of childbirth."

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