Elective caesareans: a doctor's view
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Do think that every woman should have the right to an elective caesarean section on the NHS if she so desires - not for medical reasons, but personal preference? If so, why, and if not, why not?
Dino
As you may know, this very issue is being hotly debated at the moment, particularly in the light of the draft UK’s NICE guidance which is anticipated to ‘open the door’ to Caesarean Section requests without there being a strong medical indication. In fact, the debate is not new: in the early 1990s, at the time of the Changing Childbirth report on maternity services, there was a strong acknowledgement of a woman’s choice as to the place and type of her delivery.
We are very sympathetic to this, though we would suggest some caveats: Where a woman is very young and/or may expect to have several more babies, unless there is a good medical reason, trying for a vaginal delivery is almost certainly more medically safe for her in the longer term.
If a woman has had a previous one or more uncomplicated vaginal delivery, then her chances of another are very high. Where a woman is older and/or having her first and only baby, or of she has twins or a complicated pregnancy, then most of us would feel that a Caesarean is not at all unreasonable.
The fact that many different views are heard and debated probably means that it’s a healthy debate. Many of the arguments are very complex: how can you equate the risks to a baby of vaginal delivery (very rare) or Caesarean Section (even less likely) against the risks to the mother (higher risk with emergency Caesarean), for instance? Some obstetricians are ‘pro’ Caesarean, others are less sympathetic-the same is true of midwives. What isn’t true is that Obstetricians or midwives see Caesarean as an ‘easy answer’, as Obstetricians are as often criticized for declining to offer a Caesarean as for making it easy to decide for Caesarean. The discussion will continue…
Dr Christoph and Grainne McCartan
Get more useful information on pregnancy and birth at Pregnancy Questions and Answers
Dr Christoph Lees MD MRCOG is a Consultant in Obstetrics & Maternal-Fetal Medicine at Addenbrooke's Hospital in Cambridge, UK. He delivers babies and looks after mums in pregnancy, especially where specialist input or ultrasound is required.
Grainne McCartan RGN RM BSc PGDAE MA. Grainne qualified as a general nurse in Northern Ireland, and as a midwife in London where she has practised both in hospital and community settings. Grainne is a qualified reflexologist, family planning nurse and aromatherapist
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