NICE still have a way to go on caesarean guidelines

As a campaigner and contributor during the recent review of the NICE Caesarean Section Guideline I was pleased to see many of the changes and clarifications subsequently made in the latest version. However they did not go far enough and csections.org will continue to campaign for the following:

  • acceptance of informed choice as a valid indicator for maternal request caesareans (the document as it currently stands still makes this ambiguous, referring primarily to instances of tokophobia therefore failing to recognise the full spectrum of reasons why women may request a caesarean)
  • clear statements about the scope of antenatal education in relation to caesarean birth (the document talks about the importance of education in relation to the risks and benefits of the procedure and improved understanding of the surgical procedure). The guideline does not address the absence of balanced antenatal education on all aspects of caesarean birth as a standard part of birth preparation
  • allow women to gain early agreement for a planned caesarean, e.g. well before the current common practise of week 34. Women suffering from tokophobia or who have on-going medical indicators that suggest a caesarean delivery should be able to progress through their pregnancy without the additional stress of having to wait to see if their consultant will agree to a caesarean birth
  • removal of the assumption that women who request a caesarean should be provided with support to ‘change their minds’. Some women wish to make an informed choice in favour of a planned caesarean after careful evaluation of the risks of caesarean versus vaginal birth
  • clarification that a woman who has had a caesarean agreed but goes into labour prior to the surgery date, will have her planned caesarean upheld and conducted as soon as possible
  • ECG wires be attached to the woman’s back rather than her chest to facilitate skin-to-skin contact and breastfeeding while in theatre (see Natural caesarean)
  • post-operative debriefs are automatically offered to all women following their birth. This service is only offered sporadically across the country yet it is particularly important for women planning more family that they understand their caesarean birth and its implications for future pregnancies
  • standardised reporting techniques such that types of caesarean and their reasons can be more clearly distinguished and risk/benefits rates more accurately allocated (that maternal request caesareans be specifically identified and separated from those planned caesareans where obstetric advice has ‘suggested’ a caesarean may be preferable
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