Caesarean NICE Quality Standard issued

Today NICE issued their Quality Standard in support of their Caesarean Section NICE guideline (issued 18 months ago). This Quality Standard serves to qualify key quality statements which should actually already have been put into practise by NHS hospitals over the last 18months. in conjunction with elective surveyed all NHS hospitals in England and Wales last year to determine the extent to which specific aspects of the guideline were being implemented. In particular we wanted to know how hospitals planned to deal with women who requested a caesarean when there was no medical need. We were very disappointed to discover that a significant proportion had not only failed to implement a policy but that they were actively banning all maternal request caesareans! At we find that actually many women face an incredible battle to plan a caesarean where there is no medical need and most fail to gain agreement.

Today’s Quality Standard purely serves to highlight that NICE stands by its recommendation from 18 months ago and continues to strongly advocate that women should have access to balanced information, they should be able to request a caesarean and if, following documented discussion they still wish to proceed down this route they should be actively supported in doing so.

Statement 2 Pregnant women who request a caesarean section (when there is no clinical indication) have a documented discussion with members of the maternity team about the overall risks and benefits of a caesarean section compared with vaginal birth…The discussion should include the reasons for the request and ensure that the woman has accurate information (including written information) about the relative risks and benefits associated with different modes of birth.” The guideline itself then says “…but if, after this, the woman still prefers a caesarean this should be granted.”

Hospitals are ignoring this advice.

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