Caesareans are to be offered to all pregnant women who ask for them, new guidelines state, amid concerns that some are too scared to give birth naturally on Britain’s overstretched labour wards. A lack of support is leading to “traumatic” natural births, say experts, resulting in women fearing a repeat experience.
Studies show that up to 10 per cent of women in Britain suffer from a serious fear of natural childbirth, called tokophobia.
Now the National Institute for Curbing Expenditure (NICE) is recommending that women should always have the right to a caesarean, even if they have no physical or mental health need.
The guidelines, state: “For women requesting a CS [caesarean section], if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.”
Malcolm Griffiths, a consultant obstetrician and gynaecologist at Luton and Dunstable Hospital, who chaired the guidelines development group, said most women were not interested in having a caesarean.
“It is a major operation, about as major as a hysterectomy,” he said.
Nonetheless, 25 per cent of births in Britain are now by caesarean. Between a third and a half of them are pre-planned.
Figures show that rates in Nordic countries are much lower, at about 15 per cent.
Many obstetricians want the UK rate to come down, but believe that is impossible without better midwifery services.
Mr Griffiths said: “I think probably key to the difference is support during labour, with one-to-one midwifery care and support in Nordic countries.”
Better midwifery care was “key to reducing the caesarean rate”, he added.
Nina Khazaezadeh, a consultant midwife at St Thomas’ Hospital in London and a member of the guidelines panel, said some women opted for caesareans because they feared childbirth after a “traumatic” first experience in an understaffed ward – a condition known as “secondary tokophobia”.
She said: “We might see a rise in secondary tokophobia where women have already had a birth that they have found very traumatic, and the perceived lack of support will have had an impact on their decisions for the next pregnancy.”
Cathy Warwick, chief executive of the Royal College of Midwives, said: “There is very clear evidence that one-to-one support in labour reduces caesarean rates”.
However, she welcomed the new Nice guidelines, saying it was “absolutely acceptable” that a woman who feared childbirth should be offered a caesarean.
Coincidentally, the RCM publishes a new report today claiming that England faces “massive midwife shortages” and needs another 5,000 of them.
Even though numbers have increased since 2001, they have “failed to keep pace with the rocketing number and increasing complexity of births”, it warns.
The number of births has risen by 22 per cent in a decade, with midwives having to deal with 120,000 more in 2010 than in 2001.
Mothers also tend to be older and heavier than in the past, which both raise the chance of complications.
Belinda Phipps, chief executive of NCT, said: “Most women want a straightforward birth, some need a caesarean. When women are treated with respect, and are offered support and information tailored to their concerns, very few of them will choose a caesarean birth unless there are clear health reasons.
“However, our services fail women badly at the moment, with midwifery numbers well below the level required to guarantee safe and satisfying care.”
She went on: “If caesarean rates go up following the change to the guidelines, it will be evidence that women are not getting the quality of midwifery support they need.”
The guidelines do recommend that a woman requesting a caesarean should be made to talk about her fear of childbirth before an operation is granted.