The technical bits of guidance on caesarian section are directed at secondary care. There are 3 elements that really affect us. The first is that all pregnant women should be given information about caesarean-section (CS), given that 25% of women will go on to have one.

The second element is in the after-care. Heavy bleeding after CS is very unlikely to be due to retained products of conception and so is much more likely to be due to endometritis. Women often ask about when they can drive. NICE just advises that they can resume driving when they have ‘fully recovered’ from the CS. They give no absolute time-spans.

The element of this guidance that got a lot of media attention is that women can now ‘ask’ for a CS, even when there is no medical necessity. Studies show that women with a previous negative birth experience are much more likely to ask for CS. Therefore their concerns should be explored. They should be referred to the obstetric team and offered advice, support and explanation. If they still request a CS, it should be offered. The expectation is that the majority of these women will then go on to have a much more satisfactory birth experience – whether by vaginal delivery or CS. A CS costs £700 more than a vaginal delivery, so the time spent with these women is likely to be cost-effective. A CS is a safe procedure and so it is not felt reasonable to refuse it if ultimately requested.

NICE puts in a lot of statistics in a table at the end of this about planned CS vs planned vaginal delivery, which are worth a glance at if you are sceptical. There is surprisingly little difference between the 2 groups in areas such as mortality, length of stay in hospital etc.

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