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Doctors told to curb 'posh' caesareans
Lois Rogers, Medical Editor
NHS DOCTORS will this week be told to curb caesareans on demand for women who wish to avoid natural childbirth.
The government’s clinical advisers are alarmed by the number of women who are asking NHS doctors to give them caesareans merely because they are convenient.
It follows a number of high-profile “too posh to push” cases in which celebrities have opted for the operation when there were no pressing medical reasons to do so.
The instructions to halt the practice will be contained in new guidelines from the National Institute for Clinical Excellence (Nice) to be published on Wednesday.
The advice will say caesareans on demand should no longer be an option because “maternal request is not on its own an indication for caesarean section”.
Women who want planned births to fit in with work or social commitments will be told they will have to pay up to £10,000 for a private delivery.
The Nice document tells doctors that they should interrogate pregnant women about exactly why they want a caesarean, and emphasise the potential dangers. Expectant mothers who complain they will be traumatised by the pain of a natural birth should be offered “counselling or psychotherapy,” the document says.
Doctors will also be expected to write a full account of how they talked her out of a caesarean in the woman’s notes. The risks include post-operative infection, haemorrhage and possible greater difficulty in conceiving subsequent children.
Up to one in three women have caesarean births in some parts of Britain — twice the 15% maximum recommended by World Health Organisation childbirth guidelines.
At least 10,000 such births on the NHS are recorded as taking place for no other reason than maternal choice — at a cost of £25m to the health service.
However, government obstetric advisers believe many more of the annual total of 150,000 surgical deliveries are recorded by doctors in patients’ notes as being medically necessary, purely to avoid questions being asked about the extra cost.
A natural hospital delivery costs only £700, and many women go home within hours of birth. However, a caesarean costs the NHS £1,700 because it involves a longer stay and expensive surgery.
“When a woman requests a CS (caesarean section) in the absence of an identifiable reason, there should be a record of the overall benefits and risks of CS compared with vaginal birth, discussed with the woman,” the document says.
It is thought the guidelines are unlikely to fuel a big switch to private births because most health insurance does not cover the substantial cost.
However, many wealthy mothers are prepared to pay up front for caesareans, and the “too posh to push” maxim has almost become a fashion statement in the private sector. Top maternity hospitals such as the Portland in London, perform caesareans on half the 1,800 women who give birth there annually.
Many celebrities openly admit they have planned childbirth to fit in with their lives. Elizabeth Hurley, Catherine Zeta-Jones and Zoë Ball all had pre-planned caesareans.
Victoria Beckham had one for the birth of her son Romeo to fit around the football commitments of her England captain husband, David.
Earlier this month Jo Williams, wife of the world snooker champion Mark, organised a caesarean birth for their son Connor ahead of her husband’s defence of his title, in order not to distract him. However, the strategy did not work: he was knocked out of the tournament in Sheffield yesterday.
This weekend pop star Sophie Ellis Bextor became the latest recruit to the ranks of celebrity caesarean mothers, but in her case it was to avert a life-threatening emergency caused by the blood pressure condition pre-eclampsia. Her baby boy Sonny was delivered on Friday, eight weeks early, and mother and baby are both healthy and now doing well.
Privately, obstetricians fear the Nice guidelines may be ignored by some NHS doctors.
“If you say there was a clinical need for an operative delivery, they can’t argue,” said one. “Lots of women don’t want to risk incontinence and damage to their sex lives by having a natural birth.”
Ironically the guidelines are being published just days after the department of health admitted it cannot offer home births in many areas because of a chronic shortage of midwives competent enough to work away from the panoply of hospital monitors and equipment.
Last week Abbie Gregg, 21, a low-risk pregnant mother from the Pennine village of Heptonstall, West Yorkshire, was told she would have to get the bus into hospital when she goes into labour.
Linda Green, from nearby Todmorden, was given a similar story. “I am furious,” she said. “I have never used the NHS for anything and when I need it now, the service isn’t there.”