UK approves informed C-sections on demand
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* Colin Meek

The UK has entered the debate about women's right to choose how they give birth (*CMAJ* 2004;170[5]:813-4) with the publication of new clinical guidelines for cesarean sections by the National Institute of Clinical Excellence (NICE) ([http://www.nice.org.uk](http://www.nice.org.uk)).

The guidelines for the National Health Services in England and Wales provoked a flurry of media reports claiming that the institute had decided that cesareans must be discouraged. *BBC Online* and others stated that NICE wanted doctors to try to persuade women not to elect for cesareans.

But one of the guidelines authors says these reports are wrong: the new recommendations do not restrict choice. Obstetrician David James said: “The fact is that there are benefits and disadvantages to both vaginal and cesarean delivery. Both methods never leave the woman unscathed. What the guidelines say is that it is irresponsible to do a cesarean on request without exploring with the woman why she made that choice and [ensuring] that she understands the pros and cons and risks.” 

The guidelines say that individual clinicians have the right to decline a request for a cesarean in the absence of an identifiable reason, but the woman has a right to a further referral. 

“Undoubtedly, we'd do a cesarean for someone if we've gone through these steps,” added James, a professor at the Queen's Medical Centre in Nottingham. 

While critics say the guidelines overstate the risks of cesarean delivery, James said the vast majority of obstetricians and gynecologists agree with the new recommendations. 

Consultant obstetrician and fetal medicine specialist Chris Griffin said most of his colleagues back NICE. However, he said more fundamental problems in NHS maternity services — such as understaffing — should be addressed first. 

Like Canada, about 1 in 5 births in England and Wales is by cesarean. In the UK, 7% of cesarean births were elective. — *Colin Meek*, Wester Ross, Scotland