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NHS caesareans open to all

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Women in England and Wales can now choose to have a caesarean even if there is no medical reason for them to do so, under new guidelines drawn up by the NHS.

The directive from NICE (The National Institute of Health and Clinical Excellence) means expectant mothers should always have the right to a caesarean if they want one. It is particularly aimed at those who suffer from a fear of natural childbirth.

The new report published this week states, "For women requesting a CS (caesarean section), if after discussion and offer of support, a vaginal birth is still not an acceptable option, offer a planned CS."

Under previous guidelines from 2004, doctors could decline the procedure "in the absence of an identifiable reason."

The new set of NICE guidelines stipulates that those requesting a caesarean should be informed of the risks involved and offered counselling before making a decision.

The proposal was first mooted last month amid research that showed caesareans are now much safer than they used to be.

The plan met with a mixed reaction, with some critics believing the cost of the operation (up to £1500 more than a natural birth) will be an unnecessary drain on the NHS and take away from funding for midwives helping with natural childbirth. They also raised concerns over medical side effects of the operation, such as scarring.

But NICE said this week's revision to guidelines were "a very long way" from offering all women surgery.

"This guideline is not about offering free caesareans for all on the NHS," said Dr Gillian Leng, deputy chief executive of NICE. "This guideline is not about offering free Caesareans for all on the NHS. It is about ensuring that women give birth in the way that is most appropriate for them and their babies."

Around quarter of women in the UK currently give birth by caesarean. Around 12 percent of women who plan to give birth naturally undergo emergency caesareans.

Research indicates that around 10 percent of women in Britain suffer from a serious fear of natural childbirth, called tokophobia. Those welcoming the new guidelines pointed to yet another category of women who may have suffered traumatic births in the past due to a shortage in resources and so want a caesarean the next time round.

Nina Khazaezadeh, a consultant midwife at St Thomas' Hospital in London, told the Telegraph, "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."

What do you think? Is it a good thing that caesareans are now available to all women, regardless of reason? Or do the risk and costs involved still make this a grey area? Let us know your thoughts on Twitter or in the comments section below.

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