Pregnant women anxious about giving birth should be able to choose to have a caesarean section on the NHS, NICE has recommended.
The guidelines state that doctors and midwives need to explain overall risks and benefits of a caesarean compared with a vaginal birth when there is no medical need.
And women who want a caesarean because of anxiety should be offered counselling but ultimately it is their choice.
On the other side of the coin, pregnant women who have previously had a caesarean section will now be offered a vaginal birth as a matter of routine.
NICE says the change dispels the myth ‘once a caesarean, always a caesarean’ and points out that the risk of complications for women who have up to four previous caesarean sections is the same for a vaginal birth as it is for a caesarean section.
Recommendations have also been updated for women with HIV who will also now be offered a vaginal birth.
The updated advice also recommends prophylactic antibiotics before a caesarean section rather than after it, which could reduce the number of post-op infections by around a third, say NICE.
Dr Gillian Leng, NICE deputy chief executive, stressed that the guideline was not about offering free caesareans for all on the NHS and could actually reduce the rate by highlighting women who do not need to have the surgery.
She said: ‘For a very small number of women, their anxiety about childbirth will lead them to ask for a caesarean section.’
‘The new recommendations in this guideline mean that these fears will be taken seriously and women will be offered mental health support if they need it.’
Malcolm Griffiths, consultant obstetrician and gynaecologist at Luton and Dunstable Hospital and NICE guideline chair added: ‘Caesarean section is major surgery which most pregnant women want to avoid if they can.
‘We want women who do not need to have a caesarean section to be able to avoid such surgery.’