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Looking at those links to NICE, the consultation deadline has now passed (June 2011). I think perhaps the news reports has blown it up (surprise surprise) and the following guidelines aren't much different to what I have seen in practice Maternal request for CS 34 When a woman requests a CS explore, discuss and record the specific reasons for the request. [new 2011] 5.9 35 If a woman requests a CS without a clinical indication, discuss the overall risks and benefits of CS compared with vaginal birth (see tables 4.3 and 4.4) and record that this discussion has taken place. Include a discussion with other members of the obstetric team (including the obstetrician, midwife and anaesthetist) if necessary to explore the reasons for the request, and to ensure the woman has accurate information. [new 2011] 5.9 36 When a woman requests a CS because she has a fear of childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her fears in a supportive manner. [new 2011] 5.9 37 Ensure the healthcare professional providing perinatal mental health support has access to the planned place of birth in order to provide care. [new 2011] 5.9 38 If after providing support, a vaginal birth is still not an acceptable option to the woman, offer a planned CS. [new 2011] 5.9 39 An obstetrician has the right to decline a woman’s request for a CS. If this happens, they should refer the woman to an obstetrician who will carry out the CS. [new 2011] Best wishes Claire Feeley (NQM) ________________________________ From: "McCourt, Christine" <[log in to unmask]> To: [log in to unmask] Sent: Monday, 31 October 2011, 10:46 Subject: Re: c-section for all women who request it by NICE? Re: c-section for all women who request it by NICE? Dear Rena If so, they are misinformed. The review of evidence on costs undertaken by Petrou et al showed that CS is more expensive. On 31/10/2011 11:41, "Rena Papadopoulos" <[log in to unmask]> wrote: I cannot help thinking that this retrograde step is based on economics. Is it possible that routine booked births via cs are cheaper (more efficient use of staff) than the unpredictable natural start and length of labour of normal births? Someone must have put forward such an immoral argument which obviously has fallen on economically fertile ears. Forgive me for putting a conspiracy theory forward but the cs proposal is so bizarre….As far as I know the WHO is supporting natural birth. >Regards, >rena > > >Irena Papadopoulos, PhD, MA, BA, DipNEd, DipN, RGN, RM, NDNCert, RNT, FHEA, >Professor of Transcultural Health and Nursing, >School of Health and Social Sciences, >Middlesex University, >Archway Campus, >Highgate Hill, London N19 5LW. >Tel: 0208 411 6626 >Fax: 0208 411 6106 > >To subscribe to our Transcultural mailing list send a message to: [log in to unmask] with the command SUBSCRIBE TRANSCULTURAL-EUNET-L in the message body > > >From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Soo Downe >Sent: 30 October 2011 22:50 >To: [log in to unmask] >Subject: Re: c-section for all women who request it by NICE? > > >Just in case you cant download the information I have just sent: > > > >Increased with CS > >• Abdominal pain > >• Bladder injury > >• Ureteric injury > >• Need for further surgery > >• Hysterectomy > >• Intensive therapy/high dependency unit > >admission > >• Thromboembolic disease > >• Length of hospital stay > >• Readmission to hospital > >• Maternal death > >• Antepartum stillbirth in future pregnancies > >• Placenta praevia > >• Uterine rupture > >• Not having more children > >• Neonatal respiratory morbidity > > > >No difference after CS > >• Haemorrhage > >• Infection > >• Genital tract injury > >• Faecal incontinence > >• Back pain > >• Dyspareunia > >• Postnatal depression > >• Neonatal mortality > >(except breech) > >• Intracranial haemorrhage > >• Brachial plexus > > > >Reduced with CS > >• Perineal pain > >• Urinary incontinence > >• Uterovaginal prolapse > > > >All the best > > > >Soo > > > >________________________________ > >From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] on behalf of Soo Downe [[log in to unmask]] >Sent: Sunday, October 30, 2011 10:40 PM >To: [log in to unmask] >Subject: Re: c-section for all women who request it by NICE? > >Hmm - CS is now safe? Maybe it depends on what outcomes you look at: These are the risks cited in the current NICE CS guidelines: > > > >NICE 2004 Cesarean section: Quick reference guide. Available at: http://www.nice.org.uk/nicemedia/live/10940/29333/29333.pdfdopwnloaded on 6th Oct 2011 <http://www.nice.org.uk/nicemedia/live/10940/29333/29333.pdfdopwnloaded%20on%206th%20Oct%202011> > > > > > > > > > > > >Longer term, CS has also been linked to type one diabetes in the neonate, athsma, excema, and, most recently, multiple sclerosis: > > > >Mult Scler.<http://www.ncbi.nlm.nih.gov/pubmed/21982872> 2011 Oct 7. [Epub ahead of print] >Cesarean delivery may increase the risk of multiple sclerosis. >Maghzi AH<http://www.ncbi.nlm.nih.gov/pubmed?term=%22Maghzi%20AH%22%5BAuthor%5D> , Etemadifar M <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Etemadifar%20M%22%5BAuthor%5D> , Heshmat-Ghahdarijani K <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Heshmat-Ghahdarijani%20K%22%5BAuthor%5D> , Nonahal S <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Nonahal%20S%22%5BAuthor%5D> , Minagar A <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Minagar%20A%22%5BAuthor%5D> , Moradi V <http://www.ncbi.nlm.nih.gov/pubmed?term=%22Moradi%20V%22%5BAuthor%5D> . >Source >IRCOMS, Iran/Neuroimmunology Unit, Centre for Neuroscience & Trauma, Blizard Inst. of Cell &Molecular Sci.,UK/Med. Schl, Isfahan Uni. of Med.Sci, Iran. >Abstract >Background: Prenatal and perinatal factors are believed to contribute to the risk of developing multiple sclerosis (MS). Objective: This study was designed to evaluate whether mode of delivery (vaginal versus cesarean section), as a perinatal factor, affects susceptibility to MS. Methods: MS patients were recruited from the MS registry of Isfahan Multiple Sclerosis Society (IMSS) and were compared with their healthy siblings. Data regarding mode of delivery, birth order, and gestation week of birth were obtained through a specially designed questionnaire. Preterm or post term deliveries were excluded. We used conditional logistic regression statistics and adjusted for gender and birth order. Results: This study included 1349 participants (449 MS patients and 900 controls). Subjects who were born by cesarean sectionhad significant risk of MS (odds ratio, OR = 2.51; 95% confidence interval, CI: 1.43-4.41; p = 0.001). There was significant MS risk for females who were born by cesarean section (OR = 2.69, 95% CI: 1.30-5.58; p = 0.008), but not for males (OR = 2.25, 95% CI: 0.90-5.63; p = 0.082). The mean age at onset was lower in MS patients born by cesarean section (24.58 ± 6.33) compared with that of patients born by vaginal delivery (27.59 ± 7.97; p = 0.041). There was no significant difference between the two groups for birth order (p = 0.417). Conclusion: Our results suggest that those born by vaginal delivery are at a lower risk of subsequent MS. These preliminary findings will need to be addressed in a much larger and preferably prospective study. > >PMID: >21982872 >[PubMed - as supplied by publisher] > >________________________________ > >From: A forum for discussion on midwifery and reproductive health research. [[log in to unmask]] on behalf of Pamela Harnden [[log in to unmask]] >Sent: Sunday, October 30, 2011 10:25 PM >To: [log in to unmask] >Subject: Re: c-section for all women who request it by NICE? > >Dear Lucia, > > > >The impression in Australia is that it is true and that the risks are so small now because the obstetricians are so expert at it, the suggestion is that it is actually safer than birthing normally! > > > >Pam > >On Mon, Oct 31, 2011 at 9:18 AM, LUCIA ROCCA <[log in to unmask]> wrote: >Dear All, > >I am sure this must be misinformation but I am a bit worried about the news from Sky news: > >http://news.sky.com/home/uk-news/article/16099301 > >about NICE publishing a new report saying that women must have the right to ask, at NHS expenses, a CS without medical indication. > >could please somebody reassure me ( while I am on holiday...) that I got it wrong? > >Thanks > >Lucia >