NICE Caesarean Guidance Information For You

Also see NICE Stakeholder Work

The current NICE caesarean guidance is going to be updated. In the meantime, you might find it helpful to quote some of the information below during your antenatal appointments, and you can also view the NICE Caesarean Pathway here.

2017
– Caesarean section (2011) NICE guideline SURVEILLANCE REPORT (CG132)

(January 10, 2017)
Surveillance decision: We checked this guideline in January 2017 and we are updating the recommendations on woman-centred care and procedural aspects.
Woman-centred care: Planning mode of birth – what are the risks and benefits of planned caesarean section (CS) compared with planned vaginal birth for both women and babies?
– Topic experts highlighted there is a need to consider long-term outcomes when planning the mode of birth. Evidence was identified about CS and its impact on maternal outcomes (risk of future ectopic pregnancy, stillbirth or miscarriage, sub-fertility) and infant outcomes (cerebral palsy, childhood obesity, asthma, bowel disease, and iron-related haematological indices).
Decision: This question should be updated.

2013
– Caesarean section QUALITY STANDARD (QS32)
(June 11, 2013) Caesarean Birth press release on QS32

2011
Caesarean section CLINICAL GUIDELINE (CG132)
(November 23, 2011) Full (long) and NICE (short) versions published.

Key priorities for implementation:

Maternal request for CS
– When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner.
– For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.
– An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS.

Recommendations:

Maternal request for CS
34. When a woman requests a CS explore, discuss and record the specific reasons for the request.
35. If a woman requests a CS when there is no other indication, discuss the overall risks and benefits of CS compared with vaginal birth (see tables 4.5 and 4.6) 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.
36. When a woman requests a CS because she has anxiety about childbirth, offer referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner.
37. Ensure the healthcare professional providing perinatal mental health support has access to the planned place of birth during the antenatal period in order to provide care.
38. For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.
39. An obstetrician unwilling to perform a CS should refer the woman to an obstetrician who will carry out the CS.

Important update to Health Economics:

An economic model developed for this guideline suggested that planned vaginal birth was cost effective compared to a maternal request CS. However, this finding was limited to outcomes that were reported in the included studies for the clinical review undertaken for this guideline (see Section 4.2). A sensitivity analysis suggested that the inclusion of adverse outcomes not reported, such as urinary incontinence, could make the conclusion regarding cost effectiveness less certain. On balance, this model does not provide strong evidence to refuse a woman’s request for CS on cost effectiveness grounds.
(Full version pp. 100-101; £84 cost difference between PCD & PVD on p.220)

NICE Caesarean section COSTING REPORT (CG132)
(November 23, 2011)

– NICE Caesarean section CLINICAL AUDIT (CG132)
(November 23, 2011)

– NICE Caesarean section (update) FINAL DRAFT (CG132)
(September 5, 2011)

Recommendations:

Maternal request for CS
38. For all women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS.
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 NHS obstetrician in the same unit who will carry out the CS.