CG132 Caesarean section: Malcolm Griffins, Chair of the Guideline Development Group
Caesarean Section: Malcolm Griffiths, consultant obstetrician and gynaecologist and chair of the Guideline Development Group, discusses the updated guidelines.
This podcast was added on 23 Nov 2011
Caesarean section podcast with Malcolm Griffiths
Hello and welcome to this podcast from NICE on updated caesarean section guidelines. In this podcast we will focus on new recommendations concerning maternal request for caesarean section.
Joining me is Malcolm Griffiths who worked on the guideline development group responsible for the guidelines.
Q1: So Malcolm can you tell me a bit more about these new recommendations?
Malcolm: “The most important point about this group of women requesting caesarean section is that women who have some particular reason for wanting a caesarean section, we should be attempting to identify these women as early as possible.
“The next point would be that we should have in place services that we can direct those women towards where their concerns can be properly addressed and where we can put in place any support that’s necessary that hopefully will allow the majority of these women to opt for a vaginal birth rather than pressing for a caesarean section.
“But ultimately if a woman has gone through those various processes and still has a strong clearly expressed need for a caesarean section then we should not be denying her that choice.”
Q2: Why do you think it is that some women might request a caesarean section?
Malcolm: “I think that some women may request a caesarean section because they have misunderstood, they have been misinformed, or for cultural reasons they have latched onto vaginal birth being a bad thing.
“There will also be women who have been abused or have otherwise been psychologically traumatised who will have a considerable fear of any kind of interference down below and vaginal birth would be one of the things that they would have difficulty in tolerating.
“There are other women who have perhaps misconceived some of the risks, this may be where we can turn things around and allow women to make an informed choice to have a vaginal delivery.”
Q3: What type of advice and support should midwives give to women who have tocophobia or anxiety about vaginal delivery?
Malcolm: “I think that to some extent we have a problem in this area in that there isn’t enough research base to demonstrate clearly what does and does not work. And so I think that we need to approach this from a pragmatic point of view to try and understand what is the problem for the woman, where her concerns lie and once we have understood what the problem is to be able to address that often by information giving and sharing experiences rather than here’s a tablet or a treatment that will change people’s minds about these things.
“We have made recommendations in the guideline that this is an area for further research and hopefully some of that research will get done and then in a few years’ time we will be able to give a better answer to that question.”
Q4: If after receiving psychological support, a woman still decides that she wants a caesarean section, what steps should an obstetrician then take?
Malcolm: “I think you need to make sure that you have an informed choice from the woman and that she is making that choice and understanding the pros and the cons and what the risks involved are. But I don’t think we should berate women with the risks and over emphasis the risks of caesarean section. But she should know what the consequences of her choice are. Then I think that we should go along with that choice.”
Q5: And finally, what impact do you think these recommendations will have on caesarean section rates?
Malcolm: “I think that this particular recommendation will have a marginal impact on caesarean section rates because we are talking about a minority of women, and because my understanding is that with appropriate support these women will generally be able to continue and have a normal labour and a vaginal delivery, so it won’t make a big impact. Whereas at the same time, the recommendations in general are facilitating the choice of vaginal birth against caesarean section birth for a group of other women who have had multiple caesarean sections, women who are HIV positive, who are now going to be empowered to choose a vaginal birth over a repeat caesarean section."
Malcolm thank you very much for your time.
This resource should be used alongside the published guidance. The information does not supersede or replace the guidance itself.
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This page was last updated: 19 September 2012