NICE consults on updated caesarean section guideline
In draft guidelines on caesarean section (CS) published today, 23 May, NICE has made a number of new and updated recommendations on several aspects of the procedure.
These draft recommendations are now open for consultation until 20 June 2011.
NICE's original clinical guideline on caesarean section was published in April 2004. Since then, much new evidence has been published and there have been changes in clinical practice. These factors were felt to warrant a review and update of the guideline.
The latest draft features several new and updated recommendations, including:
- women who have had up to and including four caesarean sections should be informed that their risk of fever, bladder injuries, surgical injuries and rupture of the womb is the same with a planned CS as it is with a planned vaginal delivery.
- women should be offered prophylactic antibiotics to reduce the risk of possible post-operative infections before the skin incision is made.
- when a woman requests a CS because of a fear of childbirth she should be offered a referral to a healthcare professional with expertise in providing perinatal mental health support to help her address her fears in a supportive manner.
- If, after providing support, a vaginal birth is still not an acceptable option to the woman, offer a planned CS.
- The condition of the woman and the unborn baby should be taken into account when making decisions about rapid delivery. It should be remembered that rapid delivery may be harmful in certain circumstances. For this reason, the recommended decision-to-delivery intervals should be used as audit standards only, to measure the overall performance of an obstetric unit. They should not be used to judge multidisciplinary team performance for any individual CS.
When NICE consulted on whether or not the guideline should be updated, many stakeholders said that they particularly welcomed the tables outlining the relative risks and benefits of caesarean section versus vaginal birth. This information has therefore been updated and included in the new draft guideline, so that health professionals can help women make an informed decision.
Christine Carson, Programme Director for the Centre for Clinical Practice at NICE said: "Rates of caesarean section have been rising in developed countries over the past four decades. In England, the rate was 13% in 1992, whereas in 2008/9 it was 23%. Recent evidence shows that a caesarean section is not necessarily the best course of action in some cases, for instance, where the mother has had previous caesareans, or is HIV positive. This new updated guideline includes revised recommendations for these scenarios. It also looks at the need for all category 1 emergency caesarean sections to be carried out within 30 minutes of the decision to operate: in some cases, hitting this target could cause harm, and so we are recommending that the decision-to-delivery interval should be used as an audit standard rather than as a target for each caesarean birth.
"The draft guideline will be open for consultation until 20 June and we would encourage stakeholders to give us their views on our suggested updates."
Notes to Editors
About the draft guidance
For further information about the draft recommendations on Caesarean Section including how stakeholders can submit their comments, visit: http://guidance.nice.org.uk/CG/WaveR/97
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This page was last updated: 23 May 2011