Recommendation ID
CG132/4
Question
Maternal request for Casarean Section (CS): What support or psychological interventions would be appropriate for women who have a fear of vaginal childbirth and request a CS?
Interventions for evaluation could include:
• support from a named member of the maternity team
• continuity of carer
• formal counselling
• cognitive behavioural therapy.
Outcomes could include:
• mode of birth planned at term
• psychological outcomes (postnatal depression, post-traumatic stress disorder, self-esteem, mother–infant bonding)
• breastfeeding.
Any explanatory notes
(if applicable)
Why this is important:-
Fear of vaginal childbirth may stem from:
• fear of damage to the maternal pelvic floor
• damage to the baby during childbirth
• self-doubt on the ability to physically achieve vaginal birth
• previous childbirth experience
• unresolved issues related to the genital area.
Currently there is a wide variation in practice and limited resources lead to limited availability of effective interventions. Interventions that may be appropriate include:
• antenatal clinics dedicated to providing care for women with no obstetric indications who
request a CS
• referral to a psychologist or a mental health professional
• referral to an obstetric anaesthetist
• intensive midwifery support
Continuity of healthcare professional support from the antenatal to the intrapartum periods and 'one to one' midwifery care during labour are also often lacking and may make a difference to women who are anxious or afraid.
All of these interventions have different resource implications and there is no clear evidence to suggest that any are of benefit. The proposed research would compare in a randomised controlled trial two or more of these interventions in women requesting a CS. In the absence of any evidence, there is a case for comparing these interventions with routine antenatal care (that is, no special intervention).
This research is relevant because it would help to guide the optimal use of these limited resources and future guideline recommendations.

Source guidance details

Comes from guidance
Caesarean section
Number
CG132
Date issued
November 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   No