This guideline covers when to offer caesarean birth, discussion of caesarean birth, procedural aspects of the operation, and care after caesarean birth. It aims to improve the consistency and quality of care for women who are thinking about having a caesarean birth or have had a previous caesarean birth and are pregnant again.
There is a shortage of diamorphine (see the Specialty Pharmacy Service's memo on the shortage of diamorphine injection 5 and 10 mg) affecting our recommendation on diamorphine for managing pain after caesarean birth. We plan to review alternatives to diamorphine, but in the meantime you may need to develop alternative local protocols and training to ensure patient safety. See for example the Obstetric Anaesthetists’ Association commentary on alternatives to intrathecal and epidural diamorphine for caesarean section analgesia.
The guideline uses the terms 'woman' or 'mother' throughout. These should be taken to include people who do not identify as women but are pregnant or have given birth.
The recommendations in this guideline were developed before the COVID-19 pandemic.
This guideline includes new and updated recommendations on:
- discussing benefits and risks of caesarean and vaginal birth
- prevention and management of hypothermia and shivering during caesarean birth
- surgical techniques for caesarean birth
- care of the woman after caesarean birth
- recovery after caesarean birth
It also includes recommendations on:
- planned caesarean birth
- factors affecting the likelihood of emergency caesarean birth
- procedural aspects of caesarean birth
- care of the baby after caesarean birth
- pregnancy and childbirth after caesarean birth
Who is it for?
- Healthcare professionals
- Pregnant women, their families and carers
Is this guideline up to date?
We checked this guideline in 2021 and propose to update the recommendations on:
- maternal request for caesarean birth (update decision July 2021)
- Joel-Cohen transverse incision (update decision July 2021)
- offering diamorphine after caesarean birth (update decision October 2021)
- morbidly adherent placenta (update decision October 2021)
Guideline development process
This guideline updates and replaces NICE guideline CG132 (November 2011).
This guideline was previously called caesarean section.
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.