A midwifery-led care pathway for women requesting caesarean sections
The caesarean section rate in the UK has increased dramatically in the last 20 years. Subsequently, there has been a rise in caesarean sections for maternal request (CSMR) without medical indications. In 2011, the National Institute for Health and Care Excellence (NICE) added to their guidance, that if after discussion and support, a vaginal birth is not acceptable, elective caesarean should be offered. This article proposes the implementation of a midwifery-led care pathway for women requesting caesarean section without medical indication. The care pathway includes group psychoeducational therapy which has been found to reduce CSMR, emergency caesarean sections and negative birth experiences. The challenges and barriers that may be faced when leading developments in maternity services are discussed, with reference to political, economic, social and technological factors.
The caesarean section (CS) rate in the UK has increased substantially in the last 20 years from 13% in 1992 to 25.5% in 2012/13 (National Institute for Health and Care Excellence (NICE), 2004; Health and Social Care Information Centre, 2013). With this increase has come a change in the indications for CS, one of which has been a rise in CS for maternal request (CSMR) without medical or obstetric indication. Caesarean sections save lives, and with medical advancements in the developed world, it could be argued that CSs are safer than ever. However, the increased maternal and neonatal morbidities associated with unnecessary caesareans, and the impact on subsequent pregnancies should not be underestimated (Lauer et al, 2010). In 2011, NICE added to their guidance for women requesting CS, that if after discussion and support, a vaginal birth is not acceptable, elective CS should be offered (NICE, 2011a). This article will explore the care of women who request CS and critically analyse the challenges and barriers that may be faced when leading developments in maternity services within the NHS. The implementation of a midwifery-led care pathway is proposed.
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