PLD.50 Maternal Request Caesarean Section: 2 NICE Pathways?

Background In November 2011, the National Institute for Health and Clinical Excellence (NICE) in the UK published clinical guidance on Caesarean Sections. NICE states “For women requesting a CS, if after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer a planned CS”. What impact has this had on our CS rate and service provision here at University college London Hospitals NHS foundation trust? Method We identified all cases of maternal request CS over the last 3 years using our electronic patient records and prospective data collected by our Consultant Midwife. Results In 2013, there were 768 patient contacts by our consultant midwife with 192 women going through the maternal request Caesarean Section pathway. Abstract PLD.50 Table Annual number of deliveries Number of maternal request CS (%) As a proportion of all elective CS 2011 5841 54 (0.92%) 7.3% 2012 5953 121 (2.03%) 19.4% 2013 6095 152 (2.49%) 18.7% Conclusions We have seen a definite rise in maternal request CS related to the publication of the CS guidance by NICE. We have had to implement a multidisciplinary Care pathway for these women. This includes a Consultant Midwife, Consultant Psychologist, Consultant Obstetricians and other supporting staff. This pathway uses up additional resources but is worthwhile. Our consultant Midwife has had to split these women into 2 pathways: lifestyle choice requests and tocophobia requests. The tocophobia group receive more intense 1 to 1 support from the consultant midwife. Reference National Institute for Health and Clinical Excellence. Caesarean Section. London. NICE; 2011