Dr Foster's Case Notes

Social class and elective caesareans in the English NHS

BMJ 2004; 328 doi: http://dx.doi.org/10.1136/bmj.328.7453.1399 (Published 10 June 2004) Cite this as: BMJ 2004;328:1399

Over the past two decades the rising rate of caesarean section delivery in the United Kingdom and worldwide1 has led to concern that many caesarean sections are unnecessary. “Maternal request” is reported to be the fifth most common reason given for performing a caesarean section.2 Recently published NICE guidelines aim to reducevariations in caesarean rates around the country and guarantee consistent quality of care.3 Some commentators have blamed rising caesarean rates on wealthy women requesting the operation in the belief that it is less painful and avoids problems associated with natural delivery (thus the phrase “too posh to push”)4; others support the notion that the trend is provider led.5 An analysis of NHS …

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