Letters NICE on caesarean section

NICE says caesarean section is not available on demand unless clinically indicated

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f4649 (Published 30 July 2013) Cite this as: BMJ 2013;347:f4649
  1. Mandie Scamell, lecturer in midwifery1,
  2. Alison Macfarlane, professor in women’s and child health1,
  3. Christine McCourt, professor in women’s and child health1,
  4. Juliet Rayment, research fellow1,
  5. Judith Sunderland, lecturer and programme lead in midwifery1,
  6. Mary Stewart, research midwife2
  1. 1Early Years Division, City University London, London EC1A 7PN, UK
  2. 2Life Study, University College London, London WC1N 1EH, UK
  1. mandie.scamell.1{at}city.ac.uk

We were alarmed by the letter from Mascarenhas and colleagues entitled, “NICE promises on infertility and caesarean section are unmet.”1 We agree with the authors that current underfunding in the NHS is having grave consequences on national maternal health service provision and deserves careful scrutiny and critical comment, and we recognise that they are excellently placed to offer such scrutiny and comment. What is unhelpful is the misleading medicolegal description of elective caesarean section.

They claim that current NICE guidelines “state that all pregnant women should be able to choose an elective caesarean without obstetric or psychological indications.” This is at variance with both the guideline and current legal/ethical precedent.

NICE suggests that when requests for caesareans are based on anxiety, mothers should be offered referral to a perinatal mental health professional.2 The recommendation is that a caesarean section should be offered only if this fails. The authors’ reading of the 2011 NICE guideline, by contrast, suggests that caesarean section is available on demand. This reading not only fails to pass the Bolam test but contravenes existing medicolegal precedent set in 2004 through the R (Leslie Burke) v General Medical Council, where it was held that there is no right to treatment on demand (paragraphs 30-31).3

We emphasise therefore that current legal precedent and clinical guidelines hold that surgical interventions, such as caesarean section, are not available on demand unless clinically indicated.


Cite this as: BMJ 2013;347:f4649


  • Competing interests: None declared.


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