NICE's soon to be announced recommendation that all women be allowed to have a caesarean birth is surprising given the current economic climate.

However as having a caesarean is medically safer than it used to be a decade or so ago, the argument seems sound for no longer discouraging expectant mothers from opting for one on heightened risk grounds alone.

I also welcome the move on the basis it will ease the very real fears some women have of giving birth naturally. One friend of mine had a horrendous birth experience with her first child and was so scared of a repeat performance that she agonised for months before requesting an elective caesarean for fear she would be maligned, such was the perceived climate at the time. It was only when she broke down in tears that her concerns were taken seriously by her midwife.

Another friend's wife confessed she has a phobia of getting pregnant because she can't face the thought of giving birth naturally - this may seem extreme but I have heard anecdotally of other women sharing this same fear. NICE's move will make requesting elective caesareans for all these women far less stressful.

However, I have concerns about NICE's decision on other grounds. Requesting a caesarean on purely "cosmetic" grounds has always seemed suspect to me and it is alleged that some celebrities opt for early electives in order to maintain their figures. I believe this is not only morally wrong, but potentially detrimental to the baby's health.

I also believe that by legitimising a women's right to choose, we may perversely be in danger of limiting their choice. Women may be lulled into thinking a Caesarean is now a "safe" option when in reality it is still a major operation with serious risks involved. Overstretched midwives with limited resources may no longer have the time to assuage expectant mothers' fears or explain alternative birth options and methods of pain relief such as hypnobirthing, water births, etc.

I base this argument partly on my own personal experience. Although I am forever grateful that two emergency caesareans at the hands of an expert medical team brought my two daughters safely into the world, it is with the benefit of hindsight that I wish that I myself had been better informed of all the options. Although I attended NCT and pre-birth yoga classes, I felt fairly powerless when faced with the painful reality of childbirth. If I had known about hypnobirthing when I was pregnant, then perhaps I could have learned techniques that would have helped me achieve natural births.

So, my overriding fear is that if women are commonly and increasingly presented with limited choice then they won't explore all the options. It would also be a real shame if NICE's ruling pushes the recent call by top doctors for more home births to the sidelines. This would be a retrograde step and we'd be letting future generations of mothers and babies down.

Posted 1415 on November 1st 2011. Comment on this blog by emailing penny.hosie@pavpub.com