Individual research recommendation details

Recommendation ID

NG192/04

Question

Maternal request for caesarean birth: What support or psychological interventions would be appropriate for women who have a fear of vaginal childbirth and request a caesarean birth?

Any explanatory notes
(if applicable)

Why this is important:
Fear of vaginal childbirth can stem from:

• fear of damage to the maternal pelvic floor
• damage to the baby during childbirth
• self-doubt on the ability to physically have a vaginal birth
• previous childbirth experience
• unresolved issues related to the genital area.

Currently there is a wide variation in practice and limited resources lead to limited availability of effective interventions. Interventions that might be appropriate include:

• antenatal clinics dedicated to providing care for women with no obstetric indications who request a caesarean birth
• referral to a psychologist or a mental health professional
• referral to an obstetric anaesthetist
• intensive midwifery support.

Continuity of healthcare professional support from the antenatal to the intrapartum periods and 'one-to-one' midwifery care during labour are also often lacking and could make a difference to women who are anxious or afraid.

All of these interventions have different resource implications and there is no clear evidence to suggest that any are of benefit. The proposed research would compare in a randomised controlled trial 2 or more of these interventions in women requesting a caesarean birth. In the absence of any evidence, there is a case for comparing these interventions with routine antenatal care (that is, no special intervention).

This research is relevant because it would help to guide the optimal use of these limited resources and future guideline recommendations.

Source guidance details

Comes from guidance

Caesarean birth

Number

NG192

Date issued

March 2021

Other details