article: The National Institute of Health and Clinical Excellence (NICE) states that women should be offered counselling and told of the risks first. Ultimately, however, the decision would be made by the mother-to-be, it said. NICE said this was "a very long way" from offering all women surgery. The last set of NICE guidelines, which were published in 2004, clearly stated that "maternal request is not on its own an indication for Caesarean section" and that clinicians could decline the procedure "in the absence of an identifiable reason". The rules on requesting a C-section have been revised. Clinicians say this is to bring the instructions into line with what is already taking place in hospitals. The 2011 guidelines say that women requesting a C-section because of anxiety should be offered mental health support. A phobia of childbirth is thought to affect 6% to 10% of women. Nina Khazaezadeh, a consultant midwife at St Thomas' Hospital, says she often meets patients who want a Caesarean due to a "perceived lack of control, fears of inadequate care provision and lack of support during labour and delivery". "But, after a discussion of all the pros and cons of both types of birth, and having been assured of one-to-one midwifery support and an individualised birth plan, they will choose to try for a vaginal birth." The updated guidelines state that if such women still wanted a C-section, they should get one. Women with no medical need can also ask for a Caesarean section. The guidance states that they should be told of the risks and discuss their request with a clinician, but their request cannot be denied. Malcolm Griffiths, a consultant obstetrician and gynaecologist who led the development of the guidelines, said: "Caesarean section is a major operation, it's about as major as a hysterectomy. "It's not a major operation that most pregnant women are interested in or want to have." Dr Gillian Leng, deputy chief executive of NICE, said: "This guideline is not about offering free Caesareans for all on the NHS. "It is about ensuring that women give birth in the way that is most appropriate for them and their babies. "Offering these women a planned Caesarean section in these circumstances is a very long way from saying that Caesarean section should automatically be offered to every woman." Planned Caesarean section may reduce the risk of the following in women: Planned Caesarean section may increase the risk of the following in babies: Planned Caesarean section may increase the risk of the following in women: Source: NICE There will be wider changes to clinical practice. Being HIV positive will no longer be treated as grounds for an automatic C-section. Improvements in anti-retroviral therapies mean it is now safe for some woman with HIV to deliver vaginally. There will also be changes to break the mentality of "once a Caesarean, always a Caesarean". The latest evidence suggests that even for women who had up to four previous C-sections, that the risks of fever, bladder injuries and surgical injuries were the same for planned vaginal and planned Caesarean
summary: Pregnant women who ask for a Caesarean delivery should be allowed to have the operation, even if there is no medical need, according to new guidelines for England and Wales.