BOTH the organisations which have published guidelines on the indications for Caesarean section are government sponsored. Women’s pressure groups and the NHS have for many years been campaigning to reduce the number of Caesarean sections.

About one in five labours ends in a Caesarean; 22 per cent are carried out for the sake of the babies’ well-being, 20 per cent because of failure of the labour to progress, 14 per cent because of a previous Caesarean, 14 per cent because of a breech presentation and 7 per cent because of a request.

It is presumably this last indication which the NHS has in its sights, although it also suggests that a baby’s irregular heartbeart in labour should not be routinely regarded as an indication for Caesarean unless there is other evidence that the baby is distressed.

It also recommends that there should be a return to attempting to turn a baby from the breech position so that it is lined up for a head-first arrival in this world.

This used to be standard practice when I was a junior doctor. Too enthusiastic turning could damage the placenta and thus the practice was abandoned.

Unfortunately not all would-be mothers share the politically correct enthusiasm for a normal vaginal birth, and their opinion isn’t refuted by the majority of women obstetricians who, having seen disasters from long labours or delayed Caesarean sections, opt for a Caesarean section.

The standard indications for Caesarean section are divided into the absolute or relative.

The absolute ones are those which make vaginal delivery impossible. These include foetopelvic disproportion, in which there is no doubt that the baby’s head is too big to pass through the pelvis; a presentation of the baby, such as by a shoulder, which would make it impossible for the baby to be delivered; or a placenta implanted over the cervical entrance to the uterus.

There is a longer list of relative indications, none of which should be abandoned.

The problem of accepting broad principles and working on assumptions is that they may become an excuse for a laissez-faire conduct of a delivery that would serve neither the best interests of the mother, who might be put off childbirth for ever, nor the child.

The validity of the assumption that, for instance, Caesarean section doesn’t reduce the risk of babies dying can be assessed only case by case. Daily, babies’ lives are saved by an emergency Caesarean.

Likewise, the statement that babies born by Caesarean section are more likely to have breathing problems at birth would have to be judged against the reason why the Caesarean was initially arranged.

Premature babies, for instance, are often delivered by Caesarean and are more likely to have breathing difficulties, but it is their immaturity which is responsible for this and not the operation.

Authorities dislike Caesareans at a mother’s request but there can occasionally be a good psychological or social reason why a Caesarean might be the preferred option. This shouldn’t be denied in an appropriate case.

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