£5,OOO bill for caesareans

A major clampdown on caesarean births has been ordered by health chiefs.

Doctors have been told they must have a valid medical reason to perform one, not just because the mother is 'too posh to push'.

Women will instead be encouraged to endure natural labour - and could face private medical bills of up to £5,000 if they insist on a surgical birth.

Doctors currently agree to one in three requests for a caesarean, allowing 10,000 women to deliver surgically without good medical reason at a cost to the Health Service of up to £15million.

But for the first time, hospitals will have to spell out the serious health risks to both mother and baby of choosing a caesarean.

Women having caesareans are five times as likely to die as those who have a normal delivery, because of the higher risk of haemorrhaging and fatal blood clots after surgery.

And their babies have seven times the risk of developing breathing difficulties as infants born naturally.

Experts hope that the unprecedented new measures will cut surgical birth rates by at least 10 per cent and save the taxpayer millions. The NHS guidance, to be launched today, follows mounting concern about Britain's soaring caesarean rate, which has doubled in a decade.

The Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and childbirth charities yesterday threw their weight behind the rationing of caesareans.

Louise Silverton, deputy general secretary of the Royal College of Midwives, said: 'We need to look at the fact that the NHS has limited resources. In any other area, unnecessary procedures would not

be supported by the NHS.' Celebrities such as Victoria Beckham and Elizabeth Hurley have had caesareans. Childbirth experts fear the operation has been ' glamourised' and is seen by some mothers as a lifestyle choice rather than the serious surgery it is.

One in five births is by caesarean, while the natural birth rate has dwindled to less than 50 per cent. The remainder is accounted for by induced births and deliveries using medical equipment including forceps.

In some major hospitals dealing with 'high risk' births in which the baby's life may be in danger, the caesarean rate may reach 65 per cent. But in other general

hospitals it has crept up to 33 per cent - with little or no medical explanation.

Ministers told the National Institute of Clinical Excellence to draw up the guidelines to force the NHS to bring down the surgical birth rate.

Professor David James, of the Royal College of Obstetricians and Gynaecologists, said: 'This guideline makes clear recommendations about when it is medically appropriate and necessary to carry out a caesarean.

'It will result in better care for pregnant women and their babies and a standardisation of services across the NHS.'

Mary Newburn, head of policy at the National Childbirth Trust, said: 'The culture of maternity services needs to be one in which birth is seen as a normal physiological process.'

The NICE guidance says 'maternal request' is not a good reason for a caesarean and a doctor 'has the right to decline a request for caesarean section in the absence of an identifiable reason'.

If women insist, they will be referred for a second opinion from another doctor.

Women who are afraid of natural childbirth or who have

been traumatised by a previous delivery will be offered counselling.

If they still refuse to try natural birth, some doctors may give in and agree to carry out a caesarean.

A NICE spokesman said: 'In a small number of cases you may end up with women choosing to go privately to have a maternal request caesarean-because both NHS doctors-have refused it. 'The guideline is not about forcing women to pay and it would be wrong for doctors to interpret it in that way.

'It is about helping women reach the best decision and helping them be aware of the risks of a caesarean that is not medically necessary.'

NICE executive director Andrea Sutcliffe added: 'A caesarean section is a major operation and any woman deciding whether to undergo one should be aware of the risks and benefits for herself and for her baby.'

But the Royal College of Midwives warned that staff shortages may hamper efforts to implement the guidance.