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This report provides guidelines on the use of Caesarean section (CS).

Key priorities for implementation

Making the decision:

When considering a caesarean section (CS), there should be discussion on the benefits and risks of CS compared with vaginal birth specific to the woman and her pregnancy.

Maternal request is not on its own an indication for CS and specific reasons for the request should be explored, discussed and recorded. When a woman requests a CS in the absence of an identifiable reason, the overall benefits and risks of CS compared with vaginal birth should be discussed and recorded.

Carrying out the procedure:

The following interventions should be used to decrease morbidity from CS: - regional anaesthesia - antibiotic prophylaxis - thromboprophylaxis - antacids - anti-emetics.

The risk of respiratory morbidity is increased in babies born by CS before labour but this risk decreases significantly after 39 weeks. Therefore, planned CS should not routinely be carried out before 39 weeks.

Reducing the likelihood of CS:

Women who have an uncomplicated singleton breech pregnancy at 36 weeks gestation should be offered external cephalic version. Exceptions include women in labour, and women with a uterine scar or abnormality, fetal compromise, ruptured membranes, vaginal bleeding or medical conditions.

Women should be informed that continuous support during labour from women with or without prior training reduces the likelihood of CS.

Women with uncomplicated pregnancies should be offered induction of labour beyond 41 weeks, because this reduces the risk of perinatal mortality and the likelihood of CS.

A partogram with a 4-hour action line should be used to monitor progress of labour of women in spontaneous labour with an uncomplicated singleton pregnancy at term, because it reduces the likelihood of CS.

Consultant obstetricians should be involved in the decision making for CS, because this reduces the likelihood of CS.

Electronic fetal monitoring is associated with an increased likelihood of CS. When CS is contemplated because of an abnormal fetal heart rate pattern, in cases of suspected fetal acidosis, fetal blood sampling should be offered if it is technically possible and there are no contraindications.