3.National guidelines lowered the threshold for intervention in order  to reduce the rate of perinatal morbidity and mortality e.g., reduced fetal movements (2012) and small for gestational age (2013). Introduction of ‘Saving babies lives’ care bundle (2016) enhanced the effect.

 

4.NICE Caesarean section guideline (2011) supported caesarean birth for tokophobia and amended in 2021 supporting maternal request CS following discussion of risks and benefits.

 

5.Greater awareness and acknowledgement of psychological morbidity related to childbirth.

 

6.Covid-19 pandemic was associated with deteriorating mental health within the population. Women reported anxiety associated with and restrictions on visiting
times for family members whilst in hospital. Increasing demand on capacity led to delays in the IOL processes, worsening public perception of IOL.

 

7.NHS drops the CS targets in order to increase safety and supporting women and clinicians make patient centred decisions

 

Conclusion: The overall increasing rates of IOL and CS over the last decade reflect the national trend and have been influenced by multiple factors such as rising complexity and comorbidities in obstetric population. Greater awareness of psychological morbidity related to childbirth and worsening public perception of the IOL processes, are some of the reasons cited by women as a reason for requesting a caesarean section.

Discussion and Recommendations: To ensure that the decisions are not just made out of fear of experience with one option without truly understanding the consequences of other, it is important that the information is being provided in the way that it can be personalised with timely antenatal education and psychological support where required. Current maternity services are not resourced to provide this service or the burden of increasing demand for caesarean sections; this should be addressed when planning future maternity services locally and nationally.