Some pregnant women are afraid of giving birth

The National Institute of Clinical Excellence, suggests "maternal request" is not a good enough reason for a woman to have the operation.

However, the vast majority of women who have caesareans on the NHS do so because doctors feel there is a medical reason for the procedure.

NICE's final guidance will not come into effect until April 2004.

It is not the case that there are lots of women asking for caesareans Frances Day-Stirk, of the Royal College of Midwives

Around 600,000 babies are born in the UK each year, and it is estimated that almost one in four births are caesarean sections.

This is well above the 10% rates recommended by the World Health Organization.

'Vague request'

NICE's recommendations are contained in a first draft of the guidance, which is out for consultation.

It says: "When a woman requests a caesarean section, specific reasons for the request should be sought, recorded and discussed.

"The term 'maternal request' is vague, its use should be discouraged and it is not on its own an indication for caesarean section."

The guidance suggests women who are concerned about the pain or after-effects of giving birth naturally should be offered information about the risks and benefits of a caesarean compared to a vaginal delivery.

Babies born by caesarean are more likely to experience breathing difficulties and need specialist neonatal care.

Rare complications for the mother can include haemorrhaging and scarring or damage to the fallopian tubes or ovaries.

Childbirth experts say it is already extremely rare for caesareans to be carried out on the NHS simply because a woman does not want a natural birth.

An audit carried out two years ago found that only around 1% births - around 6,000 babies - had been caesareans carried out for non-medical reasons.

Confidence

Frances Day-Stirk, of the Royal College of Midwives, said: "It is not the case that there are lots of women asking for caesareans. The audit showed that the numbers are very small.

"It is very rare on the NHS."

But she said: "Some women do have a phobia of childbirth - and that is a medical reason which would be considered as grounds for a caesarean.

"Professionals should find out why women want the operation and look at the alternatives."

She added: "We know that women who have midwife-led care where they know the midwife, and can build up a rapport have more confidence in giving birth."

She said some doctors did err on the side of caution when deciding if a woman should have the operation.

"Some have been feeling pressure from women to recommend caesareans."

Andrea Sutcliffe, an executive director at NICE said, "The Institute follows an open and consultative process when developing clinical guidelines.