The right to choose, but not on the NHS

The issue of unborn babies and a woman's right to choose was again propelled into the headlines last week, as Channel 4 aired its controversial documentary "My Foetus", in which viewers were treated to the spectacle of an abortion procedure at four weeks of pregnancy. Tomorrow, the issue of choice regarding unborn babies will again be tackled head on, when an important medical quango publishes a set of guidelines telling doctors that women should no longer be given the right to choose. If they want to choose, says the National Institute for Clinical Excellence, which enjoys the acronym Nice, they should be compelled to go private. Choice is a luxury that should no longer be available on the National Health Service.

But fear not, this will not mean the widespread return of the grisly backstreet abortion, of old crones drawing hot baths and brandishing knitting needles. This right to choose concerns not the termination of the unborn child, but its mode of arrival. It is caesarian sections, not abortions, that preoccupy Nice, specifically the increasing practice of women booking caesarians to fit in with their or their partner's work or social commitments.

Last week, Jo Williams gave birth to her son Connor by pre-booked caesarian. Mrs Williams wanted Connor to arrive before the World Snooker Championship at the Crucible Theatre, Sheffield, where her husband Mark was defending champion. As it turned out, Mark Williams could probably have been at her bedside to see her give birth naturally; becoming a father for the first time did nothing for his concentration, and he was knocked out on Saturday, in round two.

Victoria Beckham had her second child, Romeo, by a caesarian. One wonders whether she has reminded her husband David of this, and more to the point flashed her abdominal scar, amid the claims that he had an affair with his personal assistant, the presumably scar-less Rebecca Loos?

Other well-known women have booked caesarians to fit in with their hectic lifestyles. They are at the vanguard of a group of mothers who eschew vaginal births either because they can't quite embrace the uncertainty of when and how the baby will arrive, or because they are worried about the pain, or merely because they want to keep their pelvic floors nicely buffed. They are the women called "too posh to push".

Being too posh to push, they are also, invariably, too posh to give birth on the NHS. But those who choose caesarians without going private cost the health service £1,700, about £1,000 more than the cost of a natural hospital delivery. This is why Nice has stepped in, suggesting that unless pregnant women need caesarians for manifest physical reasons, they should be denied it.

On Sunday, I batted this subject around with two women, one of them my wife, Jane, who have had six babies between them. Our friend Giselle decided that it was perfectly reasonable for women to be able to choose caesarians on the NHS. "After all, there are lots of things not done naturally any more," she argued. Like what, we asked. She thought for a while. "Washing dishes," she ventured.

Incidentally, of those six babies, one - our middle child, Joseph - was born by emergency caesarian after Jane was found to have placenta praevia. As anyone who watches ER will know, placenta praevia is the condition in which the placenta covers the opening to the uterus.

As I understand it, from listening to ER's Dr Mark Greene down the years, natural childbirth in the event of placenta praevia means a ruptured cervix, extreme blood loss, and probably death.

When the obstetrician told Jane that she would have to give birth by caesarian, in hospital, she burst into tears. Far from wanting this extreme form of birth intervention, she had hoped to have her baby at home, without so much as gas-and-air.

The obstetrician offered no sympathy. "For goodness sake," she said crossly. "Before ultrasound scanning, placenta praevia was the biggest cause of death in childbirth. You should think yourself extremely lucky." It was a fair point. Given the choice, Jane would have had a vaginal birth, but she was denied that choice for life-or-death reasons.

There is a different life-or-death reason why Nice is right and why women should be denied the opportunity of choosing to have a caesarian birth when there is no pressing medical need; the life or death of the health service. Plainly, £1,000 is far too high a price to pay for every woman who, for whatever whimsical or even weighty reason, feels the need to predetermine her child's date of birth.

This unleashes another question. If convenience caesarians can be bought privately, then why shouldn't they be available on the NHS? Well, because life's like that, and caesarians for convenience's sake should be categorised with cosmetic surgery for vanity's sake, as too indulgent for a stressed health service. But more especially because parenthood is a sequence of uncertainties that begin with conception, and those who don't like those uncertainties maybe, just maybe, shouldn't join the club in the first place.

b.viner@independent.co.uk