ÐÏࡱá>þÿ *,þÿÿÿ)ÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿì¥ÁÀ ð¿bjbjÓÒÓÒ .±¸±¸ÿÿÿÿÿÿ·>>˜˜˜˜˜ÿÿÿÿ¬¬¬¬ ¸ ¬U0ÄÄÄÄÄŸŸŸÔÖÖÖÖÖÖ$…²7fú˜ŸŸŸŸŸú˜˜ÄÄÛŸR˜Ä˜ÄÔŸÔh�Äÿÿÿÿ�͆¶‘Óÿÿÿÿñ€À%0Uˆ����˜�0ŸŸŸŸŸŸŸúúŸŸŸUŸŸŸŸÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿÿ�ŸŸŸŸŸŸŸŸŸ> ^:  Extract from Care of women undergoing Caesarean section Obs 103 ELECTIVE CAESAREAN SECTION Pre-operative care is necessary to provide the appropriate physical and psychological care to women who are having elective caesarean section. (Mallett and Dongherly 2000). At antenatal clinic when women are booked for elective caesarean section, Where a woman requests a caesarean section explore, discuss and record the specific reasons for the request as well as a record of discussion of the overall risks and benefits of caesarean section compared with vaginal birth. If she has anxiety about childbirth, an offer of referral to a healthcare professional with expertise in providing perinatal mental health support (birth after thoughts provides an appropriate forum for this) should be made to help her address this in a supportive manner. If after discussion and offer of support (including perinatal mental health support for women with anxiety about childbirth), a vaginal birth is still not an acceptable option, offer her a planned caesarean section with Consultant approval. Women who have an uncomplicated singleton breech pregnancy at 36 weeks' gestation should be offered external cephalic version (Guideline Obs 1). Exceptions include women in labour and women with a uterine scar or abnormality, fetal compromise, ruptured membranes, vaginal bleeding or medical conditions. If a woman chooses to plan a vaginal birth after she has previously given birth by caesarean section, she should be fully supported in her choice as “clinically there is little or no difference in the risk associated with a planned caesarean section and a planned vaginal birth in women who have had up to 4 previous caesarean sections.” (NICE qs32. 2013). This discussion should be documented in the woman's notes (Guideline Obs 51). 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