NHS trusts have for the first time barred women from routinely having elective caesareans because they cost too much.

The procedure, which costs twice as much as a natural birth, will be rationed in Greater Manchester so that it is only available to women with specific medical conditions.

Some top obstetricians condemn the decision, arguing that, while it will curb the fashion for choosing caesareans to reduce the pain of childbirth, it will also penalise those who opt for them on the grounds that they are safer for the mother.

Caesareans have been placed on the same lists for rationing by the NHS trusts in Greater Manchester as infertility treatment, cosmetic surgery and acupuncture.

The lists, called Effective Use of Resources Policies, state that planned caesarean sections should only routinely be offered to women in particular categories. They include women who have previously already had at least two caesareans.

Dr Christoph Lees, an obstetrician and gynaecologist at Addenbrooke’s hospital in Cambridge, said: “I strongly disagree with this prescriptive condition setting. Sometimes well-informed women, often older and very unlikely to have further children, do request caesarean sections and it is unreasonable to refuse if they are fully informed.

About 23% of deliveries in Britain are by caesarean section, and, of these, more than half are emergency operations.

A spokesman for NHS Manchester said: “Where caesarean section is likely to be the safer option for the mother or baby, it will be the mother’s choice how the baby is delivered.”