Are Too Many Women Being Refused Requests For a C-Section?

The BBC’s Victoria Derbyshire programme has been told that women at 75% of UK maternity units are being denied their right to choose a Caesarean (C-section).  According to an online article published recently by The Guardian, almost 1 in 6 NHS Trusts in the UK do not offer women C-sections on request. 

Best Practice

Let’s consider what the NICE guidelines say on this issue.  NICE, the National Institute for Health and Care Excellence provides national guidance and advice to improve health care. The NICE guidelines are evidence based recommendations for health and social care in England and are considered to be what represents best practice.  Health practitioners would have to have good reason to depart from these guidelines.

The NICE Guidelines on this topic state that pregnant women should be offered evidence-based information and support to enable them to make informed decisions about their care and treatment. 

When a woman requests a C-section because she has anxiety about childbirth, the guidelines state that referral should be offered to a healthcare professional with expertise in providing perinatal mental health support to help her address her anxiety in a supportive manner. If after discussion and offer of support, a vaginal birth is still not an acceptable option, a planned C-section should be offered. An obstetrician unwilling to perform a C-section should refer the women to an obstetrician who will.

Campaign

Between November 2017 and January 2018 the charity, “Birthrights”, wrote to every NHS Trust in the UK and every Clinical Commissioning Group in England to find out about their policy on maternal request caesarean.  Details of the full report can be found on the charity’s website. The report states that 146 hospital trusts shared their policies with the charity and of those 146, 26% fully complied with NICE guidelines, 47% partially complied and 15% refused all elective C-sections. 

A BBC article published recently refers to the case of one woman whose request for a C-section was denied in her second pregnancy and shows what negative consequences this can potentially have for both mother and baby. She had had a serious haemorrhage after the birth of her first child and was later diagnosed with post-traumatic stress disorder. She went on to have another haemorrhage and her baby was admitted to neo-natal intensive care.

Informed Consent

Women should be given enough information about the risks and benefits of any treatment option, and any anxieties about a proposed course of treatment or procedure fully explored so that a woman can make a fully informed decision about her future treatment. This is very much something that should be assessed on an individual basis. Every woman is different. 

The NICE guidance says women should be allowed to opt for a planned Caesarean even if it is not for medical reasons. According to Birthrights, maternity request C-sections are the number one reason that women contact the Birthrights advice service. This can be for a number of reasons, including women who have previously had traumatic births.  It appears that if hospital trusts policies are to refuse maternal request C-sections in a blanket way, this may even be incompatible with human rights law.

The NICE guidance states that as many as 1 in 4 women will have a C-section. It is so important therefore that this is discussed with women during pregnancy, and not just because there may be clinical indications that C-section may be likely. If a woman has worries or concerns and requests delivery by C-section, those concerns should be listened to and the woman offered appropriate support to enable her to come to a fully informed decision.

We have acted for many mothers and children where the request for a C-section was not respected leading to a poor outcome. If you feel that you have gone through a similar experience and have concerns, please do get in touch with us.