NHS England Abandons Targets for ‘Normal Births’

Maternity units throughout England have been instructed to stop using targets aimed at limiting the number of caesarean sections in the bid to pursue normal births, over fears that mothers and babies have been put at risk by using total caesarean rates as a measure of performance management.

In a letter, Jaqueline Dunkley-Bent NHS England’s Chief Midwife, and Dr Matthew Jolly, the National Clinical Director for Maternity, raised concerns that ’the potential for [maternity] services to pursue targets may be clinically inappropriate and unsafe in individual cases’.

For several years, medical bodies have been calling for the targets to be scrapped, and following the announcement these bodies have now welcomed the changes. Last July, a Commons Heath and Social Care Committee Report said it was ‘deeply concerning‘ that maternity services have been penalised for having high rates of caesarean section in the past. The Royal College of Obstetricians and Gynaecologists (RCOG) have welcomed the change, with Dr Jo Mountfield Vice President saying ‘the targets carry certain benefits and risks which should be discussed with women as they choose how they wish to give birth. Women and people giving birth should feel supported and their choices should be respected’.

The Royal College of Midwives (RCM) formally abandoned its normal birth campaign in 2017. Responding to the change of policy, the RCM’s chief executive, Gill Walton, said that decisions about clinical care should be made in the best interests of the woman and the baby ‘and not because of an arbitrary target’.

A caesarean section is when a baby is delivered through a surgical cut into the abdomen and womb. They are carried out for a number of reasons and it can be a planned or emergency procedure.

A “normal delivery” is one that refers to childbirth through the vagina. 

The National Institute for Health and Care Excellence (NICE) have provided new guidance which suggest that maternity staff should treat cases on an individual basis, rather than following the aim to promote as many natural births as possible.

Currently around one in four babies are born by caesarean section in the UK but there is some variability between hospitals and trusts nationally. Our local Shrewsbury and Telford Hospital NHS Trust (SaTH) had among the highest normal delivery rates in England between 2010 and 2018.

There has been some concern that the pursuit of normal deliveries may have contributed to some instances of poor maternity care, including at SaTH where the deaths of a number of mothers and babies are being investigated by Donna Ockenden, the Chair of the Independent Maternity Review at SaTH. Publication of the second part of the Independent Maternity Review is currently scheduled to take place no later than 24 March 2022.

Listen to our podcast about the concerns at SaTH, via this link

Here at Lanyon Bowdler our solicitors have been involved in a number of cases that concern labour and delivery method decisions in maternity care. 

If you have concerns about the maternity advice and care you have received, please get in touch with our team who will be able to assist you sensitively.