Caesarean Sections – More Choice for Mothers
University Hospitals of Morecambe Bay NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust and East Kent Hospitals University NHS Foundation Trust.
2012 advice by the Royal College of Obstetricians and Gynaecologists (“RCOG”), hospitals had been encouraged to promote natural births and keep the Caesarean rate to around 20%. BBC News reports that, in a letter seen by them, the maternity staff have been told to treat cases on an individual basis and follow allowing women to opt for a planned Caesarean even if it is not for medical reasons.
The NICE Guidance published in March 2021 contains an updated section advising how to act in circumstances concerning maternal request for caesarean birth. This guidance is available to both professionals and expectant mothers.
The guidance encourages clinicians to discuss and record the specific reasons for a C-section request; to discuss the overall benefits and risks of caesarean birth compared with vaginal birth.
If a vaginal birth is not an acceptable option after discussion of the benefits and risks and offer of support, the clinicians are to offer a planned caesarean birth for women requesting a caesarean birth.
“1.2.31 If a woman requests a caesarean birth but her current healthcare team are unwilling to offer this, refer the woman to an obstetrician willing to perform a caesarean birth”.
These changes highlight the importance of the right to make an informed decision based on informed consent, after being presented with all the options available along with the associated risks and benefits.
BBC News reports that the RCOG vice-president Dr Jo Mountfield welcomed the clarification to end target-driven clinical decision making for Caesarean births, saying:
“Women and people giving birth should feel supported and their choices should be respected”.
Unsafe maternity services and the NHS
NHS England chief midwife Jacqueline Dunkley-Bent and clinical director for women's health Dr Matthew Joly said in the letter which was presented to the BBC News that they were "concerned" by trusts focusing on hitting targets:
“We therefore ask all maternity services to stop using total Caesarean section rates as a means of performance management, as we are concerned by the potential for services to pursue targets that may be clinically inappropriate and unsafe in individual cases," the letter says.
In 2021, that 1,000 more babies a year would survive if England had safer maternity services by the Health and Social Care Committee. The committee has found that the lack of sufficient and qualified staff to satisfy the demand was one of the biggest concerns.
The announcement on discontinuing the use of the 20% target for Caesarean births target comes shortly after 7 February 2022, when the Royal College of Midwives reported on the shortage of full-time midwives.
. It was proposed that approximately £2m will be spent on researching how to spot early signs of babies in distress.
The Healthcare Safety Investigation Branch reviews all term stillbirths, early neonatal deaths and cases of severe brain injury in babies, as well as all maternal deaths. A Perinatal Mortality Review Tool is now used by all maternity providers, supporting high quality reviews of the circumstances and care leading up to and surrounding each stillbirth and neonatal death.
Denise Stephens, partner, (supported by her experienced team in the Reading office) deals with complex and high value claims for brain injured babies, many of the claims resulting from a failure to convert a natural birth to a caesarean section. You can view videos showing some of the clients that she has helped here: Shoosmiths | Serious Injury Team |Denise Stephens
Susan Prior, Shoosmiths partner in the Thames Valley (Reading) office whose caseload includes cases involving stillbirths and neonatal deaths says:
“Having acted for many women who have been encouraged to and felt obliged to proceed with a vaginal birth when they have had concerns about natural birth and dealt with cases where there was a clear failure to recognise a distressed baby, this clear option of choice is an important move. Hopefully, it will also take the pressure off the maternity staff who, so far, have felt that they have had their hands tied by the need to meet targets”.
This information is for educational purposes only and does not constitute legal advice. It is recommended that specific professional advice is sought before acting on any of the information given. © Shoosmiths LLP 2023