At some time during any pregnancy, a discussion will take place with a midwife or obstetrician about the mother’s preferred mode of delivery. For many women, this can raise additional questions or concerns about what is best for them and their baby.
A large proportion of women will opt to have vaginal delivery and will discuss their preferred setting. The discussions will include choices such as whether the birth takes place at home or in hospital, whether they want to have the baby’s heart monitored continuously during the labour and whether, for example, they want to use a birthing pool.
However, a vaginal birth is not a woman’s only option for delivery.
Elective Caesarean
Whilst in some scenarios, a planned caesarean is recommended for delivery for various medical conditions (for either mum or baby), some women elect to have a caesarean and it is important that you understand your rights if this is a delivery method you wish to consider.
What can you ask for?
You have the right to ask for a caesarean birth, even if your medical team do not think you need one.
The National Institute for Health and Care Excellence (NICE) recommends that the hospital should support a mother who decides they want a caesarean birth, if they are satisfied they are making an informed decision.
If the reason you have requested an elective caesarean is due to severe anxiety around childbirth, you should be offered an appointment with a perinatal counsellor. You are not obliged to accept this referral.
What are the doctors obliged to tell you?
To help you to decide how you wish to deliver your baby, you should be given a range of options for the delivery and an opportunity to discuss the risks and benefits of each method. Your doctor and midwife should explain to you the potential risks of having a caesarean as opposed to the risks associated with a vaginal birth, so that you can fully understand the potential risks and benefits of both methods.
If you feel you have not been given a balanced and rounded explanation of all methods of delivery, you should challenge the medical professional you are speaking with.
In the case of Montgomery v Lanarkshire Health Board, it was decided that a doctor is obliged to ensure a patient is fully aware of any material risks when recommending a course of treatment and that they should discuss any alternative treatment options with you.
One of the most recent cases relating to the issue of consent and providing patients with treatment options is the case of McCulloch v Forth Valley Health Board (Scotland) [2023]. In this case, the Supreme Court unanimously held that whether a treatment is a reasonable alternative is to be determined by application of the ‘professional practice’ test.
The ‘professional practice’ test is whether a responsible body of medical practitioners, presented with the same circumstances would have acted in the same way as the medical practitioner in question.
In McCulloch the Court confirmed that:
- A doctor cannot simply inform a patient about the treatment option or options that the doctor himself or herself prefers.
- Instead, once a range of reasonable treatments have been identified, absent of any indication from the patient to the contrary, the doctor must explain all of those alternatives and the risks involved, to the patient. However, the doctor is not obliged to tell a patient about treatments which the doctor does not consider to be reasonable (i.e. clinically appropriate), and this is to be judged by applying the professional practice test.
- A doctor is not obliged to tell a patient about treatments that the doctor does not consider reasonable (applying the professional practice test), even where the doctor is aware of an alternative body of opinion which considers the treatment to be reasonable.
Whose decision is it?
Your doctor and midwife must listen to your reasons for requesting a caesarean.
If the Obstetrician refuses to provide a birth by caesarean section, they must refer you to another Obstetrician who would be willing to carry out the operation.
At the end of the day, the decision regarding how you give birth is yours and once you have made a decision, this should be respected.
You should feel empowered by your medical team rather than overwhelmed by the information which is being given to you.
If you feel you were pressurised into a delivery which you didn’t feel comfortable with and this resulted in an injury to you or your baby, please do get in touch to discuss your experience.
Disclaimer
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 2024
