A Caesarean section (often known as a C-Section) is when an incision is made to the abdomen and womb in order to deliver the baby. Caesareans are defined in three categories; elective (at the request of the mother), planned (for medical reasons, for example if the baby is in the wrong position or very large), or emergency (due to labour complications). More than a quarter of the babies born in England are delivered by either elective or emergency Caesarean. 

Birthrights, a childbirth charity specialising in human rights, used a Freedom of Information request to ask 153 NHS Trusts how their maternity units applied the current National Institute of Clinical Excellence (NICE) guidance on Caesarean sections. NICE guidance says women should be allowed to choose an elective Caesarean section even if it is not medically required.

Out of the 146 NHS Trusts that responded to Birthrights’ request for information, 47% confirmed they only partially complied with the NICE guidance, 15% confirmed that they refused maternal requests for elective Caesareans outright, and 12% did not have a clear policy.

Under the guidelines, women requesting an elective Caesarean "should be offered appropriate discussion and support - but ultimately, if they are making an informed choice, a Caesarean should be offered". If an obstetrician is unwilling to perform an elective Caesarean at the request of the mother, the woman should be referred to another obstetrician who will.

The charity is aware that some NHS Trusts have been informing women that they cannot elect for a Caesarean before they had ever been spoken to, either when they had been being booked on to maternity care or in a letter.

It costs around £700 more to have a Caesarean, than to have a vaginal delivery. Birthrights’ chief executive, Rebecca Schiller said "Some women say they have had cost quoted at them - 'You can't have a Caesarean because it will cost too much,' the trust might be fined, that the clinical commissioning groups themselves won't fund those requests - but there doesn't seem to be one reason”.

Lucie Tidman, 32 was denied her request for a caesarean delivery of her first child. She had a vaginal delivery and suffered a serious haemorrhage, and was later diagnosed with post-traumatic stress disorder (PTSD). When pregnant with her second child she again asked for a Caesarean, but was refused. She unfortunately went on to have another haemorrhage and her baby was treated in neo-natal intensive care.

Mental health professionals argue that cases like Ms Tidman's need to be taken more seriously. Consultant perinatal psychiatrist Rebecca Moore has commented: "For some non-mental-health-based colleagues, perhaps there's a perception about anxiety, or a misunderstanding about how severe anxiety can be for some women, so women are often denied Caesareans."

Birthrights have confirmed that the reason women may want to have a C-Section can include previous traumatic births, mental ill-health, childhood sexual abuse, or simply having made an informed decision based on their circumstances.

Gill Walton, chief executive of the Royal College of Midwives said: "Women must be given the information to explore their views and feelings about Caesarean birth, to enable them to come to an informed decision about their preferred type of birth.” She went on to say that, “This information should reflect the individual woman's current and previous medical, obstetric and psychological history."

Freeths’ Clinical Negligence Solicitors have a national reputation for providing the highest quality advice in birth injury medical negligence cases. See our website for further information:http://www.freeths.co.uk/legal-services/individuals/clinical-negligence/

Karen Reynolds, Partner of our Derby and Stoke on Trent offices represented the claimant in the case of Webster v Burton Hospitals NHS Foundation Trust [2017] EWCA Civ 62.

The Claimant won at the Court of Appeal where the court confirmed that the claimant’s mother’s wishes to be induced should have overridden the views of the Consultant Obstetrician who was advising her. The Court ruled that the Obstetrician had been negligent in failing to discuss the presence of excess liquor and the fact that the claimant was small for his gestational age. The Court held that these features should have been discussed with the claimant’s mother as there was a risk that suggested the presence of these features could cause the claimant harm.

This decision has been referred to as a “landmark case” and emphasised the importance of patient choice in respect of the treatment they receive. This decision confirmed that the role of the medical practitioner is to advise, that they must ensure that they discuss all material risks with their patients, and that a patient has the ultimate choice as to which treatment they receive.

If you have concerns about the care that you or a loved one has received during labour or delivery, and would like some free initial advice from a medical negligence lawyer please contact our national team:

Karen Reynolds, Partner (Derby/Stoke on Trent) on 0845 272 5677 or karen.reynolds@freeths.co.uk

Carolyn Lowe, Partner (Oxford/Milton Keynes) on 0186 578 1019 or carolyn.lowe@freeths.co.uk

Jane Williams, Partner (Leicester) on 0845 272 5724 or jane.williams@freeths.co.uk

Siobhan Genever, Director (Nottingham) on 0845 271 6793 or siobhan.genever@freeths.co.uk

If you would like further information about this news report please follow this link: https://www.bbc.co.uk/news/health-45245489