Women still being denied their right to a caesarean

PREGNANT women are routinely being denied the opportunity to plan a caesarean birth, despite the introduction a decade ago of national guidance giving them such a right.

The National Institute for Care and Health Excellence (Nice) stipulated in 2011 that women should be able to choose a caesarean, even if there is no obvious physical reason for it.

The ruling came as the NHS was engulfed by a scandal involving the deaths of mothers and babies in Cumbria because midwives were obsessed with a so-called ‘normal’ birth.

Nice said: ‘For women requesting a caesarean section, if after discussion and offer of support... a vaginal birth is still not an acceptable option, [NHS Trusts should] offer a planned caesarean section.’ But an investigation using Freedom of Information reveals that dozens of hospital authorities in England and Wales are still obstructing such requests.

Analysis of responses shows only around a third of hospital trusts and boards allow unfettered access to ‘maternal request caesarean sections’.

A similar number offer maternal request caesarean ‘partially’, with some saying ‘maternal choice alone’ is not sufficient reason.

The findings are contained in a report by solicitors Tees Law, which was commissioned after lawyers became dismayed at the high number of medical negligence cases involving women denied a caesarean.

It follows a similar study in 2018 by the charity Birthrights which found only 39 of the 138 NHS Trusts and Boards providing maternity services in England and Wales offered maternal request caesarean fully in line with Nice guidelines.

When Tees Law went to the remaining 99, it found just four could be added to a ‘green list’ of those complying. It classed 43 as ‘amber’ because they offer caesarean ‘partially’ or had ‘concerns’ about the way they provided them.

Janine Collier, head of medical negligence at Tees Law, said: ‘While there have been some improvements, Birthrights’ summary of the situation in 2018 still holds true. The task of ensuring all women have autonomy over their mode of birth is far from over.

‘It’s vital that women are fully supported to come to an informed conclusion about how they would like their baby to be delivered, and for Trusts to respect that choice.’

Jen Hall, of birth injury charity MASIC, said: ‘We hear from many women whose request for a caesarean was denied and they live on a daily basis with the long-term complications of birth injury.’

Dr Jo Mountfield, Vice President of the Royal College of Obstetricians and Gynaecologists, said: ‘The reasons why some women request a caesarean birth includes fear of having a complicated vaginal birth or of physical damage to their bodies, or having had a previous traumatic experience.

‘Talking to a midwife or obstetrician may provide reassurance. However, if a woman decides a caesarean birth is the right option, that should be fully respected.’

More than 90 per cent of caesareans are carried out for purely clinical reasons.

‘It’s vital that they are fully supported’