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Baby being born via caesarean section.
Baby is born via caesarean section. Photograph: arcticflea/Getty Images
Baby is born via caesarean section. Photograph: arcticflea/Getty Images

One in six NHS trusts do not offer caesareans on request – charity

This article is more than 5 years old

Birthrights suggests blanket bans could be incompatible with human rights law

Almost one in six NHS trusts in the UK do not offer women caesarean sections on request and many more have inconsistent policies, a charity has said.

Official guidance states that women should be offered a planned c-section “if after discussion and offer of support ... a vaginal birth is still not an acceptable option”.

But Birthrights found that 22 out of 147 trusts who responded to a freedom of information request did not offer maternal request caesareans (MRCs). A further 70, almost half, had policies that the charity deemed problematic or inconsistent, thereby creating a postcode lottery, Birthrights said.

The organisation’s chief executive, Rebecca Schiller, said: “Maternal request caesareans are the number one reason women contact the Birthrights advice service. The women we support have endured previously traumatic births, physical ill-health, childhood sexual abuse or have carefully examined the evidence available and made informed decisions that planned caesareans will give them and their baby the best chance of an emotionally and physically healthy start.

“It is clear that women requesting caesareans meet judgmental attitudes, barriers and disrespect more often than they find compassion and support. We are concerned that this lack of respect for patient dignity could have profound negative consequences for the emotional and physical safety of women.”

Of the 22 trusts Birthrights classified as not offering MRCs, some had an explicitly stated policy not to do so, others did not specify whether or not they did so but were found not to have carried out any in 2016-17, and some said they did offer them but sent out information to pregnant women that contradicted this. Some of the trusts with an explicit policy not to offer MRCs still told Birthrights they would do so in exceptional circumstances.

The charity claims that a blanket ban on MRCs could be incompatible with human rights law and lawyers acting for Birthrights wrote to one of the trusts – Oxford University Hospitals NHS trust – last month about what it claimed was such a policy at John Radcliffe hospital.

In response, the trust said its practice in providing MRCs was in line with National Institute for Health and Care Excellence guidance, in that when its obstetricians were unwilling to perform it they referred the woman in question to a neighbouring trust.

Veronica Miller, the trust’s clinical director of women’s services, said: “A caesarean section which is not clinically indicated may have serious consequences for a woman and her baby ... All requests are considered on an individual basis and a plan for the woman’s care put in place.”

Almost three-quarters of NHS trusts were found not to have written guidelines clearly committing to a woman’s right to have an MRC and only 39 were found to offer caesareans in line with Nice’s best-practice guidance.

Both the Royal College of Midwives (RCM) and the Royal College of Obstetricians (RCOG) and Gynaecologists said that the rights of women who wanted MRCs needed to be respected.

Dr Alison Wright, the vice-president of RCOG, said she was disappointed by the findings. “This denies women choice about their birthing experience and highlights the importance of trusts updating policies and guidelines to ensure women have access to safe and personalised care,” she said.

“We strongly believe that women’s voices and choices should be respected and supported to ensure a good birth.”

Gill Walton, the RCM chief executive and general secretary, said: “Midwives have an important role in supporting women who request caesarean section and respecting their reasons.”

‘The perception is that you’re not prepared to be a proper mother’

Kasia Lech-Hill, 37, is scheduled to have a caesarean on 3 September but it has taken four stressful months to get to that point.

The university lecturer, from Canterbury, Kent, said: “It’s happening in two weeks but it took a lot of time and a lot of hours and a lot of pushing.”

Lech-Hill was told by her eye doctor that because she has a thin retina, pushing during a vaginal birth could risk the retina detaching, potentially causing blindness.

“I raised this from the beginning with my midwives but they said they didn’t recognise this as a reason,” she said. “I had a doctor from Poland [where Lech-Hill is from originally] and they said it would be better from a British doctor and even better, a doctor from east Kent.”

Lech-Hill went to see a GP, who initially refused to refer her to an eye doctor. “I was very much faced with the ‘too posh to push’ attitude,” she said.

She said the GP only agreed to refer her when she said she would pay to see an eye doctor privately, which she was forced to do, but the specialist was unsympathetic. “When I got really upset, he told me to manage my emotions better. It’s extremely sexist. I said: ‘Can you guarantee nothing will happen to my eyes?’ He said: “No. But even if it does, you can’t be sure that’s the cause.’”

It was the obstetrician who eventually agreed to a caesarian. “She approved it straight away on medical grounds but until then everyone was telling us we weren’t going to able to do it, how irresponsible it was, how it would be harming the baby,” said Lech-Hill. “It feels like you’re doing something wrong, you’re not following the maternal route. It’s been extremely stressful, I had panic attacks. I was just blaming pregnancy and hormones but as soon as she said ‘you can have a caesarean’ I felt like something in my stomach had changed.”

Lech-Hill was so worried that she was considering going overseas to have her baby. While she is relieved that she does not have to travel, she said there remained a stigma attached to it. “The judgment is still there,” she said. “The perception is that you’re not prepared to be a proper mother, who’s prepared to push.”


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