Do I have a right to a c-section? Update on Oxford University Hospitals

On 24th May we launched a campaign to engage with Trusts who state that they do not offer maternal request caesarean sections, thereby denying women the individual respect and consideration they are entitled to. The first Trust we wrote to was Oxford University Hospitals whose policy on offering planned caesarean sections is stated in this leaflet:

http://www.ouh.nhs.uk/patient-guide/leaflets/files/10405Pcaesarean.pdf

OUH responded to our original letter stating that their approach was in full compliance with NICE guidelines, and that they offered a “kind, friendly and professional service”. Unfortunately the reports we have received of women not being listened too, being left shaken by consultations, and being left distressed and anxious knowing that their request for a caesarean section would not be granted by OUH, are at odds with OUH’s account.  Therefore, this week, we wrote again to the Trust, their Commissioners, Healthwatch Oxfordshire and the CQC, to share some of your stories and to urge them to reconsider their approach. If you would like to tell us about your experience or requesting a maternal request caesarean section at OUH or elsewhere, please comment below…

Letter to R Schiller (Birthrights) from OUH

Second letter to OUH from Birthrights with case studies

17 thoughts on “Do I have a right to a c-section? Update on Oxford University Hospitals

  1. I was denied an elective ceasarean section with my daughter almost 18 months ago. I requested it because of a chronic bladder condition and pelvic floor dysfunction. I was told a vaginal delivery was recommended over a c section. I went on to deliver vaginally after a long induction. I was given an episiotomy and then sustained a bad 3rd degree tear. I have been left with muscle damage that can’t be fixed and will face bowel issues in later life. This was exactly the scenario I was trying to avoid when I requested the section and I will forever regret not following my gut and being more forceful. It is a shame women all over the UK are not making decisions about their own health and bodies, I can’t understand how such a lack of consent can exist in this area of medicine. And all for saving money. I feel I had been allowed the section I requested it would have saved the NHS thousands…I have been seen by my hospital every month for 18 months, god knows what the cost of that was. It just makes me sad that women are made to feel guilty or even stupid when they choose the mode of delivery, we should have control over our bodies and medical treatment.

    • Hi Natalie We have been approached by a reputable current affairs TV programme who want to do a feature on maternal request caesarean. If you might be prepared to tell you story on camera in the next week or two could you drop us a line at info@birthrights.org.uk? Thank you

  2. My cousin DIED from direct complications of repeat elective Caesarean section. She left her husband with 2 children under 1 years old. They have never really known their lovely mother. This is the ultimate price by choosing CS and one that is less likely after vaginal birth. I understand choice, anxiety, fear and the outcome of abuse and the effect this has, but it has to be balanced against the real risks of CS and the effect on families. Oxford does care and has to look at the whole picture.

    • So so sorry to hear that Anita, that is terribly sad. However, there is not clear evidence that planned c section has higher maternal death rate than planned vaginal birth. The results from studies are conflicting. (See NICE 2011 Cesarean Guideline) Added to this, planned caesarean births are usually offered to women and/or babies with more risk factors and the raw data does not take account of this. Maternal death is absolutely the worse outcome anyone can image. Sadly women still die as a consequence of both planned vaginal and planned caesarean birth and many of these deaths could be avoided. However, there is no evidence it has anything to do with planned mode of birth.

  3. After being 17days over due following fail induction with pessaries
    I asked for a c-section and was advised that St Mars Manchester di not
    Do maternal request c-sections.
    I was 17days over as there was a waiting list to have your waters broke -not by choice but still it wasn’t an option.

    Eventually after the drip also failed I give birth with forceps in theatre but was wa ms all set for an emergency c-section which carries more risk then a planned procedure. I felt under valued and out of control that medicwere choosing how I give birth. The experience resulted in complications a hospital stay and birth trauma requiring counselling and additional aupport. Slot more expensive for the NHS – but I guess the individual hospital didn’t have to mop up the cost so they don’t get to know the aftermath of their actions. Maybe If they were charged for the “clean up@ they’d look different at it

    • Hi Sarah We have been approached by a reputable current affairs TV programme who want to do a feature on maternal request caesarean. If you might be prepared to tell you story on camera in the next week or two could you drop us a line at info@birthrights.org.uk? Thank you

  4. Sadly none of the case studies here surprise me. Royal Berkshire Hospital has the same policy as Oxford and every woman within the area is given a letter at their booking appointment to say they do not offer maternal request c section. This is obviously designed to shut the conversation down before its started and is really terrifying for women who have many reasons for wanting a caesarian whether it be anxiety or past abuse, or a previous traumatic birth. The letter even states a previous section is not a good enough reason to warrant another, aggressively pushing vbac as the best option. I met a consultant who, after waiting 18 weeks for an appointment and who was 90 minutes late to the meeting, simply said ‘we don’t do maternal request c section’. I practically had a panic attack in her office. When asked if she could refer me to another consultant as per NICE guidelines she said no consultant here will agree to it. Note there was also no offer of counselling or support which also contravenes the guidelines. I did eventually get my caesarian agreed thanks to the intervention of my wonderful GP and i am very grateful for this but I really feel for those women who are vulnerable or lacking in confidence to assert themselves with this. It is those women who end up ignored, scared and unsupported.

    • I have just had my first booking-in appointment with my midwife and was surprised to find the letter regarding elective c-sections (as you detail above) provided as standard in the pregnancy record book. I previously had an emergency c-section and at least expected to be consulted / advised / listened to, before being shut down with regards to an elective cesarean. I agree with you that it seems to intend to shut-down any conversation before it even starts, but it seems a very strange way to deal with women who need support after a difficult first birth.

      • Hi Catherine We have been approached by a reputable current affairs TV programme who want to do a feature on maternal request caesarean. If you might be prepared to tell you story on camera in the next week or two could you drop us a line at info@birthrights.org.uk? Thank you

  5. This is my hospital trust. I had an emergency c-sec with my first baby. During my second pregnancy I was very open with everyone that I was torn between elective c-sec and VBAC, it was always my choice. Every consultant and midwife I spoke to was considerate of my thoughts about it and I was never pressured either way. I did eventually decide on VBAC although it did end in emergency c-sec.

    I also have two friends who both had traumatic vagainal deliveries with first babies and both were offered elective c-secs second time, both declined and went on to have successful vaginal birhs.

    I’m not sure the whole story is being shown here.

    • But surely informed consent is what we should be aiming for ? It is absolutely correct that there are many successful vaginal births after caesarean..and some that are not successful.Women need accurate information on which to make these choices but also understand there are no certainties. The ‘whole story’ at the moment is that women who have made an informed decision about what they want to do are being forced into a choice that is wholly unacceptable to them. This is morally wrong. I understand what you are saying about some vbacs being very successful but I am aware Birthrights supports women who are being ‘bounced’ into caesarean against there will. It is exactly the same issue but from different perspectives; supporting respect for women’s choices. I completely applaud that.

  6. As a prospective mum reading through these comments and the stories I’ve heard from other mums, I find this all deeply frightening. I feel I have a legitimate fear of birth. It’s not as a result of a traumatic previous experience or abuse, I’ve just always felt a paralysing fear of birth. Now in my mid-30s I feel the tick-tock of the biological clock and I feel petrified that if I don’t face it now I’ll never know the joys of parenthood. It doesn’t seem as though we’re asking a lot to be able to choose our mode of birth.

    I live in Oxford and hoped that it was simply a case of bad press, and that if I went down the right route – went to the GP, got referred to perinatal mental health services and got acknowledgement of my fear that Oxford NHS Trust would surely agree to the procedure but it seems that will not be the case. I don’t understand it! Surely it’s a direct violation of the Hippocratic oath to ignore these concerns?

  7. I was raped when I was 15 and again, repeatedly, during an abusive relationship between the ages of 19 and 24. For a long time I did not think that I would ever be with someone good or that I would want children. Now I am 33 and deeply in love with my partner of 6 years who has known me since I was 18 and who is the most wonderful man, I cannot believe how lucky I am. We want to start a family in the next year or two, if we are able to. But I am terrified. The idea of vaginal birth leaves me shaking and in tears. I still have nightmares and flashbacks to past violence and abuse and these have increased since we have talked about having children. My partner understands this and is completely supportive of me feeling that I need to have a c-section if we do have a baby. The idea of strangers putting their hands or instruments inside of me and of not having control over my body is unbearable. I live in Oxfordshire and am distraught about the apparent lack of understanding and option for elective c-section for prospective mothers who might need to avoid vaginal birth for their own sanity. I am a senior nurse (working in OUHFT for >10 years) so fully understand the risks of surgery and I am quite competent to be able to weigh up the risks and make this decision. OUHFT’s position on this means that we may not be able to have a child. We can not afford to pay privately.

    • Jayne – so sorry to hear what happened to you. Please do contact us if we can do anything to help. We can advise about which other local NHS hospitals are likely to give you a c-section. We have been approached by a reputable current affairs TV programme who want to do a feature on maternal request caesarean – if you would be prepared to talk about the impact this policy has had on you on film (potentially anonymously if this would make a difference) or if you would like some advice about local hospitals please get in touch at info@birthrights.org.uk

  8. I have literally just left the hospital after my appointment at the VBAC assessment clinic, I had an emergency c-section with my first child and was unsure what I wanted this time round. After my meeting today I was given all the facts including all the risks associated with a c-section and still elected to go ahead with a c-section which they booked for me there and then. While it was apparent that it wasn’t the midwives preferred choice I never felt under any extreme pressure to go with a virginal birth. I think it’s really sad that people are put under pressure, especially with some of the stories above but I just wanted to let people know that it’s not all bad.

  9. I’m really grateful for the work you’re doing in this area.

    I wanted a drug free ‘natural’ birth; the messaging is consistently that this is the way a model mother does it and I wanted nothing less for my long-awaited first child. My first baby had other plans and ended up being pried out with forceps after he got stuck too far out for a c section. Thankfully we were both okay, but the risks related to forceps haunt me. I was asked to provide consent and make a decision with potentially life altering implications at a time when I literally would have agreed to anything.

    When I became pregnant again, I was terrified of having another vaginal birth but while I was given a chat about birth plans with a senior midwife, c section was not on the table. I was advised to have an early epidural but this didn’t happen either. Instead, I went into labour very overdue (41.5 weeks) and spent three days in an agonising and slow labour. When the hospital eventually admitted me, it did not want to provide an epidural because they said it would slow labour down. When I finally got the epidural, labour instead progressed rapidly – basically I had been so afraid after my first labour that my body spent three days fighting off what it was ‘supposed’ to do. I did everything ‘right’ (yoga, daily exercise, hypnobirthing) and yet there were still potentially severe complications that would have been avoided in a c section.

    I completely understand that the hospital’s advice may have been right in most cases and am a huge fan of the NHS, but, at the least, a woman who has been through a previous traumatic birth should be taken seriously when she requests a c section. I would have willingly paid the excess cost to the NHS to have a c section (I have private insurance but while it pay out lavishly for all sorts of elective procedures, it won’t pay anything for anything related to labour and delivery of any sort).

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