Maternal request caesarean research highlights postcode lottery

Birthrights has published research today concerning the treatment of women who request a caesarean section. Results of a nationwide Freedom of Information Act request show that the majority of Trusts in the UK make the process of requesting a caesarean lengthy, difficult or inconsistent adding anxiety and distress to women at a vulnerable time. And lawyers acting for the charity are concerned that at least one Trust may be acting unlawfully.

Official NICE guidelines states: ‘For women requesting a caesarean section, if after discussion and offer of support… a vaginal birth is still not an acceptable option (Trusts should) offer a planned cesarean section.’ But pregnant women in some regions who ask about the procedure are simply told to go elsewhere. Statistics show that 15% of Trusts have policies or processes that explicitly do not support maternal request caesarean, while 47% of Trusts have policies or processes that are problematic or inconsistent. Only 26% of Trusts offer caesareans in line with NICE best-practice guidance.

Commenting on these results, Chief Executive of Birthrights, Rebecca Schiller said: “Maternal request caesareans are the the number one reason women contact the Birthrights advice service. The women we support have endured previously traumatic births, mental 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 judgement, 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.”

On 27th July 2018 lawyers acting for Birthrights wrote to Oxford University Hospitals NHS Trust and Oxfordshire Clinical Commissioning Group asking for further information about the policy in place at the John Radcliffe hospital not to offer maternal request caesareans.

Programmes Director Maria Booker explains, “Many women have contacted us about disrespectful treatment at the John Radcliffe hospital. We first wrote to the Trust and CCG in May 2017. Trusts are bound by human rights duties to offer individualised care. Any statement or policy from a Trust that caesarean would only be granted on medical grounds may be incompatible with Trusts’ obligations to have an open, supportive, two-way discussion that explores all reasonable options. If such a policy is then applied in a blanket way then it could be incompatible with human rights law. We have made the Trust and CCG aware that we hope to resolve this issue without litigation and we encourage Oxford University Hospitals NHS Trust and its commissioners to begin to work with us constructively to change their policy. Otherwise we will look to explore all options, including judicial review, to ensure that women living in Oxford get the respectful care they deserve and that the law obliges their caregivers to provide.”

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