Six months on and still no response from OUH on maternal request caesarean policy…

Our Chair, Elizabeth Prochaska, has today written to Dame Fiona Caldicott, Chair of Oxford University Hospitals NHS Foundation Trust to urge her to hold her board to account over the lack of response to a letter sent in July, asking OUH to clarify important details surrounding its maternal request caesarean policy. It is somewhat surprising that an NHS Trust that is accountable to the public, should feel able to ignore a serious request for information, made on behalf of local women, and we look forward to receiving a substantive response by the 3rd January.

The full letter to Dame Caldicott can be found here.

Happy Human Rights Day 2018

As the UK’s only organisation protecting human rights in pregnancy & childbirth, Birthrights are very proud to be supporting #HumanRightsDay2018 & to join forces with 155 organisations asking the PM to safeguard our freedoms here in the UK #weareallhuman #humanrightsday2018 #humanrights

Full text of the letter, co-ordinated by the British Institute of Human Rights (BIHR):

Dear Prime Minister

Today, on Human Rights Day, we ask you to join us in celebrating universal human rights in the UK and commit to standing firm on our hard-won freedoms and protections.

Created 70 years ago, the Universal Declaration of Human Rights (UDHR) is a milestone in human history. Following the horrors of World War II, the world community came together to say never again and set down the protections every person has simply because we are all human.

Heralded as Magna Carta for all human kind, the UDHR has set a common standard of achievement for all peoples and all nations, inspiring law and action across the world.

Through the European Convention on Human Rights and our own Human Rights Act we have brought those rights home, making them real and meaningful for people everyday across the UK.

2019 marks another milestone in our history. As the UK prepares to exit the European Union, and uncertainty surrounds us, we ask you to ensure that our commitment to universal human rights at home remains strong and certain.  


advice@birthrights.org.uk

Birthrights now has a dedicated email address for advice enquiries:

advice@ birthrights.org.uk

If you have any queries about human rights relating to maternity care – please get in touch with us. Our free email advice line is not only for women and their families but also for healthcare professionals.

If you have any other enquiries about training, speaking engagements or anything else then do continue to contact us on info@birthrights.org.uk

Birthrights welcomes new Legal Officer

Birthrights is delighted to welcome Reilly Willis, our new Legal Officer to the staff team. Reilly, who starts with Birthrights this week, is an experienced international human rights lawyer specialising in women’s rights and gender equality. You can find out more about Reilly here.

Reilly will be responding to our advice line enquiries, ensuring our resources are up to date and accessible, and will be leading any legal interventions undertaken by Birthrights, and we are very excited to have her on board!

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.”

Click here to find out more about our campaign and to see our interactive map.

Shropshire Midwifery Led Units re-open their doors

New Year’s Day saw the re-opening of the three Midwifery Led Units in Bridgnorth, Oswestry and Ludlow, which is great news for local women expecting a baby in 2018. A consultation expected to propose their permanent closure and replacement with community hubs is due to be published shortly. The response from Shropshire CCG to our letter of the 7th December can be found here.

How should Health Care Professionals handle a maternal request for caesarean?

Its been unusually noisy in the maternity world over the summer, as media reports have reignited discussion about what a safe” birth looks like. At Birthrights we believe that the need to listen to women is the mast that all those who care about the safety of women and babies during birth, can cling to when the seas of discussion get rough. 

Many women want to avoid unnecessary interventions in childbirth and, on the 15th August, Birthrights CEO Rebecca Schiller wrote about the vital role midwifery care plays in ensuring women who don’t need and want intervention have the best chance of avoiding it safely

We have also been working hard to support a smaller but important group of women who feel a planned caesarean section is the right choice for them. We created our recent maternal request for caesarean campaign to ensure that these women’s voices were heard and to discover the barriers to their requests being granted

In this blog post, our Trustee, midwife Simon Mehigan, shares his experience of working with women who want a caesarean for no medical reason, and why the approach of a number of Trusts to shut off this option from the outset, is counter-productive.

“A few years I was employed as a consultant midwife at a large teaching hospital in the Northwest of England. One of my responsibilities was to see all the women requesting a caesarean section in the absence of what was considered to be a medical reason.

Over the course of three years I saw over 500 women. I saw the majority of these women just once with a follow up either by email or by phone. Some I saw twice and for a small proportion I took over all of their care, as it was apparent that continuity would have a significant impact on their decision-making. Here’s what I learnt:

Saying no initially to a womens request for an elective caesarean section creates an antagonistic starting point for discussion and doesnt reduce the overall caesarean rate.

I very quickly discovered that by telling women very early on in my conversation with them that “if a caesarean section is ultimately what you want I will help arrange that for you”, that they relaxed, were prepared to listen to what I had to say and were receptive to discussing alternatives.

In fact having met me and discussed their options, 85% of women opted to aim for a vaginal birth of their own accord and over 70% of those women ended up having a vaginal birth.

A couple of women actually informed me after our consultation that because I had said I would support them in their request for a caesarean section that they no longer wanted one. Being told “no” by consultants had made them more determined to have a caesarean section because they were not prepared to let someone else make decisions about their birth.

A de-brief of their last birth often alters a womens view.

A number of women didn’t understand what happened to them last time. Going through it with them, explaining why things might have happened often helped women in realising that things could be different in this new pregnancy and birth.

After 28 weeks it is more difficult to alter the view that caesarean section is the right choice

Many Trusts schedule these conversations for the last few weeks in pregnancy and yet what I experienced was a direct correlation between the gestation at which I met women for the first time and whether they would be open to explore options that might ultimately feel better to them than a caesarean section. The later I saw them the less likely they were to consider any other options.

The plans of care I developed in conjunction with the women often focused on having an uncomplicated birth with a low threshold for a caesarean section.

The majority of women I saw had had a previous traumatic birth experience. Common themes were a lack of control, lack of communication from staff and a negative experience of induction. Therefore the plans we made together often stated no induction of labour, no rotational forceps, minimal examinations and diverting to a caesarean rather than trying other interventions if the birth wasn’t completely straightforward

Once a decision had been made a line had to be drawn.

Women found it very stressful having to revisit their decision every time they met a health professional.

A caesarean is the right choice for some women.

I have over the years met many women that have felt a caesarean section was the right choice for them. They could all explain rationally why they wanted to birth their babies in that way.

By listening to them, talking to them as an equal and ensuring they felt in control of the process they not only developed confidence in their bodies but more importantly in their caregivers and the organisation irrespective of whether their final decision was to opt for a caesarean section.

In over 20 years as a midwife I have yet to meet a woman that has made irrational decisions or choices. They have always been the right choice for that women based on her individual circumstances.”

Simon Mehigan

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

Birthrights on Mumsnet

We’re really pleased to announce that we have not only updated our own set of factsheets, but have partnered with Mumsnet, to update our answers to their most frequently asked questions about rights relating to pregnancy and birth.

You can find Mumsnet users’ questions and our answers here. Ranging from common concerns about the right to an epidural or a homebirth, to more specific questions about water birth and antenatal check-ups our work with Mumsnet helps us to give definitive answers to millions of women.

We’ve grateful once again to the team at Mumsnet HQ for the chance to speak directly to so many women directly affected by these issues.

About Mumsnet

Mumsnet is the UK’s largest network for parents, with over 10.5 million unique visitors per month clocking up over 100 million page views. It has 170 local sites and a network of 10,000 bloggers and vloggers. It regularly campaigns on issues including support for families of children with special educational needs, improvements in miscarriage care and freedom of speech on the internet.

Mumsnet logo

 

Birthrights Administrator vacancy

Birthrights is very excited to be expanding our small team. Are you highly organised? Have experience of running a busy (virtual) office? Then you could be our new administrator! You will be the key to ensuring our organisation runs smoothly as our work continues to grow at pace. The role is part-time (22.5 hours), flexible and home-based. Closing date for applications is the 23rd June, with interviews in mid-July. Download the job description here for more details.