Maternal Request Caesarean

Birthrights has published a report today concerning the treatment of women who request a caesarean section. We revealed on the Victoria Derbyshire show this morning that results of our 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.

Between November 2017 and January 2018 we wrote to every Trust in the UK and every Clinical Commissioning Group in England to find out about their policy on maternal request caesarean. All Trusts were categorised as red, amber, green, unknown or no response as shown on the interactive map below. The full analysis of the results can be found in our report.

Map key

 

Please click on each pin to view a Trust’s response to Birthrights’ Freedom of Information Act request and any supporting documentation relating to their categorisation. All Trusts were made aware of their categorisation in May 2018 and were given the opportunity for comment and clarification.

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  in our new report (add link to the report) 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, 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 judgemental 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.

 

On 27thJuly 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. This follows a chain of correspondence between Birthrights and the Trust and CCG after repeated enquiries from women about how their requests were handles at the John Radcliffe.

 

Birthrights Programmes Director Maria Booker explains,Many women have contacted us about disrespectful treatment at the John Radcliffe hospital and we first wrote to the Trust and CCG on this issue 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.”

We are delighted to share this blog by  Sara Kenyon, Professor of Evidence Based Maternity Care at the University of Birmingham on how Birmingham Women’s Hospital revised their maternal request caesarean guidance to produce a right-respecting policy and a process that works for women and clinicians.