Protecting human rights in childbirth

Maternal request caesarean

In August 2018, Birthrights published a report about the treatment of women who request a caesarean section. Between November 2017 and January 2018, we wrote to every Trust in the UK and every Clinical Commissioning Group (CCG) in England to find out about their policy on maternal request caesarean. The results showed that the majority of Trusts in the UK made the process of requesting a caesarean lengthy, difficult or inconsistent, adding anxiety and distress to women at a vulnerable time.

“I feel that my concerns were not listened to […] and the previous trauma my body had suffered along with the recovery time were ignored. I was made to feel like a number rather than seen as an individual.”

Our findings

In our report, all Trusts were categorised as red, amber, green, unknown or no response as shown on the interactive map below.

Map key

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

Official NICE guidelines state: ‘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.’ Yet our report showed that pregnant women in some regions who asked about the procedure were simply told to go elsewhere. Our statistics showed that:

  • 15% of Trusts had policies or processes that explicitly do not support maternal request caesarean
  • 47% of Trusts had policies or processes that are problematic or inconsistent
  • only 26% of Trusts offered caesareans in line with NICE best-practice guidance

Analysis of our advice enquiries on this issue (November 2016 to May 2018) reveal that a third of women wanted a caesarean due to a previous traumatic birth. Other reasons included underlying medical conditions, mental health issues, other trauma such as sexual assault – or women had examined the evidence and made informed decisions

Best practice

Our report highlighted good practice too. This blog by Sara Kenyon, Professor of Evidence Based Maternity Care at the University of Birmingham, shows how Birmingham Women’s Hospital revised their maternal request caesarean guideline to produce a rights-respecting policy and a process that works for women and clinicians.

Oxford University Hospitals

On 27thJuly 2018, lawyers acting for Birthrights wrote to Oxford University Hospitals (OUH) 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 followed a chain of correspondence between Birthrights and the Trust and CCG after repeated concerns raised with us by women. We received a response to this letter on the 3rd January and wrote again to the Trust in March 2019 cautiously welcoming moves to review their policy.

“Although we continue to have concerns that the picture painted by OUH does not match the accounts we have heard from local women, we are nevertheless pleased to hear that OUH is actively consulting its obstetric team, and considering the option of carrying out maternal request caesareans onsite at the John Radcliffe. We urge OUH to follow the example of Birmingham Women’s and others who have worked together with service users and staff to create a policy that puts women’s needs first whilst also respecting the views of staff.”

Maria Booker, Birthrights Programmes Director

Next steps

We are pleased that a number of Trusts and Local Maternity Systems have changed their policy on maternal request caesarean since we launched our campaign. We are now prioritising working with those Trusts and Local Maternity Systems that were classified “red”. If you are aware of positive local changes as a result of our campaign, we would love to hear about them! Please contact us.