Protecting human rights in childbirth

Registered Charity Number 1151152

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.

Update to 2018 report

In May 2021 Tees Law repeated our Freedom of Information (FOI) request for all Trusts we classified as amber and red and their report published in December 2021 and the individual FOI request responses can we found on their website here. We are grateful to Tees Law for undertaking this follow up work.

Oxford University Hospitals

In February 2021, after nearly four years Birthrights were delighted to share that Oxford University Hospitals NHS Foundation Trust (OUH) would offer maternal request caesareans at the John Radcliffe hospital going forward. Birthrights met with Sir Jonathan Montgomery (Chair of Oxford University Hospitals NHS Foundation Trust, OUH) and Professor Meghana Pandit (Chief Medical Officer, OUH) on the 22nd February 2021 following a number of discussions in 2020. OUH confirmed that they had been unable to come to a formal agreement with Gloucestershire about a referral pathway for individuals wanting a maternal request caesarean, and would therefore offer maternal request caesareans locally.  Women making this request now have the opportunity to discuss the pros and cons of caesarean birth and vaginal birth with a consultant midwife and are also encouraged to see a psychiatrist if appropriate (the offer of perinatal health support  does not have to be accepted). If women/birthing people still want a maternal request caesarean following these consultations with staff, they will be given one.

Birthrights welcomes this development but remains keen to hear that this is being consistently implemented. If you would like to contact us about your experience of requesting a caesarean at OUH (or elsewhere, or about any instance of not being supported to make informed decisions and/or not having those decisions respected), please email us at advice@birthrights.org.uk.  OUH also welcomes anyone who has concerns about implementation of this pathway to contact the maternity service via the Patient Advice and Liaison Service  at OUH (PALS@ouh.nhs.uk) so that all concerns are addressed promptly and effectively.

Our correspondence with Oxford University Hospitals (OUH) NHS Trust and Oxfordshire Clinical Commissioning Group about their maternal request caesarean policy can be found below:

Letter from Birthrights to OUH – 25th May 2017

Response from OUH to Birthrights – 1st June 2017

Letter from Birthrights to OUH – 20th July 2017

Letter from lawyers on behalf of Birthrights to OUH – 27th July 2018

Letter from Birthrights to OUH – 13th December 2018

Response from OUH lawyers to Birthrights – 3rd January 2019

Letter from lawyers on behalf of Birthrights to OUH – 26th March 2019

Letter from Birthrights to OUH – 17th January 2020

Response from OUH to Birthrights – 12th February 2020

Birthrights evidence to Oxford University Hospitals Clinical Ethics Advisory Group – 2nd July 2020