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

Birthrights met with Sir Jonathan Montgomery (Chair of Oxford University Hospitals NHS Foundation Trust (OUH)) and Professor Meghana Pandit (Chief Medical Officer, OUH) most recently on the 15th October 2020.

The current position is that OUH intends to continue to refer women who request maternal request caesarean to Gloucestershire in the short term if a formal arrangement can be reached (decision awaited shortly). However, in light of the discussion at the Clinical Ethics Advisory Group held in July 2020 (see evidence submitted by Birthrights below), Oxford University Hospitals has committed to ensuring that where women are unable to access care in Gloucestershire, particularly vulnerable women and those with other underlying significant health problems – a caesarean section will be offered locally. OUH has agreed that Birthrights can flag up any women contacting us about a maternal request caesarean at OUH direct to Professor Meghana Pandit. Birthrights and OUH will meet again in February 2021 to review the situation.

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