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.”
In our report, all Trusts were categorised as red, amber, green, unknown or no response as shown on the interactive map below.
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
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
We have had ongoing correspondence with Oxford University Hospitals (OUH) NHS Trust and Oxfordshire Clinical Commissioning Group about their maternal request caesarean policy since May 2017. In February 2020 for the first time, we were invited to meet the Trust to discuss and will give a further update following this meeting.
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.