Women who request a caesarean are being subjected to a “lengthy, difficult or inconsistent” process which is “adding anxiety and distress to women at a vulnerable time”, a human rights charity has warned.
Official guidance from the National Institute for Health and Care Excellence (NICE) states that women requesting a caesarean section should be offered one if, after discussion and an offer of support, a vaginal birth is still not an acceptable option.
But charity Birthrights, which specialises in maternal human rights, found pregnant women in some regions of the UK were not being given the option. The results of a nationwide Freedom of Information Act request showed one in six NHS trusts have policies or processes that explicitly do not support maternal request caesarean, while almost half (47%) have policies or processes which are problematic or inconsistent.
Just over one quarter (26%) of trusts offer caesareans in line with NICE’s guidance.
Maya, whose son was born in October 2017, said she “felt like a child being told off for doing something wrong” when she requested a caesarean.
“When I asked [the consultant] if we could discuss mode of delivery he stopped me mid-sentence and said my best option is vaginal birth,” she recalled. “I said to him that I would like to explore other options such as elective caesarean. [The doctor] told me that they do not follow NICE guidelines and that I will never get elective cesarean at the John Radcliffe hospital for non-medical reasons. The word ‘never’ was stressed to me.”
In response to Maya’s claims, Veronica Miller, clinical director of Women’s Services at Oxford University Hospitals NHS Foundation Trust, told HuffPost UK its practice in providing caesarean sections that are not medically necessary is in line with NICE guidelines.
“Some women have real anxieties about labour or have had a previous poor birth experience. We have a Perinatal Mental Health Team who see and assess women in this situation,” she added. “In these circumstances, a planned caesarean section may well be the best outcome. All requests are considered on an individual basis and a plan for the woman’s care put in place. Our practice in this area supports the NICE guidance relating to requests for elective caesarean sections.”
Miller says the trust’s obstetricians support performing caesarean sections for clinical indications, including mental health issues. “However, NICE guidance recognises that obstetricians are not required to perform a caesarean section when there is no clinical indication to do so and cannot be made to do so,” she added. If no clinical indication for caesareans is found, she explained, the woman would then be referred to an obstetrician at a neighbouring trust who might support her request.
Rebecca Schiller, chief executive of Birthrights, 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,” she said.
“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.”
Gill Walton, chief executive and general secretary of the Royal College of Midwives (RCM), said the body supports NICE guidelines on the issue.
“Midwives should listen to women who want a caesarean section and discuss the risks and benefits of caesarean section and physiological birth in a way that is understandable and accessible to them,” she said in a statement.
“Women must be given the information to explore their views and feelings about caesarean birth, to enable them to come to an informed decision about their preferred type of birth. This information should reflect the individual woman’s current and previous medical, obstetric and psychological history.
“Midwives have an important role in supporting women who request caesarean section and respecting their reasons.”