It has widely been reported that the NHS in England will no longer aspire to limit the number of Caesarean sections (C-sections) it performs to 20% of all deliveries.

Hospitals have until now been following guidance issued by the Royal College of Obstetricians and Gynaecologists given in 2012 which said trusts should try to cap C-sections at about 20% of all deliveries.

Use of C-sections is on the rise globally

The World Health Organisation international data broadly suggests that a figure of 10-15% has a positive impact on reducing maternal and new born deaths. Use of C-sections is on the increase and it varies throughout the world. In 2021, The Dominican Republic topped the table with 56.4% of births being by C-section. Norway, Sweden and Finland were at the bottom of the table with an average figure of 15% and the UK was towards the lower end of the range with a figure of approximately 26.2%. See bellybelly Highest C-section rates by country.

However, regardless of the statistics, health professionals would no doubt accept that target rates should not govern individual clinical decisions and the health and well-being of mother and baby should always come first.

When is a C-section considered?

C-sections are considered if:

  • the mother requests one
  • planned and for medical reasons identified before the labour– such as a large baby in proportion to maternal size, or a baby in the wrong position
  • emergency – due to complications that arise during the delivery, for example the baby’s heart rate drops and the delivery becomes a medical emergency for the baby’s wellbeing, or in some circumstances for the mother’s wellbeing

It seems that women have always had the right to request a C-section in the NHS, but it is unclear how well this was known. Anecdotally it seems that if a C-section is requested the midwives and doctors often work very hard to persuade the mother that she should trial a vaginal delivery first and the mode of delivery is in the gift of the consultant not the choice of the patient. This is particularly the case in the emergency situation when mothers may feel they have less agency to question decision-making. However, few mothers know that in the ante-natal period they can ask to be referred to another consultant if their request for a C-section is refused. Indeed this should be offered to them.

Perhaps this shift in policy will empower women to advocate for C-sections and remind doctors to listen and be sympathetic to these requests.

What has brought about this policy change?

This change in policy comes whilst we await the second report into maternity practices at The Princess Royal Hospital in Shropshire which has had a disproportionately high level of maternal and baby injuries and deaths.

The interim report and/or preliminary findings may have identified that this Trust was refusing C-sections because it was attempting to stick to the recommended national percentages; it is likely that this will be one of many contributory factors.

The report is now due out in March 2022 and it will be interesting to see if this is an issue which features as a factor in the adverse outcomes for mothers and babies at this particular Trust.

If you have been affected by any of the issues raised in this article and would like to discuss your legal rights issues arising from it then please contact Janice Gardner.