Caesarean Section Awareness Month

April is caesarean (C) section awareness month and in recognition of this we are exploring the recent Ockenden report concerning maternity care at the Shrewsbury and Telford Hospital NHS Trust and the decision by the NHS to scrap their C-section targets.

The intention of this is to improve patient safety and allow mothers more choice on how they give birth. Previously, the NHS guidance allowed mothers to choose a C-section for non-medical reasons but not all doctors were willing to undertake these.

What is a C-section?

The World Health Organisation (WHO) have announced that more babies than ever are being born via C-section. The figures currently stand at around one in four babies.

A C-section is when a baby is delivered through a surgical cut made into the abdomen and womb instead of being delivered vaginally.

C-sections usually take place as either:

  • Planned – due to the baby being too large, in the wrong position or due to other medical reasons;
  • Emergency – due to complications arising during a vaginal labour.

The NHS deems a C-section to be a major, but safe, surgery.

NHS Targets

Maternity units were previously targeted on numbers of ‘natural’ vaginal births. This led to concerns that ‘natural’ births were being promoted over C-sections with these targets failing to account for the reasons for the C-sections.

Between 2010 and 2018, Shrewsbury and Telford Hospital NHS Trust became the centre of the largest maternity scandal with over 1,800 cases of poor care including dozens of baby deaths.

For five out of these eight years they were the Trust with the highest natural birth rate. However, there were multiple safety concerns and cases of poor patient care.

The Ockenden report has been published reviewing the maternity services at this Trust. Completed by a senior midwife, it made 84 recommendations all which have been accepted by the NHS. They relate to areas such as training, accountability, investigations and aftercare.

In summary, the report found that over 200 babies may have died, or suffered life changing injuries, due to the repeated failures of the Trust. The reluctance to perform C-sections resulted in many of these deaths and the lack of investigation afterwards led to the repetition of failures. It has been highlighted that parents were not listened to when raising concerns and any responses from the Trust were lacking transparency and honesty.

OCKENDEN REPORT – FINAL (ockendenmaternityreview.org.uk)

Freedom of Choice

Some argue that the risks to both mother and baby associated with a C-section means that they should be a last resort and only done when medically necessary.

Others argue that, if after considering all the facts and risks, a mother decides she would prefer a C-section then it should be provided. This view is supported by the National Institute for Health and Care Excellence (NICE) who are the public body who provide guidance to health practitioners in England and Wales.

In 2018, a study was undertaken and 25% of mothers who had an unplanned C-section felt disappointed by the experience. Some felt a sense of failure when birthing plans changed and they had to have a C-section instead of a ‘normal’ vaginal birth.

However, mothers who chose to have a C-section felt less pre-birth anxiety as they knew what was happening and when. The amount of knowledge these mothers had changed their perceptions of a C-section.

It is clear that knowledge and open discussions are the way forward to ensure mothers are supported in making the correct birthing decision for themselves and their babies.

Studies

Comparing the risks of a vaginal birth vs a C-section birth is not straight forward.

One of the major issues is that emergency C-sections fall into the C-section category for comparison, but they are almost all the result of a vaginal birth not going to plan. This means the comparison is not so clear cut.

Research does not show that there is a clear distinction of one birth being ‘better’ than another.

Now the NHS has abolished the C-section targets this should lead to prioritisation of patient care and freedom of choice to expectant mothers.

Current case law agrees that mothers should be told the risks of both vaginal births and C-sections and given the option of a C-section birth. In a 2015 Supreme Court case a mother, who had an unusually large baby, was purposefully not told about the risks associated with a vaginal birth to avoid a C-section request. During the birth the baby was deprived of oxygen and subsequently developed cerebral palsy. This is one of the leading cases regarding informed consent.

Conclusion

Having open conversations about C-sections should better equip mothers not only to decide which birth is right for them but also to give informed consent to a C-section incase an emergency occurs.

Ultimately mothers should have their choices respected. If all information and risks have been discussed with the mother, for both vaginal births and C-sections, then the mother can make an informed decision to which birth is right for her.

Medical Negligence Solicitors

Morrish Solicitors have experience in dealing with clinical negligence claims relating to substandard maternity care. If you believe you have a medical negligence claim please contact our specialist team of solicitors on 033 3344 9600 or email [email protected].

Over the years, our team of medical negligence solicitors have pursed hundreds of birth injury claims for mothers and/or babies who have sustained injuries during childbirth as a result of negligence.

Morrish Solicitors are the only law firm with an office within the Bradford postcode holding a Clinical Negligence Legal Aid Franchise. This means we have been approved by the Legal Aid Agency to offer Legal Aid funding in certain clinical negligence claims. The clinical negligence team can assist with claims arising throughout England and Wales, but we have particularly extensive experience in pursing birth injury claims against NHS Trusts in the Yorkshire region.

If you or your child have suffered a negligence mistake made by medical professionals during birth, please contact our experienced solicitors on 033 3344 9600 or complete our online contact us form, we will be happy to discuss your options in detail.