Do women have a real choice of an elective caesarean section?

Posted on: August 21st, 2018

Women are entitled to ask for an elective caesarean section and hospitals should provide it after a discussion of the risks that it carries, so says the guidance issued by the National Institute for Health and Care Excellence. However, in reality is that always the case?

A response to a freedom of information request has identified that one in four hospitals (21 of 91) would not routinely offer such surgery without a medical reason, and a further four would, but stated that it was not funded in their area. A further to that, Sandwell and West Birmingham Hospital Trust, stated that to offer it would simply encourage more women to request it.

And there lies the issue at the heart of this. A caesarean section is more expensive than a vaginal delivery. But it is clear from the guidance that cost should not be a factor and if requested, should be offered. Caesarean sections are not risk free and it will undoubtedly be for the hospital to talk through these risks with the mother. But that does not absolve the hospital from providing this information to the mother, as has been clear for quite some time following the case of Montgomery.

In the work we do representing children with brain injuries caused at birth, we have seen instances in which hospitals did not discuss these risks with the mother, or had not assessed the risks properly in the first place. The reasons for this are many and an inquiry into Morecombe Bay NHS Trust between 2004 to 2013 found that midwives’ desire for natural births “at any cost” had contributed to unsafe deliveries. This and the above evidence suggests that hospitals, when given the choice, would rather mothers proceed with a cheaper vaginal deliver, rather than a more expensive caesarean section.

But NICE is clear. Women are entitled to ask and the hospitals should provide it.

For more information, please contact our catastrophic injury and clinical negligence team.