Majority of NHS trusts refusing to offer caesareans on request – study

A pregnant woman holds her bump (Yui Mok/PA) Credit: PA Wire/PA Images

Pregnant women requesting a caesarean section face multiple barriers from the majority of NHS trusts in the UK and are sometimes refused outright, new research has revealed.

Guidelines from the National Institute for Health and Care Excellence (Nice) state women who ask for a caesarean should be offered one if, after support and discussion with a doctor, they feel it is best for them.

But a report by childbirth charity Birthrights found that only 26% of trusts were abiding by the guidelines and many women faced delays and difficulties in requesting a caesarean on non-medical grounds.

It found that 47% of trusts had inconsistent or confusing policies on offering caesareans on request.

It raised concerns that women who had previously undergone traumatic births would be unable to access the care they need.

The charity said it also feared that women who may have been through sexual assault or were vulnerable due to language barriers, mental health problems or learning difficulties were being forced to undergo unsafe vaginal births.

It found 28% of women requesting a caesarean did so because they had an underlying health problem, such as pelvic pain, that did not meet the medical threshold for requiring a caesarean.

Many women who requested a caesarean were told to go elsewhere.

Rebecca Schiller, chief executive of Birthrights, said: “It is clear that women requesting caesarean sections 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 for women.”

Birthrights found that the John Radcliffe Hospital in Oxfordshire had a policy in place to refuse all maternal request caesareans.

Lawyers for the charity have since written to the Oxford University Hospitals NHS Trust and Oxfordshire Clinical Commissioning Group asking for more information on the policy.

One woman who requested a caesarean at the John Radcliffe Hospital in 2017 said she was made to feel “like a child being told off for doing something wrong”.

Birthrights’ programmes director, Maria Booker, said the charity had received a number of complaints about disrespectful treatment at the John Radcliffe Hospital.

She said: “Trusts are bound by human rights duties to offer individualised care.

“Any statement or policy from a trust that caesarean would only be granted on medical grounds may be incompatible with trusts’ obligations to have an open, supportive, two-way discussion that explores all reasonable options.“

She added that any policy applied in a blanket way may be incompatible with human rights law.