A recent investigation carried out by Birthrights, a child birth charity, suggested that only 26 percent of trusts were following the guidelines set out by the National Institute for Health and Care Excellence (NICE) and offering a caesarean section to women who request one. NICE guidelines suggest that where a woman requests a caesarean section, if after discussion and the offer of support, a vaginal birth is still not an acceptable option, a planned caesarean section should be offered.
Does refusing to offer a caesarean section to a woman who has requested it represent a breach of her right to autonomy? The landmark case of Montgomery v Lanarkshire Health Board (Scotland)  UKSC 11 placed an even greater onus on healthcare professionals to provide patients with information regarding the material risks involved in the recommended treatment that was being offered. Therefore, by not allowing a woman to opt for a planned caesarean section, after being fully informed of the alternatives and risks involved, does this contravene the law as set out in Montgomery?
Montgomery concerned a pregnant woman who had diabetes, predisposing her to a greater risk of having a baby that was larger than average. Mrs Montgomery was not advised of such a risk and was not offered a caesarean section as an alternative. As a result her baby suffered with shoulder dystocia, where the baby’s shoulders are too wide leading to the baby becoming stuck behind the mother’s pubic bone during delivery. The delay that was caused by the baby becoming stuck led to Mrs Montgomery’s son being starved of oxygen for 12 minutes during delivery.
As a result of this, the baby developed cerebral palsy. In Montgomery it was agreed that the material risk of shoulder dystocia should have been discussed with Mrs Montgomery. This would have allowed her to make an informed decision about whether she would prefer to have elected for a caesarean section which would have avoided her son from suffering with a life-long disability. Mrs Montgomery had raised concerns about the size of her baby and her ability to deliver such a large baby naturally.
The real cost of a C-section
There are arguments that a caesarean section costs around £700 more than a natural birth, but what these figures don’t take in to account is the further costs that can result from complications of a natural birth. What about the woman who suffers with pelvic organ prolapse or incontinence following a natural birth, or suffers from PTSD following a traumatic birth? All of which will cost the NHS further money through further complex surgery or counselling. Montgomery concerned a child that was left profoundly disabled as a result of a failure to adequately inform his mother of the risks and advise her correctly in relation to a caesarean section. Had alternatives been discussed with his mother she would have opted for a C-section and most likely gone on to deliver a healthy baby. Many women who request a caesarean section do so because of previous experiences of a traumatic birth and do not want to go through the same experience again, but their experience is that this is not a legitimate medical reason to request a caesarean section.
However, a caesarean section is not without risks. It is major surgery and carries a number of risks such as blood loss, infection and blood clots. The recovery period is significantly longer than a natural delivery and consideration must be given to the residual pain following open surgery. This can make it very difficult for mothers to care for and feed their new baby for up to 8 weeks post birth and can limit them in other ways including the ability to drive and even pick up their baby. Anaesthetic such as an epidural or spinal block and in some cases a general anaesthetic will be administered for a caesarean section, which also carries the risk of nerve damage and can prolong the recovery period. The decision to choose a caesarean section is not one which can be made without consideration of the risks involved in comparison to a natural delivery.
Many women feel there is a taboo around opting for an elective caesarean section and face comments such as being ‘too posh to push’ when in fact they are merely exercising their right to choose what they feel is the most appropriate action for them and their unborn child. New figures suggest that around 47 per cent of Trusts have inconsistent or confusing policies on offering a caesarean upon request, only further heightening the upset and anxiety of pregnant women and encouraging them to feel less empowered to make their own decision after weighing up the risks.
f you feel that some of the issues raised above affect you and you would like some legal advice, please do not hesitate to contact me Charlotte Brown or a member of our clinical negligence team at Taylor&Emmet LLP on 0114 218 4195 or email firstname.lastname@example.org