Women are being denied their right to choose a caesarean section according to new research.
Birthrights, a UK charity that improves women’s experience of pregnancy and childbirth, reported that women are not being given the chance to choose a caesarean at up to 75% of UK maternity units.
Of the 146 trusts that shared their policies with Birthrights, only 26% fully complied with the guidelines - a further 15% refused all elective caesareans. This is despite obesity and age being reported to have caused a caesarean section spike.
'The women we support have endured previously traumatic births, physical ill-health, childhood sexual abuse or have carefully examined the evidence available and made informed decisions that planned caesarean section will give them and their baby the best chance of an emotionally and physically healthy start,’ said Rebecca Schiller, chief executive of Birthrights.
‘It is clear that women requesting caesarean meet judgemental attitudes, barriers and disrespect more often than they find compassion and support.’
NICE guidance states: ‘For women requesting a Caesarean, if after discussion and offer of support… a vaginal birth is still not an acceptable option (trusts should) offer a planned Caesarean.’
Caesarean section is when a baby is delivered by making a surgical cut in to the abdomen and womb. The fall into three categories: elective - at the mother’s request, planned - usually for medical reasons and emergency - usually because of complications during labour.
However, not all women are being offered the choice of having a caesarean because of cost, lack of facilities, and ward space, however, it is still unclear, due to the confusion from doctors and midwives, why a large number of women are being refused a caesarean.
‘Some women say they have had cost quoted at them – ‘You can’t have a Caesarean because it will cost too much,’ the trust might be fined, that the clinical commissioning groups themselves wont fund those requests – but there doesn’t seem to be one reason,’ explains Ms Schiller.
Birthrights reported that a caesarean costs £700 more than a vaginal delivery.
‘We support NICE recommendations on this issue and these are the recommendations and guidelines that midwives and doctors work with,’ explained Gill Walton, chief executive and general secretary of the Royal College of Midwives.
‘Midwives have an important role in supporting women who request a Caesarean section and respecting their reasons.’
More than a quarter of all babies born in England are now delivered by either elective or emergency caesarean. In 2016 the number of conventional births dropped from 407,031 to 382,514.
‘For some, non-mental-health-based colleagues, perhaps there’s a perception about anxiety, or a misunderstanding about how severe anxiety can be for some women, so women are often denied Caesareans perhaps because there’s a lack of understanding about how unwell they actually are,’ explains Rebecca Moore, a consultant perinatal psychiatrist.
Birthrights have said that they handle more support requests from women unable to access a caesarean section than any other issue. ‘We are concerned that this lack of respect for patient dignity could have profound negative consequences for the emotional and physical safety of women,’ Ms Schiller concluded.