A Caesarean Section or C-Section can be undergone during pregnancy for three reasons:
- An unplanned caesarean birth if the child’s health/life is threatened during labour
- An obstetrician may advise a caesarean birth, if in his/her opinion a vaginal birth would put the health/life of the bay at risk. This is known as an elective planned caesarean birth
- A third reason for undergoing a c-section is following the direct request of the patient, with or without any obstetric advice. This also falls under the heading of a planned elective c-section, however it is more commonly called a maternal request caesarean.
A maternal request caesarean may be requested, even if the patient’s doctor or midwife does not believe that there is a medical reason for carrying for the procedure, at any time even during labour.
Any patient who requests a caesarean birth should be listened to and taken seriously.
Any maternity unit that refuses a request for an elective c-section must have a good reason for refusing this request, an example being the risk of likely harm to the patient or the child versus the patient’s given reason for the request.
What NICE Says
The NICE Guidelines state that where a C-Section is requested and the patient is making a clearly informed decision then this decision should be respected.
The guidelines further state that where the given reason for electing to have a c-section on maternal request is birth anxiety, then counselling should ne offered to the patient, It should be noted that the patient is not obliged to accept this offer of support. In such circumstances the maternity department should offer a c-section.
It should be noted that this does not place an obligation on obstetricians to perform c-sections against their will. However should an obstetrician refuse to carry out a c-section, he/she should then refer the patient to an obstetrician who is willing to perform the procedure.
What the Law Says
The recent leading case of Montgomery v Lanarkshire Health Board [2015] the Supreme Court stated that where there is an increased risk in a vaginal birth the patient should be offered the option of a c-section, nevertheless this case is silent on this particular issue, nor is there any case law in support of a mother’s right to a c-section on demand and at present court rulings support the view that a vaginal birth to be the first choice of treatment.
Claimant’s who are denied a maternal request caesarean are likely then to have to fall back on the NICE Guidelines. HRA Article 8 does provide some report as the Courts have traditionally interpreted the right to a private and family life very broadly.