CS postcode lottery

By Hollie Ewers on 21 August 2018 Research Caesarean Section MRCS Policy Birthrights NICE - The National Institute for Health and Care Excellence

According to research published today (21 August), responses to maternal requests for CS (MRCS) are varied and differ greatly in NHS trusts and boards across the UK.

The childbirth charity Birthrights published the results of a Freedom of Information request on MRCS, revealing the process is often lengthy, difficult or inconsistent in the majority of regions.

Pregnant women in some regions who ask about the procedure are simply told to go elsewhere.

Statistics from the Birthrights report Maternal request caesarean show that 15% of trusts and boards have policies or processes that explicitly do not support MRCS, while 47% have policies or processes that are problematic or inconsistent. 

Only 26% of trusts and boards offer CS in line with NICE best-practice guidance.

NICE guidance states: ‘For women requesting a CS, if after discussion and offer of support… a vaginal birth is still not an acceptable option (trusts should) offer a planned CS.’ 

RCM CEO Gill Walton said: ‘We support NICE recommendations on this issue and these are the recommendations and guidelines that midwives and doctors work with.

‘Midwives should listen to women who want a caesarean section and discuss the risks and benefits of caesarean section and physiological birth in a way that is understandable and accessible to them.

‘Women must be given the information to explore their views and feelings about caesarean birth, to enable them to come to an informed decision about their preferred type of birth. This information should reflect the individual woman’s current and previous medical, obstetric and psychological history.

‘Midwives have an important role in supporting women who request a caesarean section and respecting their reasons.’

Between November 2017 and January 2018 Birthrights wrote to every trust and board in the UK to find out about their MRCS policy. 

All organisations were then categorised as red, amber, green, unknown or no response. (Red meaning MRCS is not offered, amber is MRCS is partially offered/offered with concerns, green is MRCS is offered in line with NICE guidance, and grey is unknown.) 

An interactive map of the UK with corresponding coloured pins for each trust and board was created to show the variation in policies.

Commenting on the results, Birthrights chief executive Rebecca Schiller said MRCS are the number one reason women contact the Birthrights advice service. 

‘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 CS will give them and their baby the best chance of an emotionally and physically healthy start,’ Rebecca said. 

She added: ‘It is clear that women requesting CS 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 of women.’

Read the full report here.

Access the interactive map here.