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NHS removes limits on caesarean births in light of patient safety concerns

Posted: 24/02/2022

The BBC has reported that the NHS will no longer use caesarean section rates as a means of measuring performance. Maternity wards are being advised to treat cases on an individual basis, rather than having to meet targets for caesarean births.

A caesarean section birth is when the baby is delivered through abdominal surgery, rather than pushed through the birth canal. Most caesareans are carried out under spinal or epidural anaesthetic. Currently around 25% of births in the UK are caesarean sections. Like any operation, it carries risks, and the recovery period is usually longer for the person giving birth than after vaginal birth.

The previous guidance provided to hospitals was to promote vaginal births and to try to keep the caesarean rate to around 20%.

The new guidance means that pregnant people will now be able to choose a caesarean section, even if this is not for medical reasons, in line with National Institute for Health and Care Excellence (NICE) guidance. The news is a welcome move to improve care and safety for people giving birth, rather than focusing on targets that may not take individual circumstances into account.

This news comes in light of a report published in July 2021 by the Health and Social Care Committee on the safety of maternity services in England, further details on which can be found here. The report found that, while the vast majority of births are safe, there was a worrying variation in the quality of maternity care. One of the recommendations made by the report was to end the use of total caesarean section percentages as a metric for measuring performance of maternity services.

The report by the Health and Social Care Committee followed a number of maternity scandals reported over the preceding years, most notably in relation to Shrewsbury and Telford Hospital NHS Trust, which is being investigated for nearly 2,000 maternity incidents. A full history so far of the review into avoidable deaths at this trust can be found here.

The review into Shrewsbury and Telford Hospital NHS Trust has identified a number of problems with the care provided to pregnant people and babies. Among these were:

  • The desire to keep caesarean section rates low - caesarean section rates at the trust were 8% to 12% lower than the national average.
  • A perception that good maternity care meant patients having a ‘normal’ (vaginal) birth.
  • A lack of freedom for pregnant people to express a preference in the mode of the baby’s delivery.

Victoria Johnson, an associate in the clinical negligence team at Penningtons Manches Cooper, said: “It is important to remember that most babies are delivered safely, whether the birth is vaginal or by caesarean section. However, the loss or injury of even one baby is a tragedy. If the harm was avoidable, then this may also lead to more costs to the NHS in the long-run if an investigation is needed and/or a clinical negligence claim is brought.

“Focusing on targets rather than individual patient safety does not help the NHS, its staff, the person giving birth or their baby. While this change relates to just one aspect of maternity care, it is hoped that this new guidance will reduce the number of avoidable deaths and injuries to both babies and pregnant people.”

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