Recent media reports show major hospitals in the United Kingdom are denying women c-sections unless they have a clear medical reason for having one.

Women who seek to have an elective c-section because they’re afraid of labour or have had previous traumatic experiences will find they can no longer do so at Oxford University Hospitals (OUH).

UK Hospitals Banning C-Sections

As outlined in this leaflet, the hospital trust believes women who are anxious about vaginal birth should discuss their concerns with their midwife or doctor.

Their care providers will suggest resources and support to help pregnant women overcome their fears.

Birthrights UK says the hospital trust is breaching the health guidelines set by the National Institute for Health and Care Excellence (NICE). The OUH Trust says it is in compliance with the NICE guidelines.

What Do The NICE Guidelines Say About Elective C-sections?

A quick look at the NICE guidelines shows maternal requested c-section should be treated as follows:

Care providers should discuss and record the specific reason a woman requests a c-section.
Discuss risks and benefits of c-section compared with vaginal birth and record the discussion has occurred. Include other health professionals (midwife, obstetrician, anaesthetist) if necessary, to explore reasons and ensure the woman is fully informed.
If anxiety is the reason for the request, care providers can offer to refer to a healthcare professional who has expertise in perinatal mental health.
If, after discussion, an offer of support for a vaginal birth is not acceptable, offer a planned c-section.
If an obstetrician is unwilling to perform an elective c-section, the woman should be referred to a doctor who will undertake the surgery.

It appears, from the leaflet, the OUH Trust is in fact respecting the NICE guidelines, and choosing to refer women who want elective c-sections for non-medical reasons to other hospitals.

Why The C-Section Ban?

C-section rates in the UK overall are around 26%. Of these, about 2.5% of c-sections are elective (meaning planned).

For some time, the World Health Organisation has recommended c-section rates should be about 10-15%. This was due to observations regarding infant and maternal mortality; they decrease up to this level and then remain unchanged once c-section rates climb higher.

More recently, the WHO’s stance on c-section places an emphasis on making every effort to provide c-sections to women in need rather than striving to achieve a certain rate.

The WHO stresses c-sections can save lives but are often performed unnecessarily, without medical reason.

There are well documented and evidence-based statistics on the risks of c-sections for both mothers and babies.

The OUH Trust still offers c-sections to women in an emergency, and to those who have multiple babies, or have a medical condition that makes vaginal birth risky for either mother or baby.

Some birth advocate support groups have suggested the ban on c-sections is less altruistic. They claim it comes from a cost saving push. An ongoing financial crisis in the National Health Service (NHS) means many hospitals are understaffed and underequipped.

The OUH Trust was reported in the media as saying the decision was ‘not related to targets but to good practice and reducing harm to women’.

Is There Pressure To Reduce C-Sections?

While there could be a financial incentive to reduce c-sections, overall it doesn’t make sense. In 2017, around 8,000 women had babies at OUH and the c-section rate was 24% – 2% lower than the national rate.

A c-section costs the NHS around AUD$2,700, which is more than double the cost of a vaginal birth (AUD$1,200). Women who have c-sections stay twice as long in hospital as those who give birth vaginally; this increases the cost to the hospital and reduces the availability of beds and staff to other patients.

There have been reports of women feeling pressured into opting for a vaginal birth, despite NICE guidelines stating women should ultimately be free to choose their mode of birth.

What do you think? Should women have free choice at any birth place, or are hospitals in the best position to support a rise in vaginal birth rates and a reduction in c-section rates?

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