The NHS has revealed that it has abandoned targets that encourage hospitals to pursue natural or normal births over fears for the safety of mothers and their babies.
It has recently been reported that maternity units were told in a letter to stop using caesarean section rates to assess their performance. This is due to repeated scandals in NHS maternity units across the UK, which is partly blamed on a focus on pursuing natural births at the expense of patient safety.
The letter from NHS England’s Chief Midwife, Jacqueline Dunkley-Bent and Dr Matthew Jolly, the National Clinical Director for Maternity, informed:
“…all maternity services to stop using total caesarean section rates as a means of performance management. We are concerned by the potential for services to pursue targets that may be clinically inappropriate and unsafe in individual cases.”
July last year saw the Commons’ Health and Social Care Committee call for an immediate end to the use of c-section targets, stating it was “deeply concerning”.
Deaths of babies at Shrewsbury and Telford Hospital NHS Trust
A final report, which is anticipated to be highly critical, will be published next month on the deaths of many babies at the Shrewsbury and Telford Hospital NHS Trust.
The Trust is at the centre of the biggest maternity scandal in NHS history, with a reported 1,862 cases being investigated. For further details of the investigations currently taking place see here.
Donna Ockenden, the Midwife leading the inquiry, has said:
“women felt pressured to have a normal birth and there was a multi-professional, not midwife-led, focus on normal birth pretty much at any cost.”
Between the years 2010 and 2018, the Trust had the highest natural birth rate in England and was amongst the top three in the remaining years.
Death of babies at Nottingham University Hospital NHS Trust
Hayley Coates, 29, lost her son, Kaylan, after staff at Nottingham University Hospital NHS Trust ignored her pleas for a caesarean section in March 2018.
A coroner ruled that neglect contributed to Kaylan’s death. During his delivery, he suffered prolonged bradycardia, a slow heart rate, and associated hypoxia, a condition where the brain is starved of oxygen. Emily Rose, Associate in our Medical Negligence team, assisted Kaylan’s Mother in preparation for the inquest.
Hayley, Mother of three, said she welcomed the NHS England letter, adding:
“I was just ignored when I asked multiple times for a caesarean section. I was told repeatedly: You will have this baby naturally, you don’t want to go into theatre.”
However, if Hayley had gone into theatre many hours before, Kaylan could have survived.
Nottingham University Hospital NHS Trust is facing its own inquiries into the poor care of its maternity units, with nearly 70 cases being investigated. The Trust has apologised for failings and said it has learned from Kaylan’s death.
However, the hospital’s website states, midwives working on its midwifery-led unit are described as:
“Committed to promoting normal birth.”
This suggests the Trust has not learned from Kaylan’s deaths as it is continuing to promote a ‘normal birth’ as opposed to offering c-sections for pregnant women.
What does this mean going forward?
For years, NHS Trusts have benchmarked their caesarean section rates against the average. In 2012, the Royal College of Obstetricians and Gynaecologists advised a rate of 20%.
The Office for National Statistics data showed that still-births had fallen by 25% in 2020 compared with 2010, and neonatal deaths for babies born at 24 weeks were down by 36%. The NHS is aiming to halve the numbers by 2025.
In 2017, the Royal College of Midwives (RCM) formally abandoned its normal birth campaign, as it was decided that a targeted approach did not support the right decision-making process. Chief Executive, Gill Walton, said:
“While we welcome the decision by NHS England to remove targets that penalise maternity services for higher caesarean section rates, it’s a shame it’s taken so long. Decisions about clinical care should be made in the best interests of the woman and her baby.”
The Chief Executive also warned that there was a shortage of 2,500 midwives already, which was causing a big impact on services, and urged ministers to “get a grip on this before it becomes a full-blown crisis”.
The RCM has also released guidance recently in respect of when and how midwives should raise the alarm about unsafe care.
The Vice-President of the Royal College of Obstetricians and Gynaecologists, Dr Jo Mountfield, commented:
“These targets are not appropriate in individual circumstances. Both vaginal and caesarean births carry certain benefits and risks, which should be discussed with women as they choose how they wish to give birth. Women giving birth should feel supported and their choices should be respected. The RCOG does not promote one method of birth over another.”
Investment in NHS maternity service
Despite NHS England investing £95 million in NHS maternity services this year and promising to recruit 1,200 midwives, according to recent data, the number of full-time-equivalent midwives has fallen when compared with 12-months ago.
How can we help?
Emily Rose is an Associate in our expert Medical Negligence team, which is ranked in Tier One of the independently researched publication, The Legal 500.
At Nelsons, we are currently retained on a number of cases in relation to the maternity care at Nottingham University Hospitals. If you have experienced poor medical treatment, our specialist team can provide you with support regarding your circumstances.
Please contact Emily or another member of the team in Derby, Leicester or Nottingham on 0800 024 1976 or via our online form for more information.
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