NHS maternity units abandon targets for caesarean sections

John Bennett
John Bennett

Published: March 1st, 2022

7 min read

The Times Newspaper has recently reported that NHS maternity units have been informed that they should not be focusing on the need to deliver babies naturally and should not be avoiding performing caesarean sections on mothers in order to meet targets to comply with delivery being natural.

NHS maternity units have been provided with a letter from Jacqueline Dunkley-Bent, NHS England's chief midwife, and Dr Matthew Jolly, the national clinical director for maternity, instructed "all maternity services to stop using total caesarean section rates as a means of performance management".

These targets have now been abandoned due to the real risks and unsafe consequences this has had for recent birth cases. It has previously been reported on the failings of The Shrewsbury and Telford Hospital NHS Trust ("SaTH") maternity unit. This is due to a report being leaked to them that was prepared by midwifery expert Donna Ockenden, who has led an independent investigation into more than 600 cases from 1979 to 2018. A final report is anticipated to be produced next month. The trust is at the centre of the largest maternity scandal in NHS history, with 1,862 cases under investigation.

The Commons health and social care committee have previously requested ending c-section targets in the NHS saying it was "deeply concerning" that maternity services had been penalised for having high rates in the past. This clearly depends on the individual circumstances for each woman giving birth and should consider the health and safety factors of the mother and the baby when delivering.

Royal College of Midwives (RCM)

The chief executive at the Royal College of Midwives (RCM) supports the decision to remove targets stating that a target approach did not support the right decision-making, and added: "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."

There is already a shortage of 2,500 midwives which was having an impact on services, and the Chief Executive urged ministers to "get a grip on this before it becomes a full-blown crisis".

The Royal College of Obstetricians and Gynaecologists (RCOG)

The Royal College of Obstetricians and gynaecologists also shared the same view, stating: "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."

Case Example - Hayley Coates

In 2018 Hayley Coates was pregnant with her son and was admitted to Nottingham University Hospitals NHS Trust, who ignored her pleas for a caesarean section. A coroner ruled that neglect contributed to her son's death. He suffered a fractured skull when he was delivered with forceps and was starved of oxygen.

Hayley Coates stated "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 to theatre.' If I had gone to theatre many hours before, my baby wouldn't have died. They have a duty of care, and the mother's wishes are supposed to be priority."

The Nottingham University Hospital NHS Trust have also placed emphasis and focus on promoting natural birth. The trust is also facing its own enquiry in relation to poor care in the maternity services.

Planning ahead for the future change

The latest data suggests the number of full-time-equivalent midwives is falling. However, the NHS has invested £95 million in maternity services this year and has promised to recruit 1,200 midwives in order to try to resolve the ongoing maternity unit issues.

A study by researchers at Southampton University published last week showed that women on postnatal wards were more likely to experience poorer care in NHS units where there were fewer midwives. Therefore, an increase in recruitment of midwives is at the forefront of the NHS objective to attempt to make positive changes to ensure the maternity units have sufficient staffing rates.

This confirmation from the NHS has provided clarity that there should be no preference from midwives to attempt to deliver a baby naturally to meet targets for a low rate of caesarean sections. Going forwards, it should be a case of assessing each mother and baby on a case-by-case individual basis to establish their needs to decide which type of birth should be performed. The mother's concerns should be listened to and considered.

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