What is a Caesarean Section birth?
A caesarean birth, also known as a C-Section, is surgery that is carried out by means of an incision that is made in the woman’s tummy and womb. It is a major surgical procedure and is usually carried out by means of spinal or epidural anaesthetic, meaning that the woman on whom the surgery is performed, will be awake during the operation. A screen will be placed across her body however, so that she cannot see the details of the operation. If circumstances dictate that the baby needs to be delivered more quickly, a general anaesthetic may sometimes be used.
Studies reveal that in the UK, the numbers of women giving birth by C-Section has risen from 19% to just over 26% since the year 2000.
When and why are Caesarean births usually carried out?
A C-Section birth is usually carried out when a vaginal birth would put mother or baby at risk. The most common reasons for a C-Section are:
- A labour that has stalled.
- The baby is in a bottom down position, known as a breech position.
- The baby is in a sideways position or keeps changing position.
- The expectant mother has a medical condition such as heart disease or diabetes, or has high blood pressure.
- Multiple pregnancy.
- The baby is not growing as quickly as expected.
- The woman has a low-lying placenta (known as placenta praevia).
- Where the woman has already had at least one C-Section.
What are the benefits of a C-Section?
Caesarean births may reduce the risk of:
- The pain of giving birth
- Urinary incontinence
- Pelvic prolapse
- Vaginal injury
- Heavy blood loss
What are the risks from a Caesarean Birth?
For the mother
- Infection of the wound
- Infection of the lining of the womb
- Severe bleeding
- Problems in becoming pregnant in the future
- Pain after giving birth
- Ruptured uterus
- Placenta embedding in the wrong part of the uterus
- Blood clot
- Birth lasting longer than with a natural birth
- Possible adhesions – scar tissue that makes organs in the stomach, ‘stick’ to each other
For the baby
- Breathing problems if the baby was born premature and delivered by a C-Section birth
- Higher risk of admission to the neo-natal unit
- Cuts to the skin caused by accidents with the scalpel during the C-Section
Why are some women asking to have Caesarean births when there aren’t medical reasons for doing so?
Some women would prefer a Caesarean birth because they have a fear of the pain of labour. If they request a Caesarean for this reason, then the NICE Guidelines Quality Statements provide that they should be offered a referral to a healthcare professional with expertise in perinatal mental health support. If after receiving guidance from the professional, the person still decides that a vaginal birth is not an acceptable option, then she should be offered a planned caesarean. This is known as elective C-Section surgery i.e. it is scheduled in advance because it is not a medical emergency.
Are doctors reluctant to carry out elective C-Section surgery?
There are conflicting thoughts on this.
On the one hand, some reports suggest that some doctors themselves would prefer C‑Sections over natural birth. A report in the Daily Mail in July 2018 quoted the findings of a UK and Ireland report that indicated that 67% of surgeons preferred to carry out C‑Sections for fear of being sued for medical negligence resulting from problems that may arise during a natural birth.
On the other hand, there have been complaints that on too many occasions women who opt for elective C-Section surgery are being denied the right to have them. The Birthright charity carried out a survey of a number of NHS Trusts in 2018. The results revealed that only 26% of the Trusts offered caesareans in line with NICE best practice guidance.
It has been suggested that one of the reasons for NHS Trusts being reluctant to authorise elective Caesarean Sections is the cost involved. It costs around £700 more to carry out a C-Section, compared with a vaginal delivery.
Delayed emergency C-Sections
Most unplanned C-Sections are not life threatening in themselves. Often, they take place because although a caesarean was planned anyway, the mother’s waters burst, and she went into labour early. They are also undertaken when a natural birth was intended but labour has stalled, and a caesarean may help the baby to be born quicker.
On other occasions the reasons for an emergency C-Section may be more serious, such as if the baby is developing a life-threatening condition or mother or baby are experiencing a complication during pregnancy.
NICE Guidelines provide that if:
- You or your baby have developed a serious condition, but it is not yet life-threatening, you should have a caesarean within about 30 to 75 minutes of the medical experts making a decision as to whether a C-Section is required.
- If the complication is life-threatening, then the baby should be born as quickly as possible and a C-Section should take place within 30 minutes of the decision being taken.
Cases of obstetric negligence centering around caesarean surgery, usually occur when:
- There is a delay in making the decision to carry out an emergency C-Section
- There are delays in carrying out the surgery, once a decision has been made to operate
- The consultant wrongly decides that a C-Section is required and decides to allow natural birth to take place
- Medical staff ignore appeals from the mother for an emergency C-Section
Most birth injury compensation claims involving delayed C-Section surgery, come down to errors by medical professionals in deciding, at crucial times, to delay the surgery.
The consequences of delaying the C-Section, when it should in fact have been carried out, can be devastating. Still births and severe brain damage are sadly not uncommon where the C-Section was delayed or not carried out at all.
In 2018, a medical tribunal in Scotland found an obstetrician guilty of misconduct after she was found not to have “sufficiently addressed the risk” of continuing with a natural delivery when the mother was not fully dilated.
- Mother’s waters had broken at 25 weeks.
- On examination the baby was found to have a prolapsed cord and was in the breech position.
- Mother’s cervix was dilated between 2cms and 4cms.
- As a result, doctors indicated she may have to undergo a C-Section.
- The obstetrician ruled out a C-Section.
- Instead she urged the mother to push whilst applying traction herself to the baby’s legs. However, the baby’s neck became stretched and his body became detached leaving the head inside the mother’s womb.
- The tribunal found that had an immediate C-Section been carried out, there was a reasonable chance that the baby would have survived.
The tribunal said that it had no doubt that the obstetrician was attempting to achieve the best outcome for both mother and baby.
In essence the tragedy came down to an error of judgement, a mistake, but one that had terrible consequences.
Healys’ medical negligence partner, Jonathan Austen-Jones, is a birth injury negligence solicitor. He has previously dealt with a number of cases where injury has been caused due to delays in carrying out C-Section surgery. If you wish to discuss a birth injury matter that has affected you or your family, call Jonathan in complete confidence and without obligation on 0800 280 0432 . Alternatively, you can contact him by email: firstname.lastname@example.org