‘Risk of Death’ warning over access to Caesarean sections
Are women in need of Caesarean sections being denied them on the NHS because of financial pressures?
This question was posed to the Department of Health by North London Senior Coroner, Andrew Walker, following the inquest of Kristian Jaworski. Mr Walker has warned that favouring vaginal births over Caesarean sections because of how much they cost risks future deaths.
Kristian Jaworski was just five days old when he passed away in June 2015. He sustained brain damage during a “prolonged and extended instrumental delivery”.
Ms Taylor had a difficult delivery with her first son who had to be delivered by forceps. It was discovered that Ms Taylor had a narrow birth canal and her doctors advised that, in future, she should deliver by Caesarean section to avoid complications. Ms Taylor informed her doctors of this throughout her pregnancy with Kristian, but her concerns weren’t recorded anywhere in her medical records.
When Ms Taylor went into labour with Kristian, the delivery team continued with their plan to deliver vaginally even though Ms Taylor pleaded to have a Caesarean section, in line with the advice she had received following the birth of her first child.
Ms Taylor’s labour was difficult and Kristian’s birth was prolonged. Eventually, he was delivered by emergency Caesarean section. Tragically, as a result of the delays, Kristian was starved of oxygen and suffered a serious brain injury. He sadly passed away five days later.
An inquest was held to determine the factual cause of Kristian’s death. The Coroner heard evidence from the midwives and obstetricians involved in Ms Taylor’s care and also reviewed expert evidence into the cause of his death.
The full details of the inquest are yet to be published, but the Coroner has confirmed that the cost of a Caesarean section was a factor in Kristian’s death. According to the Department of Health, the average cost of a vaginal delivery is £1,985, while the average cost of a Caesarean section is £3,781.
As cost was a factor for promoting vaginal deliveries, Mr Walker made a section 28 warning to the Department of Health. This is a power given to coroners to report concerns where they fear there will be future deaths.
NMUH have since admitted that they made mistakes in Ms Taylor’s care but deny that costs were a factor:
“Our team took their decision to continue with the natural delivery in this case for clinical reasons alone and would have had no concerns about intervening surgically had they believed this risk was warranted. There was and never is any question of cost being a consideration.”
The Department of Health have 56 days to respond to the Coroner’s report.
Lessons to be learned
Stretched finances is not a new issue faced by the NHS. Given the difference in cost, a it is hard to justify offering a Caesarean section to every mother. However, NHS Trusts must be mindful that there will be occasions where there is a clear clinical need for a Caesarean section when considering whether to “ration” this procedure to meet their budgeting targets. Doing so simply puts women and babies at an increased risk of complications ie serious injury or ultimately death.
A Caesarean section can either be planned, which is where the procedure is medically indicated during pregnancy , or by emergency, where it becomes apparent before or during labour that delivery of the baby is required urgently. In Ms Taylor’s case, a Caesarean section was clinically indicated from the outset, so why was this not clearly noted and further, when she raised this, why was she not listened to?
In an interview, Ms Taylor described being treated as an ‘over-anxious woman’ who was ‘scared’ to have a natural birth. This assumption needs to be rebutted and replaced with an open and reassuring culture, where the needs and concerns of pregnant women are taken seriously and put first. Health Minister, Ben Gummer commented,
“Treatment decisions in maternity care should always be made by clinicians in full consultation with women. These should be based on a woman’s individual clinical needs and in line with NICE guidelines in terms of best practice.”
“It is vital that we learn from tragedies like this to ensure they are not repeated and far fewer families have to experience this kind of heartache.”
By raising concerns with the Department of Health it is hoped that cost will not form a factor when deciding the most appropriate method of delivery for a mother and infant.
At Bolt Burdon Kemp we have helped many children and families who have been affected by injury at birth. Often these children require specilaist lifelong care and can sometimes have a reduced life expectancy. We work closely with children and their families to ensure that they receive the practical and emotional support they need to adapt and cope with life post injury. Our ultimate aim is to ensure compensation is secured to enable the children to flourish, whilst giving their parents peace of mind that their complex needs will always be met.