Finally! No caesarean rate targets in England

NHS England have finally admitted that the idea of an ideal caesarean rate is absurd. In fact, they have gone so far as to admit it is potentially “unsafe and clinically inappropriate”. No doubt influenced in no small part by the inquiry into the excessive number of baby deaths at Shrewsbury and Telford hospital NHS trusts. (Note – Shrewsbury NHS trust had one of the highest rates of vaginal delivery in the country during the review period!)

The letter from Jacqueline Dunkley-Bent NHS England’s chief midwife, and Dr Matthew Jolly, the national clinical director for maternity directs:

“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.”

In response RCOG (Royal College of Obstetricians and Gynaecologists), said:

“We welcome this clarification from NHS England. 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.”

Along with other birth groups, we have been campaigning for this change for years and are very relieved such unnecessary, unethical targets have been removed.

Vaginal birth and caesarean delivery both have benefits as well as risks for mum and baby. NICE guidelines have made it clear since 2011 that it is reasonable for women to make an informed choice in either direction. However, target rates imposed by NHS England have made it very difficult for women to make use of this change to the guidance. Some hospitals sticking rigidly to the targets, others ignoring them and being penalised.

Fundamentally, we should be able to trust our Doctors to have our best interests at heart when making decisions about the progress of our pregnancy. Targets based on economics and hosptial policies has never put the women first and we welcome the NHS’ recognition of their mistake.

This letter means a mother’s right to make an informed choice for one mode over the other is now more possible. That doesn’t mean it will always be straightforward. Some practitioners stil believe “normal” (vaginal) is best and will strongly encourage you away from a caesarean. However with the hospitals no longer pressured by unrealistic targets women are in a much stronger position to argue their case. This does mean being able to demonstrate clear reasons for your choice is still very important. Knowing what is a necessary route to delivery versus just a suggestion is paramount. Caesarean Birth: A positive approach to preparation and recovery, covers everything you need to know to put your case forward effectively.