Hospitals in England have been told to abandon targets aimed at limiting the number caesarean sections carried out, over fears for the safety of mothers and babies.
Maternity units were told in a letter to stop pursuing “normal births”, with the chief midwife describing the targets as potentially “unsafe” and clinically inappropriate.
The 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”.
It added: “We are concerned by the potential for services to pursue targets that may be clinically inappropriate and unsafe in individual cases.”
The changes have been welcomed by medical bodies, who have been calling for the targets to be scrapped for several years. Scrapping the targets was also recommended in July last year by a Commons health and social care committee report, which said it was “deeply concerning” that maternity services had been penalised for having high rates in the past.
NHS trusts have for years benchmarked their caesarean section rates against the average. Around one in four babies in the UK is born by C-section, but there is considerable variability between different hospitals.
There is concern that the pursuit of normal deliveries may have contributed to some instances of poor maternity care, including at Shrewsbury and Telford hospital NHS trust, where the deaths of dozens of babies are being investigated. The Shrewsbury trust had among the highest normal delivery rates in England, between 2010 and 2018. A report into the scandal will be published next month.
The Royal College of Midwives (RCM) formally abandoned its normal birth campaign in 2017. Responding the change of policy, first reported in the Sunday Times, Gill Walton, RCM’s chief executive, said that decisions about clinical care should be made in the best interests of the woman and her baby “not because of an arbitrary target.”
“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,” she said. “Those running local services will be delighted that this target has finally been removed.”
Dr Jo Mountfield, consultant obstetrician and vice president at the 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.
“Women giving birth should feel supported and their choices should be respected. The RCOG does not support one method of birth over another.”
