A letter from Jacqueline Dunkley-Bent, NHS England’s chief midwife, and Dr Matthew Jolly, the national clinical director for maternity, has told “all maternity services to stop using total caesarean section rates as a means of performance management”.
The letter added, “We are concerned by the potential for services to pursue targets that may be clinically inappropriate and unsafe in individual cases”.
What does this mean?
Most women give birth vaginally but up to a third have a caesarean birth (sometimes called a caesarean section or ‘c-section’).
Until now, maternity units have been encouraged to promote natural births and keep the caesarean rate to about 20%.
But this has raised concerns that hospitals are focusing too much on hitting targets, rather than treating each case individually. This can result in pregnant people not getting the most appropriate care for them.
Hospitals will now focus more on individual care, which includes giving women the right to choose a planned caesarean section, even if it is not for medical reasons. This follows guidance from the National Institute for Health and Care Excellence (NICE).
This change has been welcomed by medical bodies, who have been asking for the targets to be removed for several years. Removing the targets was also recommended in July 2021 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 of c-sections.
Respecting personal choice
RCOG vice-president Dr Jo Mountfield welcomed the announcement, saying:
These targets carry certain benefits and risks, which should be discussed with women as they choose how they wish to give birth. Women and people giving birth should feel supported and their choices should be respected."
Amina Hatia, Midwifery Manager at Tommy’s said:
Being able to make an informed decision about your own care is key to having a positive birthing experience. You have the right to take part in discussions with your doctor or midwife about your care and decide what is the right birth for you
"We urge pregnant people to speak to their midwife or doctor as early as they can about their options for giving birth. They can explain the benefits and risks of vaginal and c-section births, so you can choose what’s best for you and your baby.”
More information and support
Find out more about your birth choices
Find out more about caesarean sections
Find out more about vaginal birth (labour)