Caesarean section – informed consent

page-header

 

Sarah Ratcliffe is a Clinical Negligence Solicitor; as a recent mother for the second time shares her experience.

If you have given birth by caesarean section in the past, it does not necessarily mean that you will need to have another caesarean section to deliver your next baby. You can choose to give birth vaginally, known as vaginal birth after caesarean (VBAC) or to have another caesarean section, known as elective repeat caesarean section (ERCS). Your consultant and midwife should discuss these choices with you and advise on the best option for you. This will depend on why you had a caesarean before, how it was done, your current health, your medical history and your previous pregnancies.

When I gave birth to my daughter in 2017, I went into labour spontaneously and ended up having to have an emergency c-section. When I fell pregnant with my son in February 2021, I knew I had to decide if I wanted to try and deliver vaginally, or choose to have another c-section.

As a Clinical Negligence solicitor, I was of course only too aware of my options in this situation.  And I knew that these options should be presented to and discussed with me. But this is not everyone’s experience: speaking with friends and family, there seem to be lots of different ideas about what can and can’t happen with pregnancies after a c-section.

What options are available?

Women who had a c-section with their first birth should be given the option either of going into labour spontaneously and attempting a vaginal birth, or choosing to have an elective c-section. There is some interesting reading on the subject here.

Caesarean section

A common misconception is that if you had a c-section with your first birth, you must have a c-section second time around – you don’t, and the crucial point here is you have the option.

At a certain point in the pregnancy these options should be discussed with the mother. There are pros and cons with each option, which need to be gone through. There are certain risks related to each option which are not relevant for a first birth: for example, the risk of scar rupture if proceeding with a VBAC. These risks are small, but nevertheless should be discussed. Ideally the mother should also be given more than one opportunity to discuss her options, and consider her decision.

Informed consent

It has always been the case that doctors should discuss the risks and benefits of procedures with patients – it is outlined in GMC guidance. However, the issue came to the fore with the ruling from the case of Montgomery in 2015 which involved a woman who was not given the option of a c-section when she should have been, due to certain factors relating to her health and the pregnancy, and her son suffered significant injuries. This case reinforced the importance of patients being presented with options when it comes to treatment and procedures, that they should have the various material risks explained to them, and be able to make an informed decision on their treatment. All patients are different: one patient may attach more significance to a particular risk than another patient. Whilst a medical professional is not expected to detail every single possible risk however small, it is also not for the medical professional to decide what they think are ‘significant’ risks and whether a patient should take that into consideration when making their decision.

The discussion should be clearly documented, outlining what options were discussed, their risks and benefits, and any specific questions raised by the patient. A consent form should be signed by the patient, with the medical professional having gone through the specifics with them. A copy of any leaflets or literature given to the patient about their options should also ideally be in the patient’s medical notes, or the details of anything given to the patient be documented.

The difference between consent and informed consent

There is a crucial difference between consent and informed consent, the latter being taken when the patient has been fully informed of their options and various risks. Arguably this is especially important for a mother who has not only her own health and wellbeing to consider but that of her unborn child. Medical professionals should not be afraid of presenting all the information, because by doing so, they will help expectant mothers feel genuine confidence in their decisions.

 

If you are affected by any of the issues outlined here, please get in touch today. We’re here to help.