Promoting ‘normal’ birth over patient safety: why are maternity doctors under pressure to prioritise certain modes of delivery?

Posted: 11/07/2024

When making a birth plan, most expectant parents choose the safest mode of delivery over other concerns. In order to make that decision, they need to be advised appropriately and given the relevant information about the risks and benefits of every option. This advice should be unbiased and focused on the safety of the baby and mother.

If pressures are placed on midwives or obstetricians to promote a certain mode of delivery over others, their advice to patients may be biased toward meeting that requirement, rather than each patient’s individual circumstances.

By using the terms ‘normal’ or ‘natural’ birth, most people are referring to vaginal birth (where the baby is pushed through the birth canal). Vaginal births often have a shorter recovery period for the mother than other modes of delivery, and are therefore advocated for by some healthcare providers. However, vaginal deliveries can lead to injuries such as severe tearing, so it is not necessarily the case that recovery will be easier.

Other types of birth include instrumental deliveries (where instruments such as forceps are used to help the baby down the birth canal) and caesarean sections (where the baby is delivered via abdominal surgery). Many pregnant people opt for a vaginal birth in the first instance, but due to complications or concerns over how the labour progresses, interventions end up taking place. Often, such interventions can save the baby’s life or prevent severe injuries. In other cases, a caesarean section birth is planned in advance. This may be because of the baby’s size or position, medical conditions of the mother or baby, or maternal preference.

Maternity safety has been in the news repeatedly in recent years, due to ongoing concerns about maternity care in the UK. In 2022, the NHS removed the use of caesarean rates as a measure of how well a hospital was performing. It was recognised that a more patient-focused approach was needed. This should have reduced the pressure on maternity staff to meet certain targets for vaginal births, rather than deciding what the safest option was for each mother and baby, according to their unique circumstances. However, recent references to promoting vaginal births in the UK indicate that there may still be problems in this area.

Hampshire Hospitals NHS Foundation Trust has recently been criticised for advertising for a maternity doctor who has a ‘desire to promote normal birth’. Patient safety campaigners reacted critically to the advert last month and the story was reported in the national press. This comes shortly after the Green Party were also widely criticised for stating in their 2024 manifesto that they would ‘work to reduce the number of interventions in childbirth, and change the culture of the NHS so that birth is treated as a normal and non-medical event.’ The policy has since been removed.

Victoria Johnson, associate in the Penningtons Manches Cooper clinical negligence team, said: “The majority of parents would always choose the safest method of delivery for their baby, above any other concern. If we continue to use terms such as ‘natural’ and ‘normal’, to refer to vaginal birth, there can be an implication that other types of birth are unnatural or abnormal. In reality, the mode of delivery should be a secondary concern; it is the safety of the baby, and mother, that is important.

“It is concerning that midwives or obstetricians may feel pressure to perform a certain type of delivery, or feel they must influence parents to choose a certain type of birth. What is safest is going to vary in each case and should be tailored to the specific patient and birth. The advice may change minute by minute as the birth progresses, and what was safe at the start of the labour may no longer be safe by the end.

“As clinical negligence lawyers, we sadly see the life-changing and heart-breaking consequences when births are not managed appropriately. This includes not offering interventions as soon as they are needed. While most births go well, a failure to intervene in a timely manner can lead to the baby being stillborn, neonatal death, or a life-changing brain injury.

“Having a certain type of birth is just not a priority. The only thing that doctors should be promoting is a safe delivery for mother and baby.”

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