Delivering a baby by a planned caesarean section is cheaper for the NHS than a vaginal birth, research suggests.
Around £400 could be saved once compensation costs are taken into consideration.
The majority of expectant mothers are being denied a C-section, despite official guidelines saying they should have the choice.
However experts have raised concerns over the guidelines having previously found that the risks of serious complications – including haemorrhaging – are higher with C-sections than vaginal births.
Planned C-sections are £400 cheaper for the NHS than vaginal births after taking compensation claims into consideration, a study has found
In 2017/18, maternity claims represented the biggest area of spend for NHS Resolution, the body that handles NHS compensation claims.
Gynaecological and obstetric injury claims are made when complications such as an injury arise because poor standards of care of negligence.
They can be particularly expensive because babies may need specialist care for life if they are left brain-damaged by labour, for example.
Of the clinical negligence claims notified to the organisation, obstetrics claims represented 10 per cent of clinical claims by number.
But they accounted for 48 per cent of the total value of new claims (£2,166.3million of the total £4,513.2million).
The authors of the latest study said this exceeded the entire cost of all types of deliveries for the year 2017/18 (£1,954.6 million).
ARE C-SECTIONS MORE RISKY THAN VAGINAL BIRTHS?
One in every four pregnant women in the UK now has a caesarean birth.
For many women, it is scheduled because a natural birth is deemed too risky.
Medical conditions include diabetes, high blood pressure, HIV that could be passed from mother to baby, or problems with the placenta during her pregnancy.
Women with no other medical reason should be offered appropriate discussion and support if they want a C-section to make an informed choice, NICE says.
Generally it is a safe procedure, and the level of risk will depend on things such as whether the procedure is planned or carried out as an emergency, and your general health.
It’s a major surgery that involves opening up a pregnant woman’s abdomen and removing the baby from her uterus.
One study, published in the Canadian Medical Association Journal, found that the chances of problems after a caesarean were 1.5 times higher for a mother than for vaginal births.
Older mothers – over the age of 35 -who give birth by caesarean are three times more likely to experience severe complications than those who give birth naturally.
Although uncommon, needing admission to an intensive care unit is more likely after a caesarean birth than after a vaginal birth, according to NICE. It is not clear whether this happens as a result of a caesarean section or because of the reasons for needing a caesarean section.
Midwives or doctors should discuss the benefits and risks of a caesarean section compared with a vaginal birth with the pregnant woman taking individual circumstances into consideration.
Previous economic modelling by the National Institute for Health and Care Excellence (Nice) has found that vaginal deliveries are about £700 cheaper than a planned C-section, but these figures do not take into account compensation claims.
A planned C-section, according to this study, was over £400 per birth cheaper than a vaginal birth.
But when looking at long-term indemnity costs, it could end up being £2,000 to £3,000 less expensive than a planned vaginal birth.
They said the costs for negligence relating to the planned method of birth were found to be approximately nine times higher for planned vaginal birth than for a planned C-section.
One of the authors of new study, Jonathan West, a former NHS consultant in obstetrics and gynaecology who worked at the Royal Devon and Exeter Hospital, said: ‘Planning to have a baby naturally is very safe when looked at from the viewpoint of the chance of something going seriously wrong, but very expensive when the human and financial cost of something going wrong actually occurs.
‘We should recognise that women have a right to informed choice, and our study shows that it is unfair to discourage mothers from choosing to Caesarean birth on the grounds of cost.’
For the study, which has been published on the F1000 research website and may be submitted to a medical journal, the team looked at data from Nice, NHS Resolution and NHS Improvement.
Research has shown that women at 75 per cent of UK maternity units are being denied their right to choose a C-section.
NICE guidance says women should be allowed to opt for a planned C-section even if it is not for medical reasons.
Women requesting a C-section with no other medical reason should be offered appropriate discussion and support, NICE says.
But ultimately, if they are regarded as making an informed choice, a C-section should be offered.
Of the 146 trusts that shared their policies with the Birthrights charity last August, only 26 per cent fully complied with the guidelines while 15 per cent refused all elective C-section.
Whether C-sections put women at more risk than vaginal birth is of debate due to conflicting evidence but some experts say that doctors should be more considerate.
While avoiding some after effects of labour such as urinary incontinence, the procedure can lead to scarring of the womb, which heightens the risk of complications during future births.
Older mothers – of which there are soaring numbers – who give birth by C-section are three times more likely to experience severe complications than those who give birth naturally, research has shown.
The numbers of C-sections have increased from 19.7 per cent in 2000 to 26.2 per cent in 2015.
WHAT ARE THE RISKS OF A VAGINAL BIRTH?
To the mother:
- Painful vaginal area (common)
- Urinary incontinence (unknown)
- Anal incontinence (unknown)
To the baby:
- Brachial plexus injury – when the nerves that send signals from the spinal cord to the shoulder, arm and hand are stretched, compressed, or in the most serious cases, ripped apart or torn away from the spinal cord.
Having an assisted vaginal birth with either vaccum or extraction or forceps rather than a spontaneous birth also has risks to the mother (such as hemorrhoids, psychological trauma and tear in perineum) and to the baby (brain injury).
Source: Childbirth Connection
WHAT ARE THE RISKS OF A CAESAREAN?
To the mother:
- infection of the wound (common) – causing redness, swelling and pain
- infection of the womb lining (common) – causing a fever, tummy pain, abnormal vaginal discharge and heavy vaginal bleeding
- excessive bleeding (uncommon)
- deep vein thrombosis (DVT) (rare) – a blood clot in your leg, which could be very dangerous
- damage to your bladder or tubes connecting the kidneys
To the baby:
- a cut in the skin (common) – this may happen accidentally
- breathing difficulties (common) – this most often affects babies born before 39 weeks of pregnancy