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Court Authorises NHS Trusts to Carry Out Planned Caesarean

The Court of Protection recently granted an application by two NHS trusts for authorisation to carry out a planned caesarean in respect of a woman who was due to give birth.

The 29-year-old woman had treatment resistant paranoid schizophrenia. She had previously been detained under Section 3 of the Mental Health Act 1983, and had then been subject to a community treatment order. She had been recalled to a mental health unit before being transferred to the hospital where she was due to give birth.

She had become convinced that she was being filmed by a device in the ceiling. She had lost trust in many members of staff and was reluctant to agree to investigations or examinations. Capacity assessments had concluded that she was unable to understand or weigh information about the birth. She had expressed a wish to have a natural birth, with as little intervention as possible, but had also told a clinician that she would be happy to undergo a caesarean in order to protect her child.

The Court found that induced labour was not appropriate. It would require a high degree of cooperation from the woman and would involve prolonged monitoring and examination that she would find unpleasant and distressing. Spontaneous labour might result in an emergency caesarean in the event of complications.

The Court was satisfied that the application should be granted. There was an increased risk of physical harm to the woman and her baby from one week after full term, which could be mitigated by a planned caesarean. There was also an increased risk to the woman of emotional or psychological harm if the caesarean were not carried out. Given her comment about being willing to accept a caesarean, there was a degree of nuance about her views, and if she were able to weigh up the benefits and burdens of a caesarean as against spontaneous labour, it was likely that she would wish to take reasonable steps to ensure the wellbeing of her baby. Furthermore, a planned caesarean would take place in a calm, controlled environment, with a team of people she trusted.

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