UK: Cesarean targets are dead!

It’s tremendous vindication of everything I’ve been writing for years … but tragically it has come too late for literally thousands of babies, mothers and families.

The Times of London article title says it all: Baby deaths force end to NHS targets for natural births. The subtitle contains the inevitable kicker, “Maternity units have been told to drop the focus on caesareans.”

The NHS has abandoned targets that encouraged hospitals to pursue “normal births”, over fears for the safety of mothers and babies.

Maternity units were told in a letter to stop using caesarean section rates to assess their performance. It comes after repeated scandals in maternity units, blamed in part on a focus on pursuing natural births at the expense of safety.

Who could have seen that coming?


I first wrote about the UK midwives Campaign for Normal Birth in June 2006. From the start I thought is was unethical and dangerous since it ignored both women’s desires and babies’ safety. Since then I have written repeatedly that C-section targets are both dangerous and insupportable. The scientific evidence showed at that time — and continues to show to this day — that C-sections are often safer than vaginal birth for both babies and mothers. Efforts to reduce interventions like labor inductions were equally misguided. Induction at 39 weeks is both safer and reduces the chances of C-section.

By 2011, the rising death toll at the hands of UK midwives was taking shape. In Promoting normal birth is killing babies and mothers, I reported on more than a dozen deaths that were attributed to the relentless effort to promote unmedicated vaginal birth.

Both problem (the relentless midwifery focus on unmedicated vaginal birth) and the outcome (preventable deaths of babies and mothers) had been clearly identified in 2011. Despite confirmation from multiple government reports over the following years the death toll and the liability costs continued to rise. By 2017 nearly $3.5 BILLION was paid out in a single year, amounting to 20% of the entire maternity budget!

Midwives were finally forced to shutter their Campaign for Normal Birth but many midwives refused to back down, continuing to promote unmedicated vaginal birth and demonize C-sections. So a further 5 years later, it has come to this:

The letter from Jacqueline Dunkley-Bent, NHS England’s chief midwife, and Dr Matthew Jolly, the national clinical director for maternity, instructed “all maternity services to stop using total caesarean section rates as a means of performance management”.

It added: “We are concerned by the potential for services to pursue targets that may be clinically inappropriate and unsafe in individual cases.”

In July last year the Commons health and social care committee called for an immediate end to the use of c-section targets, saying it was “deeply concerning” that maternity services had been penalised for having high rates in the past.

How big is the problem? Consider only ONE hospital system:

A final report into the deaths of dozens of babies at the Shrewsbury and Telford Hospital NHS Trust will be published next month. It is expected to be highly critical.

The trust is at the centre of the largest maternity scandal in NHS history, with 1,862 cases under investigation…

The Shrewsbury trust had the highest natural birthrate in England during five out of the eight years between 2010 and 2018 and was among the top three in the remaining years.

How did such horrors happen? Why were so many babies and mothers allowed to die in the relentless pursuit of unmedicated vaginal birth?

The UK medical system, like many medical systems, made a Faustian bargain with midwives in exchange for the promise of saving money; midwives are less expensive than obstetricians. But it turns out that dead and injured babies and mothers are more expensive than both.