independent

Friday 18 April 2014

Judge says mother can be forced to have emergency caesarean

The 36-year-old woman, a paranoid schizophrenic, has been resisting the possible treatment
The 36-year-old woman, a paranoid schizophrenic, has been resisting the possible treatment

A judge has ruled that an expectant mother can be forced to have an emergency caesarean.

The 36-year-old woman, a paranoid schizophrenic, has been resisting the possible treatment claiming that voices in her head are telling her not co-operate.

But on Wednesday, her local health authority secured permission from a high court judge for the procedure to go ahead, should her doctors believe it is necessary. He ruled that she did not have the mental capacity to make the decision.

The case has echoes of the treatment of Allesandra Pacchieri, an Italian woman forced to have her baby delivered by c-section and then removed from her by Essex social services, and comes at a time when the operations of the Court of Protection, which deals with such issues, is under renewed scrutiny.

The woman - who can be named only as Mrs P - is between 35-37 weeks pregnant and following the ruling, medical staff have been given permission to induce her labour immediately.

The woman, from Bangladesh, already has three children.

The eldest, two sons, were born in the UK in 1997 and 1999, after natural labour.

After the second birth Mrs P developed post natal depression and in 2002, both children were taken into care.

The third child, a daughter, was born by c-section in 2005, in Bangladesh, where she remains.

It is understood the woman had split up with her husband in the summer.

She was detained under the Mental Health Act late last month, shortly after returning from a visit to Bangladesh.

A team of mental health workers visited her at her home and found she had been "severely neglecting herself".

She had previously been sectioned for five months in August 2012 and been put on medication.

However, she had not always been taking these drugs and the trust's representative in court, Vikram Sachdeva, described her as having a "very severe mental health illness".

Doctors at the trust - in southern England - are concerned that they may have to perform an emergency c-section if her labour fails to develop.

They are worried she may suffer a potentially life threatening rupture, along the scar left by her earlier c-section.

Mrs P also has type 2 diabetes, meaning her baby is relatively large, further increasing the chances of a rupture.

Her doctors warn she is a "very high risk pregnancy".

The medical team want to induce labour immediately, and allow Mrs P to try a natural labour.

However, they want the option of performing an emergency c-section if they feel it is necessary to protect the welfare either of the mother or her baby.

Her consultant obstetrician told the court that in some recent conversations Mrs P did not appear to resist such a course of action. In other discussions, though, she had opposed c-sections and doctors are concerned she may again change her mind.

Mr Justice Peter Jackson said: "The fact is that this decision has to be taken on Mrs P's behalf because she simply cannot appreciate the risks of one course and another."

He said that although his decision was an "intervention of a very serious kind" and Mrs P is "very opposed to having a c-section", he was making the order "in her best interests".

Under the order, medical staff are permitted to use restraint and sedation during the labour, if they see fit.

Mrs P was represented at the hearing, at the Royal Courts of Justice, by the Official Solicitor, but he did not oppose the trust's application.

Telegraph.co.uk

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