C-section and general anaesthesia against her wishes? Capacity and best interests

Mr Justice Hayden is well-known (and celebrated) for his robust defence of autonomy and self-determination.  And yet in this instance I got the impression that, faced with a decision about a pregnant woman, his protective instincts had (temporarily) overwhelmed him. I am relieved that he adjourned the hearing rather than precipitously (in my view) declaring SM to lack capacity and making a premature decision about her best interests.

Refusing blood products during pregnancy and labour

“The Official Solicitor observes that P is considered capacitous in all the areas in which she is willing to take that [medical] advice; it is only where she is not willing to follow medical advice that she is considered to lack capacity”. 

On care, coercion and childbirth in the Court of Protection

By Ruth Fletcher, 5th July 2021 The decision in ‘An Expectant Mother’ is unsettling on many levels, not least because it takes a harsh legal approach when a care-full one is needed.  Instead of paying even more attention to the experience of the agoraphobic pregnant woman at the heart of this case, somehow the judgment has endedContinue reading “On care, coercion and childbirth in the Court of Protection”

Evidence of risk of planned home birth

By James Walker, 11th June 2021 Other experts who have contributed to this Project’s discussion of the Court of Protection case of An Expectant Mother [2021] EWCOP 33 are not alone in the misunderstanding of the data surrounding home births. This is largely due to the fact that the presentation of the data is influencedContinue reading “Evidence of risk of planned home birth”

My midwife heart weeps: Opinion on a court-ordered hospital birth

What the judge has done here is to create a precedent that any woman who has an anxiety disorder and requests birth outside of the regular menu of choice may be subjected to strong-arm maternity care – or may fear it, even if in fact the legal process is never instituted.  For many women the impact of these experiences during their pregnancy care and birth will cause deep and long-standing trauma. 

“Not nothing”? The Late Term Foetus in the Court of Protection

The right of a capacitous pregnant person to make their own medical decisions unfettered by any consideration for the life or health of the foetus they carry has been enshrined unequivocally in UK law. As Judge LJ emphasised in the Court of Appeal in St George’s NHS Trust v S, pregnancy does not reduce a competent patient’s right to make decisions about their medical treatment, and a capacitous pregnant patient therefore has the right to make a medical decision that might cause death or serious injury to the foetus, however repugnant such a decision might seem to onlookers.

Re: An Expectant Mother [2021] EWCOP 33: A lawyer’s perspective

There was no evidence before the court about the extent to which mothers with agoraphobia (or other conditions) are in fact resistant to obtaining medical intervention in the midst of labour if advised that it is necessary to ensure the safety of themselves or their baby.  In so many of the cases about mode of delivery that come before the court, the concern of the health professionals is that there will be lack of compliance in labour.  Yet in most cases, the babies are born without resort to force or the authority of the court order.

Choice, human rights and childbirth in the Court of Protection

By Rebecca Brione, 26th May 2021 Over the last two years there have been at least eight cases heard in the Court of Protection concerning place and mode of birth for women who were deemed to lack capacity under the Mental Capacity Act 2005. The case reported last week is the second in a few months aboutContinue reading “Choice, human rights and childbirth in the Court of Protection”

Human rights in maternity and the Court of Protection

Specialist perinatal mental health midwives (as well as consultant midwives who have a remit for perinatal mental health) are frequently involved in complex birth planning for women with significant mental health disorders. We have experience of creating individualised birth plans for women with severe anxiety, obsessive-compulsive disorder, post-traumatic stress disorder and psychotic illness, as well as agoraphobia. Our experience is that in all these cases,  there were safe and happy outcomes – without recourse to court orders or forced hospital transfer.

Phobias, paternalism and the prevention of home birth

At the conclusion of a three-day hearing, Mr Justice Holman declared that P lacked capacity to make the relevant decisions and ordered that it was lawful and in her best interests for medical staff to transfer her to hospital a few days before her estimated due date, and for medical professionals to offer her a choice of induction of labour or Caesarean Section in hospital.