Caesareans ‘cheaper’ than natural deliveries once negligence claims taken into account

A planned Caesarean section is cheaper for the NHS than a vaginal birth once compensation costs for botched deliveries are taken into account, new research suggests.

Experts said women should not be denied a Caesarean on cost grounds after their study found they were more than £400 cheaper once compensation claims were taken into account.

In 2017/18, maternity claims represented the biggest area of spend for NHS Resolution, the body that handles NHS compensation claims.

Of the clinical negligence claims notified to the organisation, obstetrics claims represented 10% of clinical claims by number, but accounted for 48% of the total value of new claims (£2,166.3 million of the total £4,513.2 million).

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).

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 Caesarean section, but these figures do not take into account compensation claims.

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.”

Another author on the paper, obstetrician Dr Michael Magro, has previously examined cerebral palsy claims for an NHS Resolution report.

He said: “Obstetrics contributes to 50% of the NHS litigation bill.

“When creating an economic model comparing planned Caesarean birth to vaginal birth, it is essential these costs are included.”

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.

They found that a planned Caesarean was over £400 per birth cheaper than a vaginal birth.

When looking at long-term indemnity costs, they said a planned Caesarean 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 Caesarean section.

Last August, research showed that women at 75% of UK maternity units are being denied their right to choose a Caesarean.

Nice guidance says women should be allowed to opt for a planned Caesarean even if it is not for medical reasons.

Women requesting a Caesarean 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 Caesarean should be offered.

Of the 146 trusts that shared their policies with the Birthrights charity last August, only 26% fully complied with the guidelines while 15% refused all elective Caesareans.