Planned Caesarean in Woman's Best Interests

The Court of Protection recently had to decide whether a pregnant woman had capacity to decide whether or not to undergo a planned Caesarean section and, if she did not, whether the procedure was in her best interests.

The 37-year-old woman had been detained under the Mental Health Act 1983 and had been diagnosed as suffering from mania with psychotic symptoms. After an ultrasound scan showed evidence of static foetal growth, the medical consensus was that her baby should be delivered by Caesarean section within 12 days, and the NHS trust responsible for her care made an application to the Court under the Mental Capacity Act 2005. The NHS trust stated that there were several risk factors which, taken together, meant that postponing the Caesarean section would pose a very high risk to the woman and her baby.

The woman had expressed a belief that she was carrying four babies and three of them would be taken away if she underwent a Caesarean. She had made false accusations against medical staff and attempted to physically assault them, and had been verbally aggressive to other patients on her ward.

The Court noted that the medical evidence pointed strongly towards a planned Caesarean rather than continuing the pregnancy to term – which carried the additional risk that an emergency Caesarean would be necessary – but also expressed concern that the woman's psychiatric conditions would worsen if she underwent a Caesarean against her will.

The Court was satisfied that the woman did not currently have capacity to make the decision that was urgently required of her. As such, it fell to the Court to decide what was in her best interests. Noting that the medical evidence in favour of a planned Caesarean was overwhelming, the Court found that the views she had expressed were clearly influenced by her mental illness and her delusional belief that she was carrying four babies that could be delivered with no difficulty or risk. The Court was satisfied that, in the circumstances, it was very clearly in her best interests for the planned Caesarean to go ahead.