Image copyright Tracey Taylor A senior coroner has warned of a risk of future deaths if the NHS favours vaginal delivery over caesarean sections on the basis of cost. Andrew Walker wants action taken after an inquest into the death of a newborn.
Kristian Jaworski died five days after his birth in June 2015 as a result of brain damage during a "prolonged and extended instrumental delivery".
North Middlesex University Hospital has accepted liability for his death, but said cost had not been a consideration.
Mr Walker's report, sent to the Department of Health, says that in the case of Kristian Jaworski there appeared to be a financial reason for favouring a vaginal delivery "that needed to be rebutted".
The coroner described how Tracey Taylor, Kristian's mother, repeatedly told medical staff that she needed a caesarean after complications during the birth of her first child Sebastian, three-and-a-half years earlier.
She told the inquest that doctors had informed her at that time that she had a "narrow birth canal" and would need a caesarean section if she ever had another child.
But the information was never recorded in her medical notes and she said her requests for a caesarean during a lengthy and difficult labour were ignored.
The inquest heard that doctors tried repeatedly to deliver Kristian in theatre using suction and then forceps, before performing an emergency caesarean under general anaesthetic.
But when he was born, Kristian had already been starved of oxygen and suffered severe brain damage from which he never recovered.
'Tragic death'
North Middlesex University Hospital's director of medicine, Dr Cathy Cale, said: "We are very sorry for the tragic death of baby Kristian. The team of doctors and midwives were deeply affected and both they and the hospital trust have expressed sincere apologies to the family."Although the coroner did not find the trust negligent, we have accepted liability for Kristian's death because we accept we made mistakes.
"As a result of our own detailed investigation, we have drawn up new guidance for all our staff about limiting prolonged instrumental delivery and avoiding the sequential use of instruments.
Dr Cale continued: "We have also taken steps to ensure that if a mother expresses concerns about her means of delivery that these and the reasons for them are clearly recorded in her notes.
"When deciding on the best means of delivery, doctors and midwives always have to weigh up competing risks."
She added: "It is usually safer and better for women to give birth naturally rather than to have a caesarean, because every surgical procedure carries risks of its own, including haemorrhage, injury to the mother's bladder and infection.
"Our team took their decision to continue with the natural delivery in this case for clinical reasons alone and would have had no concerns about intervening surgically had they believed this risk was warranted. There was and never is any question of cost being a consideration."
'Full consultation with women'
According to the Department of Health, the average cost of all vaginal deliveries (including normal and assisted deliveries) is calculated to be £1,985, while the average cost of all caesareans (planned and emergency) is £3,781The Department of Health now has 56 days to respond to the coroner's report.
In the meantime, Health Minister Ben Gummer said his deepest sympathies lay with Kristian's family, who had "been let down terribly".
"Treatment decisions in maternity care should always be made by clinicians in full consultation with women. These should be based on a woman's individual clinical needs and in line with NICE guidelines in terms of best practice.
He added: "It is vital that we learn from tragedies like this to ensure they are not repeated and far fewer families have to experience this kind of heartache."
Elizabeth Prochaska, barrister and chair of Birthrights, a charity which fights to improve women's experience of pregnancy, said: "The Taylor case is a tragic reminder that professionals do not always listen to the women they are meant to be caring for.
"When a woman requests a caesarean she is asking for the care she has decided is safest for her and her baby. We must trust women to make that decision. Hospital policies which refuse to honour women's decisions ultimately make birth less safe for women and babies."