When we don’t know what we don’t know: the “forced C-section” case

A heavily pregnant woman with bipolar – let’s call her A – is sectioned after a panic attack. Social workers, unable to wait until the child is born, demand that it be delivered early, ready to snatch it the moment collusive obstetricians and anaesthetists oblige. That’s how a case recent court case has been portrayed by the media: a tale of a shadowy “secret court” which allowed a baby to be “taken from the womb.” No wonder one paper called it “the stuff of nightmares.”

Only that’s not exactly how I read the story. I have been unwilling to call the case outrageous, unacceptable, despite the fact that I am a mother with bipolar and one who chose to avoid/evade any form of treatment when trying to become pregnant. I am very aware that I am fortunate to have never forcibly treated, but I have been threatened with use of the Mental Health Act to compel me to keep on with physical treatment. When I hear of a case in which it appears a pregnant woman’s bodily integrity has been violated because of her mental health, I have a strong reaction to that. It is horrifying to imagine that happening to me, or indeed to any woman.

However, I am also qualified childbirth educator who spent almost a year as a student midwife. I was unable to complete my training because I became extremely unwell, but working in the maternity unit gave me a thorough appreciation of the fact that whilst the vast majority of pregnancies and births are completely normal, even in a developed country mothers and/or babies do still die. Risk can never be eradicated, only managed; a good shift on delivery suite remains one where every mother and baby is healthy and the staff go home with a sigh of relief. For a number of life-threatening conditions, the mother faces substantive risk if the baby’s condition is not addressed, and vice versa, so the only real means of managing the risk is to end the pregnancy as soon as possible via Caesarean section. Would I ever welcome forcible treatment? No. Might I later be glad that my life had been saved at time when I could not appreciate that it was at risk? Possibly.

A third influence on my view of this case is my involvement with child protection cases through my later career in the Probation Service. I have written many Child Protection Reports and attended many Child Protection Conferences to give my recommendation as to whether a child – including unborn babies – should be made subject to a Child Protection Plan. I have also been involved in the preparation of an internal report to inform a Serious Care Review following the preventable death of a child, and it was one of the weightiest things I have ever been asked to do. However vocal criticism of Judges, social workers and obstetricians involved in this case, there would have as loud or louder an outcry had A and/or her baby died.

What concerns me about the reporting of this case is the lack of detail surrounding legal issues. Without detail speculation fills a narrative vacuum, resulting in some possibly unfounded conclusions – and frightening people, especially women with mental health issues, in the process. Reporting has given the impression that:

1)   The woman was sectioned (detained under the Mental Health Act) because of a panic attack. Although is it true to say that she was detained subsequent to a panic attack, the impression given in some reporting is that this is the same as saying she was detained because of a panic attack – the reason A initially came into contact with mental health services and her subsequent detention have been at least implicitly conflated. The required recommendation for detention would simply not be made by an Approved Mental Health Professional (AMHP) nor agreed by the two appropriately qualified doctors on the grounds of a panic attack, but many women reading the story are not to know this.

2)   Social workers forced the issue over early delivery and were waiting in the wings to snatch the baby. Reporting has also conflated obstetric risk and decision-making with Child Protection risk and decision-making. Normal practice under a pre-birth Child Protection Plan would be to wait for spontaneous delivery and take the baby into foster care (if warranted) from the maternity unit. For a caesarean to be carried out there must have been an obstetric reason great enough to place the facts before the Court of Protection for a Judge to rule whether A could make decisions about her own health or not. Being unwilling or unable to go along with an obstetric risk management plan might, in Children’s Services’ eyes, have been part of the mother’s inability to protect and care for her child, but obstetricians do not deliver early to make it easier for Children’ Services to take newborns into care. It has now been made clear by Essex County Council’s statement on the case that “it was the Health Trust’s clinical decision to apply to the High Court for permissions to deliver her unborn baby by caesarean section because of concerns about risks to mother and child.”

3)   Secretive courts are making decisions that suit predatory social workers’ agendas. There are in fact three quite separate legal processes at play here. First, use of the Mental Health Act to detain A. Secondly, Family Court matters including the request for an Interim Care Order for the baby at the time of birth and the recent request by A that she be given custody of the child. Thirdly, in was clearly an NHS decision rather than that of social workers, application to the Court of Protection, which makes decisions about a person’s mental capacity, when it seemed A was unable  to accept or refuse potentially life-saving treatment.

Blurring the issues and legal processes in this case has helped no one except, of course, those wishing to sell newspapers. Painting a picture of children’s social workers as ghoulish baby-snatchers makes pregnant women frightened to disclose their mental health problems to midwives or their pregnancy to mental health professionals, potentially missing out on vital perinatal mental health care. Implying that it is a hop, skip and a jump from a panic attack to forcible treatment likewise makes people with mild-moderate mental health issues wary of seeking help. If we are lucky, and keep pushing the agenda, cases like this will bring the need for effective perinatal mental health care into the spotlight. In the meantime, there will be some pregnant women who had read the stories and decide it’s safer to go it alone.

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About purplepersuasion

30 something service user, activist, writer and mother living with bipolar disorder. Proud winner of the Mark Hanson Prize for Digital Media at the Mind Media Awards #VMGMindAwards 2013. Winner of the World in Mentalists Mood Disorder blog 2012. Regular guest blogger for the International Bipolar Foundation http://www.internationalbipolarfoundation.org/ Expert by Experience working with Mind training department. Working on The Incoming Tide, a bipolar memoir. Find me on Twitter @BipolarBlogger or at my Facebook page http://www.facebook.com/BipolarBlogger
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8 Responses to When we don’t know what we don’t know: the “forced C-section” case

  1. Pingback: Starting a family when you have a mental health diagnosis: unfit to be a mother? | Sectioned

  2. barbs55 says:

    Thank you for this reasonable post – I have also found the reporting of this case really unhelpful for both women living with bi-polar disorder, and for the professionals involved in this case.

  3. ASIF AMHP says:

    thank u

    I shared the following email this with a friend who emailed me about it yesterday. We are both social workers.

    “I saw this & had & heard many thoughts.

    The ones I heard were mostly negative about social workers. But they reflect a fundamental misunderstanding about how these things happen – if indeed it did happen as described in the press. I even heard some doctor on the radio blaming the social workers.

    I suspect the original concern came from a doctor somewhere & that nurses, solicitor, barristers, ambulance personnel, police officers, judges & all sorts of other people were involved in making the huge decision to intervene in this way. Remember an unborn child has no legal right to life so the decision has got to have been weighted against risk to life to mum, with maybe a nod to the unborn child in the background & a Judge said yes.

    Imangine the boot was on the boot was on the other foot & mum harmed the child. I know exactly what the press head lines would be then.”

  4. PookyH says:

    I found this interesting on a number of levels – I’m daughter of a bipolar, mother to a ‘looked after child’ whose mother is a relative whose baby was induced early and taken into care at birth. Social Services were painted in a very dark light throughout much of my childhood and the early days of us trying to get custody of our now-daughter but actually they are bound by so many rules and regulations that it’s an incredibly hard job for them… that said, I never yet met a social worker who did not have the best interests of the child at heart.

  5. Abby says:

    Thank you so much for shedding some light on this case – it just did not make sense when I heard it reported earlier today.

  6. Very good blog post. Another one with mental health issues who has found the coverage far too focused on scaremongering rather than facts – especially as I had my own experience with very serious ill mental health where I was advised (by a so-called professional) not to let social services or anyone external help as they would take my child away.

    I was lucky in that I knew enough not to listen, but how many others are put off getting help because of stories like these (and the people that like to spread them)?

  7. Anne Wade says:

    Thanks for some common sense, Charlotte.
    Of course it would have needed more than a panic attack to require an involuntary admission.
    Of course a caesarean would be a medical decision, not a social work one.
    And I also read that the mother had asked for time to get her head together before she could take care of her baby, and had gone back to Italy for a year before feeling ready to ask for custody. I can imagine being so fragmented and dissociated, and lacking family support, that one needed to say this, and I sympathise with her. But meanwhile the baby needs care, needs bonds – if you are not well enough for this to take precedence over your own state of mind, no blame, but maybe you are too ill to take responsibility for a child. As you say, we do not know enough to judge.
    The real culprit here is the secrecy of the Family Courts in England, which is intended to protect the privacy of the child and in fact protects negligent professionals – and paedophiles. Competent professionals, as well as children, suffer as a result. I have many child protection cases showing this.
    Anne

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