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.