|Judge orders caesarean if needed for mentally ill mother-to-be.|
|Doctors will be allowed to carry out a caesarean if required to deliver a mentally ill mother’s baby, a judge has ruled. Photograph: Vincent Hazat/Getty stock image|
A specialist judge has given doctors permission to perform a caesarean section to deliver the baby of a 21-year-old woman detained under mental health legislation.
The woman, who was suffering from a drug-related psychosis, wanted to have her baby as naturally as possible, Mr Justice Hayden was told.
But he ruled that a caesarean section could be performed if specialists thought it necessary for the safety of mother and baby.
He made the ruling late on Wednesday after analysing evidence at a hearing in the court of protection – where issues relating to sick and vulnerable people are considered – in London.
The judge ruled that the woman, due to go into labour later in the week, could not be identified.
He said bosses at two health trusts – the Norfolk and Suffolk NHS foundation trust and the West Suffolk NHS foundation trust – had responsibility for the woman’s care and had asked for rulings on what treatment would be in her best interests.
The judge, who heard evidence from two specialists and the woman’s mother – as well as submissions from lawyers representing the health trusts and the woman – described his decision as “enormous”.
He concluded that the woman did not have the mental capacity to litigate or make decisions about treatment.
But he said the woman’s condition meant that her mental capacity fluctuated.
Doctors said the woman could be violent and her behaviour might put her, the baby and medical staff at risk.
The judge said he could not “micro-manage” the birth and was giving doctors power to make decisions.
But he stressed that everyone involved in the woman’s treatment had to respect her wishes and feelings.
The woman’s mother said her daughter wanted to give birth naturally.
She said her daughter might not feel in “control” if doctors performed a caesarean section and she feared it might have implications for her daughter’s mental health.
Hayden was told that the woman had said she would consider a caesarean section if her baby was in danger.
The judge told the woman’s mother that he would make sure that doctors “tried as hard as they can” to avoid performing a caesarean section.
Hayden said he would not authorise the use of handcuffs or leg straps – as called for by doctors in a possible care plan – but approved the use of “chemical restraint” if doctors thought it proportionate and necessary.
A lawyer representing the woman had argued the idea of physical restraints was “draconian”.
The judge was told that specialist mental health nurses would be with the woman at the birth.
Hayden said social services staff had told the woman that their plan was to remove the baby from her care at birth. A family court judge is expected to make decisions about the baby’s long-term future.
Hayden said the woman had a history of drug use dating back to her early teens. Her psychosis was related to the use of cannabis and MDMA, he said. At times she was well and at others needed specialist treatment.
Barrister Fiona Paterson had represented health trusts at the hearing – which was held in public. The woman’s interests had been represented by staff at the Office of the Official Solicitor - which offers legal help to vulnerable people. Barrister Conrad Hallin made submissions on the woman’s behalf.