The High Court refused an urgent Health Service Executive application to authorise a caesarean section against a pregnant woman’s will, finding that the risks of her planned natural delivery did not justify forced surgery. After the judgment, her waters broke and she consented to an elective caesarean section. She and her baby daughter were reported to be well.
The ex tempore judgment was delivered by Mr Justice Twomey on 2 November 2016. The HSE sought authority to use reasonable and proportionate force or restraint to perform the operation. The woman, identified as Ms B, had previously delivered three children by caesarean and had never given birth vaginally. Her due date had passed, and she was a hospital patient.
Medical evidence for the HSE described the risk of uterine rupture during a natural delivery after three caesarean sections. Dr D, an experienced obstetrician who was not Ms B’s consultant, gave a “guesstimate” of a one-in-ten risk. Ms B’s obstetrician, Dr A, said he had never overseen a natural birth after three caesareans and was not in a position to provide that service. The court heard that no other hospital in Ireland was available or willing to supervise such a delivery. No contrary medical evidence was presented.
Ms B’s counsel referred to UK and Irish clinical guidelines concerning vaginal birth after caesarean. The judge noted that the UK guidance urged caution when applying its figures and that the Irish guidance discussed labour after two or more caesareans but did not contemplate a third. The court concluded that attempting labour involved an unnecessary risk to Ms B and her child.
The judge nevertheless found that Ms B, as an adult patient, was presumed to have capacity to refuse medical advice; the evidence did not rebut that presumption. He said that, if her health alone were at issue, she could refuse treatment even at increased risk. Applying the principle that courts should intervene in parental decisions only in exceptional cases, he held that the circumstances did not justify authorising an invasive operation against her will. The court therefore refused the forced-caesarean application. It did not order or compel the later operation; Ms B chose to consent after the judgment.
The original proceedings had been held in camera. After the birth, Ms B sought to lift the restriction on reporting, with her daughter represented through her. The HSE opposed the application, including on the basis that publicity might not be in the child’s interests and that staff had given evidence expecting confidentiality. The court held that the choice belonged to Ms B and ordered the reporting restriction lifted. It released a redacted judgment using non-identifying initials to protect the parties’ identities as far as possible.