Education And Debate

Caesarean section: a treatment for mental disorder? Tameside&Glossop Acute Services Unit v CH (a patient) [1996] 1 FLR 762

BMJ 1997; 314 doi: https://doi.org/10.1136/bmj.314.7088.1183 (Published 19 April 1997) Cite this as: BMJ 1997;314:1183
  1. Bridget Dolan, lecturer in forensic psychologya,
  2. Camilla Parker, legal and parliamentary officerb
  1. a St George's Hospital Medical School and Henderson Hospital Sutton, Surrey SM2 5LT
  2. b Mind, Granta House, London E15 4BQ
  1. Correspondence to: Dr Dolan
  • Accepted 20 February 1997

Case report

CH was a 41 year old woman who suffered from paranoid schizophrenia. She was detained under section 3 of the Mental Health Act 1983 and was subsequently found to be pregnant. She had previously shown pathological reactions to major tranquillisers, and it was feared that their use would be injurious to the fetus; thus, during pregnancy she was given only minor tranquillisers. Her psychiatrists stated that were she not pregnant she would be given strong antipsychotic drugs.

At 31 weeks into the pregnancy it was established that intrauterine growth was retarded because of a poorly functioning placenta. By 37 weeks, there were concerns that if the pregnancy continued the fetus would die in utero. The obstetrician considered that it was necessary to deliver the baby as soon as possible and planned to induce labour, but there was a possibility that fetal distress could occur during labour and, if so, an immediate caesarean section would be required.

It was agreed that the death of the baby in utero would not cause any physical harm to the mother, but the psychiatrist thought that delivering a stillborn child would have “profound deleterious effect” on her mental health in the short and long term. He believed that if the child were stillborn CH would become increasingly paranoid and blame staff for its death. This would undermine the trust she had in psychiatric services, and without that degree of trust the prognosis for treating her schizophrenia was deemed to be poor.

The obstetrician (who wished to induce within two days) was concerned that, although CH consented to the induction, she might change her mind and, if so, might need to be restrained. CH had told her psychiatrist …

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