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(Family Division, Hayden J, 28 January 2014)
The 25-year-old woman, who was pregnant with her first child, suffered from affective bipolar disorder for which she was prescribed a range of antipsychotic mediation. She also had a history of substance and alcohol abuse, had only a limited insight into her medical condition and at times stopped taking medication.
At 38 weeks' gestation the woman became symptomatic and started suffering from hypomania and puerperal psychosis. She was described as being agitated, violent and exhausted from lack of sleep. She attended hospital when her membranes ruptured although she hadn't gone into labour and she was thereafter detained under s 5(2) of the Mental Health Act 1983. She remained highly agitated and largely unco-operative with almost every aspect of her obstetric care.
The NHS Trust sought declaratory relief under the inherent jurisdiction of the High Court that it would be lawful and in the woman's best interests to deliver the child via an elective caesarean.
Although a caesarean section was a major surgical operation, in contrast with an induced labour, the treating clinicians were in agreement that it was the safest option for the woman. Induced labour produced a real risk of the woman needing an emergency caesarean which would be particularly dangerous in this case. Further, even if she initially complied with the administration of intravenous medication which had not always been the case, her compliance would not be sufficiently long standing to administer the medication safely.
A best interests decision required a broader survey of the available material. This was a wanted baby in a supportive family unit. The woman's father and her partner both agreed that if she were completely florid and not suffering a profound psychotic episode she would follow the recommendation of the doctors.
It was self evident that the woman lacked capacity to make decisions regarding the safe delivery of her baby. On that basis the judge granted declarations that it was lawful and in the woman's best interests to carry out such treatment as was deemed necessary for the safe delivery of her baby, including administering anaesthetic, delivery by caesarean section and the minimum necessary physical restraint or force to administer such treatment and/or prevent her from leaving the hospital.
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