I was denied a caesarean despite a scan showing my baby would be a huge 11lb. I ended up with horrific internal damage and lost three pints of blood. This is the appalling reason I was forced to have a natural birth

After enduring a difficult 56-hour labour with the birth of her first child, India Crotty wanted to do whatever possible to ensure the delivery of her second was less traumatic.

So when, towards the end of her pregnancy, routine checks revealed that her second baby, a boy, was going to be even larger than her 8lb 15oz daughter, India requested a caesarean.

Her son wasn't going to be just a bit bigger – scans suggested he would be approaching 11lb; around a third bigger than the average baby boy – and India, who is 5ft 7in and slim-built, was understandably nervous.

'Even my community midwife was worried about me giving birth naturally,' says India, 35, a business consultant.

The midwife supported India's decision and contacted the consultant in charge at the hospital. But she reported back that the consultant felt India couldn't have a caesarean 'just because she's scared'.

When India went into labour days later, her midwife assured her she could still request a caesarean once she arrived at the hospital. But when she got there, India was left alone in a delivery room for two hours until she was screaming in agony. When midwives finally came to assess her, they said she should just 'carry on' as there was no theatre available.

'My partner was desperate to get me help, but they didn't have the staff,' she recalls. 'We were terrified. The whole thing was horrific from start to finish.

'I am normally quite a calm, composed person, but I was terrified knowing I was going to have to push out this enormous baby,' she says.

India, from rural Gloucestershire, had to give birth to her huge 10lb 12oz son naturally in a 'truly horrific' 11-hour labour, during which she suffered such severe internal damage that she haemorrhaged and lost nearly three pints of blood.

What's more she had to give birth without pain relief, after medics botched an attempt to insert an epidural.

'Words cannot express the pain I was in,' says India. 'I was screaming and crying – at several points I told my partner I wanted to die. He was completely shaken by the experience, too.'

India lost so much blood that she needed daily iron injections for weeks afterwards.

The experience left her so traumatised she has been diagnosed with post-traumatic stress disorder (PTSD) and was prescribed medication as well as talking therapy for this.

India says: 'We thought we were going into hospital for a caesarean delivery, but instead I was left with no one to help me, no one listening to me and in unimaginable pain. I felt like I wanted to die.'

India is now so anxious after her experiences that she struggles to leave the house with her children. 'Before I gave birth to my son, I had so many people reassure me not to worry and that it would all be fine, but everything was even worse than I feared,' she says.

The impact of denying women caesareans can have even more tragic implications.

Last week, an inquest found that baby Emmy Russo, who died on January 12, 2024, would have survived if a caesarean had been performed sooner.

Her mother Bryony arrived at Princess Alexandra Hospital in Harlow, Essex, after having contractions and losing meconium – a thick brown liquid that can signify that the baby is in distress.

Yet despite this and monitoring at 3pm suggesting the baby was struggling, a caesarean was not performed until that evening – almost 11 hours after Bryony arrived at the hospital.

By that time Emmy had been deprived of oxygen and, tragically, she died in her parents' arms three days later.

The inquest was told that Bryony had requested a caesarean on January 9, but this was 'laughed off' by a midwife. Philippa Greenfield, director of child health and women's services at the hospital, told the inquest they were now reviewing 'whether there should be a more structured process' around requests made for planned caesareans late in the pregnancy.

In a statement apologising to the family, the hospital's chief nurse Sharon McNally said the safety of women and babies was an 'absolute priority' and 'learning from any incident is part of our focus on continuous improvement'.

Until around three years ago, many hospitals prioritised 'natural' (now often called 'normal') vaginal births, and even had targets to limit the number of caesareans performed. Just how difficult it could be for women to get a caesarean on the NHS was brought into focus in March 2022, when senior midwife Donna Ockenden published a report into maternity failings at the Shrewsbury and Telford Hospital NHS Trust, which the trust said it 'fully accepted'.

This revealed an 'obsession' with the 'natural' birth target meant women had been denied caesareans, leading to hundreds of injuries and deaths. She recommended women must be allowed to request a caesarean.

The same year, a survey by the birth injury support charity MASIC revealed only a third of women injured during instrumental delivery (where the baby is delivered using forceps or a ventouse suction cup device) were even given a chance to discuss a caesarean as an alternative.

Weeks before the Ockenden report was published, NHS England told hospitals to scrap a target aimed at limiting the caesarean rate to around 20 per cent. Yet while rates overall have increased, a sizeable proportion involve not planned births, but riskier emergency caesareans. Close to half of all babies – 44 per cent – born in England between February 2024 and January 2025 were delivered by caesarean, the latest maternity data shows, compared with 37 per cent in 2022/23.

Furthermore, emergency caesareans accounted for more than half – 56 per cent – of all the 229,600 caesareans performed in England in the last year, despite the number of planned caesareans rising by almost a fifth since 2022.

And some NHS trusts have far lower planned caesarean rates than others, suggesting that the culture at individual hospitals may still play a part in access.

At Surrey & Sussex Healthcare NHS Trust, for example, planned sections made up 32 per cent of all births in September 2024 – the busiest month for births.

But at Barts Health in London the planned caesarean rate that month was just 8 per cent.

It was 12 per cent at Sandwell and West Birmingham Hospitals, and 15 per cent at Leeds Teaching Hospitals. (These NHS trusts were contacted for comment.)

Another factor reducing access to caesareans is capacity, says Dr Ian Scudamore, vice-president for education at the Royal College of Obstetricians and Gynaecologists.

He believes women should be 'fully supported' in their choices, but says under-investment in NHS maternity services means there are not always enough staff, beds or theatre space to ensure women get the birth they want.

'Managing planned caesarean surgery lists is more difficult when a hospital does not have access to two dedicated maternity theatres,' he adds.

Maternity units must have at least one dedicated operating theatre, but an investigation by the Health Service Journal last year found one in three do not have a second theatre. And those that did often did not staff it at nights and weekends. This means that when more than one emergency occurs at the same time, medics must find an operating theatre elsewhere in the hospital – costing up to 30 minutes and putting lives at risk.

Women may be offered a caesarean for a range of reasons – if a baby is breech (when it is feet or bottom first in the womb) or the mother has a medical condition such as pre-eclampsia or gestational diabetes, which may mean the baby needs to be delivered earlier to avoid risks to their health or their mother's. These conditions are more common in older or overweight mothers.

Abigail Latif, an NHS community midwife based in Manchester, says she is seeing more mothers like India requesting caesareans after traumatic previous births. And research last year by the maternity campaign group Delivering Better found that one in four women say their birth experience was negative.

Under guidance from the National Institute for Health and Care Excellence (NICE) medics should support women's requests for a caesarean, as long as they are satisfied they are making an 'informed choice'.

This means midwives and/or a doctor will discuss a woman's reasons for wanting a caesarean and the risks and benefits.

Anoop Rehal, a consultant in obstetrics and fetal medicine at University Hospitals Birmingham NHS Foundation Trust, says most doctors 'want to support women to have the birth that is right for them – and decisions are always made in the interests of safety'. While both vaginal delivery and caesareans are safe, caesareans carry slightly higher risks of complications, such as bleeding, infections and blood clots, particularly if the mother is overweight, and recovery typically takes longer. For example, women may be unable to drive for up to six weeks afterwards, compared with around two weeks in vaginal deliveries.

Caesareans also raise the risk of complications, such as issues with the attachment of the placenta, in future pregnancies. Some babies born via caesarean need help breathing at birth and have a higher risk of developing asthma or being overweight as adults.

But there are also risks from vaginal birth, especially in instrumental deliveries, which can include tearing, incontinence and pelvic floor dysfunction.

Under the NICE guidelines, if a woman has anxiety about childbirth, she should be offered support from a perinatal mental health team, and if she still wants a caesarean afterwards then healthcare professionals should 'support their choice'. Yet some women say they still feel pressured to not have a caesarean.

Nikki Melless Botha knew she wanted one from the start of her first pregnancy last year, but she says that midwives tried to dissuade her from it at every antenatal appointment.

'I really had to fight for it,' says Nikki, 34, from Beckenham, south-east London, who works in advertising.

She felt anxious about giving birth vaginally, especially given midwife shortages in her local hospital. And although a consultant agreed to book her in for the surgery, her choice was repeatedly questioned by four different NHS midwives.

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'Even when the surgery was booked for the following week, the midwife kept asking if I was 'sure' I didn't want to give birth 'normally',' recalls Nikki. 'To use that sort of language is so damaging because it sounds like anything else is abnormal.' Her daughter Hailey, now eight months old, was born safely via a planned caesarean. 'I'm so glad I fought for my C-section,' adds Nikki.

Dr Catherine Bernard, an NHS anaesthetist based in southern England, believes it 'doesn't make sense' for hospitals to try to talk a pregnant woman out of having a planned caesarean.

'It's denying women the choice to plan in advance, when there is a possibility they could end up with an emergency section anyway,' she says.

'Why reduce the number of planned caesarean sections, only to increase the number of emergency ones – which have worse outcomes?'

A 2021 study by doctors in France found women who had the most urgent emergency caesareans were around seven times more likely to get infections afterwards than those in the least urgent category.

'In an urgent situation, it can take as little as two minutes from the knife touching the skin to the baby coming out,' explains Dr Bernard. 'In contrast, with a planned caesarean section, the surgeon has time to carefully work down through the muscle layers over up to ten minutes.'

Recovery may be more difficult from emergency surgery after labour, and research presented at the 2025 Pregnancy Meeting of the Society for Maternal-Fetal Medicine suggests women who have an emergency delivery are also between 15 and 20 per cent more likely to develop postnatal mental health issues such as depression and post-traumatic stress disorder.

What's more, although caesarean births cost more to perform (almost twice as much as unassisted vaginal births), economic modelling carried out by NHS obstetric consultants in 2020 suggested planned caesareans actually save the NHS £400 per birth, once compensation for injuries and deaths sustained during vaginal births was taken into account.

The NHS pays out £1.15billion in maternity compensation claims per year – equivalent to nearly £2,000 for every child born, figures from its compensation body NHS Resolution show – often for delays in urgent treatment, including emergency caesareans. But there is the human cost, too.

The toll of India's birth meant that she struggled to care for her son and bond with him in the early days.

'I felt so guilty for not being able to be the mother I wanted to be,' she recalls.

As a result of her anxiety post childbirth, India now feels unable to put her children, aged two and eight months, into nursery, or to go on long journeys, because she constantly fears they could come to harm. 'I'm terrified that something bad will happen to them,' she says.

She has also now abandoned plans to have more children.

'I always wanted a large family, but I cannot risk going through that again,' she adds.

India is angry that the requests she made for a caesarean as she approached her due date last September were ignored.

'I hadn't taken the decision to choose a C-section lightly,' explains India.

'I knew the recovery would be difficult with a toddler to look after. But I knew a C-section would be the best option and I had been told this was a choice I could make.

'Bringing children into the world is supposed to be this magical thing and it's just so sad that for so many women it ends up being traumatic.'

An NHS spokesperson said: 'Each birth is different and it is important that every pregnant woman can discuss delivery methods with her maternity team – as part of a personalised care and support plan.

'There is much more we need to do to drive up standards of care and build on improvements already made, and the NHS will continue to provide intensive support to the most challenged trusts to improve care for patients.'