Ten More Years of Maternity Claims: What Can We Learn from Another Decade of NHS Litigation Data About Mode of Delivery, Informed Consent, and Patient Safety?

Objective To quantify the contribution of harm arising in labour to NHS obstetric litigation costs, compare the pathway costs of planned vaginal birth (PVB) and planned caesarean section (PCS), and review consent for planned mode of birth. Design Secondary analysis of administrative litigation and cost data, with policy review. Setting NHS England, 2015/16 to 2024/25. Population 11,881 obstetric claims notified to NHS Resolution; national NHS delivery activity. Methods Freedom of Information data on claims by primary cause and injury. Activity-weighted National Schedule of NHS Costs reference costs for 2023/24 and 2024/25. Indemnity attributed to labour by cause code (primary analysis) and by injury (sensitivity analysis). Consent guidance reviewed against Montgomery v Lanarkshire Health Board. Main outcome measures Damages and total payments by cause and injury; per-birth cost difference between PVB and PCS pathways. Results 7,216 claims were settled, with total payments of GBP 5,974 million (damages GBP 4,971 million). Eleven labour-exclusive cause codes accounted for 46.5% of total payments; cerebral palsy and brain damage accounted for 73.3%. In 2024/25, reference costs were GBP 6,202 per PCS and GBP 6,337 per PVB pathway. Including labour-attributable indemnity, the PVB pathway exceeded PCS by GBP 879 to 2,582 per birth (cause-code basis, cash to actuarial) and by GBP 1,190 to 4,142 under injury-based sensitivity analyses. No formal comparative-risk consent process exists for women planning vaginal birth. Conclusions Obstetric litigation costs are dominated by harm arising in labour. On current NHS cost data, PVB is not the cheaper pathway. Comparative-risk counselling on planned mode of birth should be offered to all women at booking.