Recommendation ID
CG132/3
Question
National audit:- Repeat of the National Caesarean Section Sentinel Audit. The original Caesarean Section (CS) guideline included a set of 'auditable standards'. It would be a straightforward task to produce an updated set of auditable standards based on the important topics covered in the updated guideline. These could include:
• consent
• indications (including maternal request)
• procedural aspects
• maternal and fetal outcomes.
Many of the outcomes documented in a new CS audit would relate directly to recommendations in this CS guideline update. Researchers may also want to consider categorising different reasons underlying maternal request for CS such as previous poor childbirth experience, longstanding fear of childbirth, belief that CS is safer for the baby etc.
An additional useful feature of the audit would be to record key related data, such as the proportion of CS deliveries for a breech presentation that had an attempted external cephalic version.
Any explanatory notes
(if applicable)
Why this is important:- During the 10 years since the National Caesarean Section Sentinel Audit was undertaken (2000–2001), many of the findings may have changed significantly. The audit examined who was having a CS and why, as well as the views of women having babies and the obstetricians looking after them. The audit found that a 20% CS rate was considered too high by 51% of obstetricians. UK CS rates now average about 25%. A repeat of the CS Sentinel Audit would reveal any changes in indications and the views of women and obstetricians. The current literature does not adequately address the issue of maternal request for CS and this is one aspect the audit may address. Women's views on maternal request for CS when there are no obstetric indications are particularly relevant. Such requests may be on the rise and the reasons are not always clearly expressed or documented.
The methodology of the audit is established, making a repeat feasible. This should be given high priority because the benefit to the NHS would be significant.

Source guidance details

Comes from guidance
Caesarean section
Number
CG132
Date issued
November 2011

Other details

Is this a recommendation for the use of a technology only in the context of research? No  
Is it a recommendation that suggests collection of data or the establishment of a register?   Yes