Introduction and overview

Introduction and overview


Caesarean section rates have increased significantly in recent years. In the UK 20–25% of births are by caesarean section, up from 9% in 1980. This quality standard focuses on improving the decision-making process and the information available to women who may need, request or have had a caesarean section. The standard also focuses on reducing potential risks or complications for the woman and the baby.

This quality standard covers the care of women who plan for or may need a caesarean section. For more information see the scope for this quality standard.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement. The quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following frameworks:

The table below shows the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving:

NHS Outcomes Framework 2013/14

Domain 1: Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

Improvement area

Reducing deaths in babies and young children

1.6.i Infant mortality ii Neonatal mortality and stillbirths

Domain 4:

Ensuring that people have a positive experience of care

Overarching indicator

4b Patient experience of hospital care

Improvement area

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

Domain 5:

Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicator

5a Patient safety incidents reported

5b Safety incidents involving severe harm or death

Improvement area

Improving the safety of maternity services

5.5 Admission of full-term babies to neonatal care


The quality standard for caesarean section states that services should be commissioned from and coordinated across all relevant agencies encompassing the whole maternity care pathway. A person-centred approach to provision of services is fundamental to the delivery of high-quality care to women who may need, request or have a caesarean section.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should cross refer across the library of NICE quality standards when designing high‑quality services.

Patients, service users and carers may use the quality standard to find out about the quality of care they should expect to receive; to support asking questions about the care they receive; and to make a choice between providers of social care services.

The quality standard should be read in the context of national and local guidelines on training and competencies. All professionals involved in the care of women who may request or need a caesarean section should be sufficiently and appropriately trained and competent to deliver the actions and interventions described in the quality standard.