Quality standard

Quality statement 2: Maternal request for a caesarean birth: maternity team involvement

Quality statement

Pregnant women who request a caesarean birth (when there is no medical indication) have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.

Rationale

The purpose of this statement is to inform decisions about the planned mode of birth. It is important that the woman can talk to the most relevant member of the maternity team depending on what her question or concern is about her request for a caesarean birth. It is important that access to members of the maternity team is possible at any point during the woman's pregnancy and promptly arranged following a request.

Quality measures

Structure

Evidence of local arrangements to ensure that pregnant women who request a caesarean birth (when there is no medical indication) have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.

Data source: Local data collection.

Process

The proportion of pregnant women who request a caesarean birth (when there is no medical indication) who have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.

Numerator – the number of women in the denominator who have a documented discussion with at least 1 member of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.

Denominator – the number of pregnant women who request a caesarean birth when there is no medical indication.

Data source: Local data collection.

Outcome

Women's satisfaction with the process of discussing options with the maternity team.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place for pregnant women who request a caesarean birth (when there is no medical indication) to have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.

Healthcare professionals ensure that pregnant women who request a caesarean birth (when there is no medical indication) have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.

Commissioners ensure that they commission services that have systems in place for all pregnant women who request a caesarean birth (when there is no medical indication) to have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.

Pregnant women who ask for a caesarean birth (when there is no medical reason) have a discussion with members of the maternity team (which is recorded in their notes) about the benefits and risks of a caesarean birth compared with a vaginal birth.

Source guidance

Caesarean birth. NICE guideline NG192 (2021), recommendations 1.2.25, 1.2.26 and 1.2.27

Definitions of terms used in this quality statement

Documented discussion

The discussion should include the reasons for the request and ensure that the woman has accurate information (including written information) about the overall benefits and risks associated with different modes of birth, based on the section on planning mode of birth in NICE's guideline on caesarean birth. This discussion should be documented in the woman's antenatal notes. [Adapted from NICE's guideline on caesarean birth, recommendations 1.2.25 to 1.2.27]

Maternity team

The core membership of the maternity team should include a senior midwife, an obstetrician and an anaesthetist. [Adapted from NICE's guideline on caesarean birth, recommendation 1.2.27]

Equality and diversity considerations

Good communication between healthcare professionals and women who request a caesarean birth is essential. Treatment and care, and the information given about it, should be culturally appropriate. It should also be accessible to women with additional needs such as physical, sensory or learning disabilities, and to women who do not speak or read English. Women who request a caesarean birth should have access to an interpreter or advocate if needed. For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard or the equivalent standards for the devolved nations.