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

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

Quality statement

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

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

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

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

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

What the quality statement means for each audience

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

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

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

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

Source guidance

NICE clinical guideline 132 recommendation 1.2.9.1 and 1.2.9.2.

Data source

Structure: Local data collection.

Process: Local data collection, included in NICE clinical guideline 132 Caesarean section: clinical audit tool – maternal request for caesarean section, criterion 2.

Outcome: Local data collection.

Definitions

Documented discussion

The discussion should include the reasons for the request and ensure that the woman has accurate information (including written information) about the relative risks and benefits associated with different modes of birth, based on box A in NICE clinical guideline 132. This discussion should be documented in the woman's antenatal notes.

Maternity team

The core membership of the maternity team should include a midwife, an obstetrician and an anaesthetist.