Quality standard

Quality statement 3: Maternal request for a caesarean birth: maternal anxiety

Quality statement

Pregnant women who request a caesarean birth because of anxiety about childbirth are offered a referral to a healthcare professional with expertise in perinatal mental health support.

Rationale

When a woman who is requesting a caesarean birth due to anxiety is given the opportunity to discuss this with someone who can answer their questions and understand their concerns in a supportive manner, the anxieties can often be reduced to the point where the woman is able to choose a planned vaginal birth. This discussion is an important part of the decision-making process and should happen before a decision on caesarean birth is made with the maternity team. A referral can be to a member of the maternity team with interest and experience in this area of antenatal support.

Quality measures

Structure

Evidence of local arrangements to ensure that pregnant women who request a caesarean birth because of anxiety about childbirth are offered a referral to a healthcare professional with expertise in perinatal mental health support.

Data source: Local data collection.

Process

The proportion of pregnant women who request a caesarean birth because of anxiety about childbirth who are referred to a healthcare professional with expertise in perinatal mental health support.

Numerator – the number of women in the denominator who are referred to a healthcare professional with expertise in perinatal mental health support.

Denominator – the number of pregnant women who request a caesarean birth because of anxiety about childbirth.

Data source: Local data collection.

Outcome

Women's satisfaction with the support provided for anxiety about childbirth.

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 because of anxiety about childbirth to be offered a referral to a healthcare professional with expertise in perinatal mental health support.

Healthcare professionals ensure that pregnant women who request a caesarean birth because of anxiety about childbirth are offered a referral to a healthcare professional with expertise in perinatal mental health support.

Commissioners ensure that they commission services that offer women who request a caesarean birth because of anxiety about childbirth a referral to a healthcare professional with expertise in perinatal mental health support.

Pregnant women who ask for a caesarean birth because of anxiety about childbirth are offered a referral to a healthcare professional with expertise in mental health support for women approaching childbirth.

Source guidance

Caesarean birth. NICE guideline NG192 (2021), recommendation 1.2.28

Definitions of terms used in this quality statement

Healthcare professional with expertise in perinatal mental health support

Someone, usually from the maternity team, who has an interest and expertise in providing support to women with higher than normal anxiety levels, to the extent that they are requesting a caesarean birth. [Expert opinion]

Referral

The referral could be an informal referral within a maternity team or formal referral to another member of staff in a different team. [Expert opinion]

Anxiety

Tokophobia or other severe anxiety about childbirth (for example, following abuse or a previous traumatic event). [NICE's guideline on caesarean birth, recommendation 1.2.28]

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.