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

Quality statement

Pregnant women who request a caesarean section 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 section 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 section 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 measure

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

Process: The proportion of pregnant women who request a caesarean section 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 section because of anxiety about childbirth.

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

What the quality statement means for each audience

Service providers ensure that systems are in place for pregnant women who request a caesarean section 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 section 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 section 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 section 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

NICE clinical guideline 132 recommendation 1.2.9.3 (key priority for implementation).

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 3.

Outcomes: Local data collection.

Definitions

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 section.

Referral

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

Anxiety

Anxiety that goes beyond the general anxiety that women have about childbirth. This refers to women whose anxiety is preventing them from wanting to attempt a vaginal birth.