Quality standard

Quality statement 5: Timing of planned caesarean birth

Quality statement

Pregnant women having a planned caesarean birth have the procedure carried out at or after 39 weeks, unless an earlier delivery is necessary because of maternal or fetal indications.

Rationale

Babies born by planned caesarean birth at term but before the due date are at a higher risk of respiratory complications. The level of risk decreases with gestational age, particularly from 39 weeks onwards. Therefore, planned caesarean birth should not routinely be carried out before 39 weeks.

Quality measures

Structure

Evidence of local arrangements to ensure that pregnant women having a planned caesarean birth have the procedure at or after 39 weeks, unless an earlier delivery is necessary because of maternal or fetal indications.

Data source: Local data collection.

Process

The proportion of pregnant women having a planned caesarean birth and not needing an earlier delivery because of maternal and fetal indications who have the procedure carried out at or after 39 weeks.

Numerator – the number of women in the denominator who have the caesarean birth carried out at or after 39 weeks.

Denominator – the number of pregnant women having a planned caesarean birth who do not need an earlier delivery because of maternal or fetal indications.

Data source: The NHS Digital Maternity services secondary uses data set collects data on delivery method and gestational length at birth.

What the quality statement means for different audiences

Service providers ensure that systems are in place for pregnant women having a planned caesarean birth to have the procedure at or after 39 weeks, unless an earlier delivery is necessary because of maternal or fetal indications.

Healthcare professionals ensure that pregnant women having a planned caesarean birth have the procedure at or after 39 weeks, unless an earlier delivery is necessary because of maternal or fetal indications.

Commissioners ensure that they commission services in which women having a planned caesarean birth have the procedure at or after 39 weeks, unless an earlier delivery is necessary because of maternal or fetal indications.

Women having a planned caesarean birth have the procedure at or after 39 weeks of pregnancy, unless an earlier delivery is needed because of problems with the baby or the mother.

Source guidance

Caesarean birth. NICE guideline NG192 (2021), recommendation 1.4.1

Definitions of terms used in this quality statement

Planned caesarean birth

A planned caesarean birth that is scheduled before the onset of labour. Planned caesarean birth should be agreed between the woman and the maternity team. The woman should be given a specific day and time at which the caesarean section will be performed. A model for delivering planned caesarean birth is for services to have dedicated planned caesarean birth lists. The lists should have protected surgical and anaesthetic time and appropriate staffing to ensure that planned caesarean births are not delayed because of surgical time being prioritised for emergency cases. [NICE's 2011 full guideline on caesarean section, glossary and expert opinion]

Maternal or fetal indications

Maternal or fetal indications include but are not limited to the following significant conditions: hypertensive disease, diabetes or gestational diabetes, significant antepartum haemorrhage, intrauterine/fetal growth restriction, congenital abnormality, hydrops or compromise resulting from blood group incompatibility, acute fetal compromise, and multiple pregnancy. [Expert opinion]