Quality standard

Quality statement 6: Consultant obstetrician involvement in decision making for unplanned caesarean birth

Quality statement

Women being considered for an unplanned caesarean birth have a consultant obstetrician involved in the decision.

Rationale

Involving a consultant obstetrician in urgent decisions about whether an unplanned caesarean birth is necessary helps to ensure that all the relevant factors are taken into consideration. This should ensure the best possible outcome for the woman and the baby.

Quality measures

Structure

Evidence of local arrangements to ensure that women being considered for an unplanned caesarean birth have a consultant obstetrician involved in the decision.

Data source: Local data collection.

Process

The proportion of women being considered for an unplanned caesarean birth who have a consultant obstetrician involved in the decision.

Numerator – the number of women in the denominator who have a consultant obstetrician involved in the decision.

Denominator – the number of women being considered for an unplanned caesarean birth.

Data source: Local data collection.

Outcomes

a) Unplanned caesarean birth rates.

Data source: The NHS Digital Maternity services secondary uses data set collects data on delivery method.

b) Women's satisfaction with the decision-making process.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers ensure that systems are in place to ensure women being considered for an unplanned caesarean birth have a consultant obstetrician involved in the decision.

Healthcare professionals ensure that women being considered for an unplanned caesarean birth have a consultant obstetrician involved in the decision.

Commissioners ensure that they commission services that have systems in place for women being considered for an unplanned caesarean birth to have a consultant obstetrician involved in the decision.

Women who, during labour, are being considered for an unplanned caesarean birth because of complications have a consultant obstetrician involved in the decision.

Source guidance

Caesarean birth. NICE guideline NG192 (2021), recommendation 1.3.3

Definitions of terms used in this quality statement

Unplanned caesarean birth

This refers to the classification of urgency for caesarean birth described in NICE's guideline on caesarean birth, recommendation 1.4.2.

  • Category 1. Immediate threat to the life of the woman or fetus.

  • Category 2. Maternal or fetal compromise which is not immediately life-threatening.

  • Category 3. No maternal or fetal compromise but needs early birth.

  • Category 4. Birth timed to suit women or healthcare provider.

Consultant obstetrician involvement

This should include direct involvement in the decision either in person or via telephone if consultant cover is through on-call arrangements. Their involvement and the way in which they were involved (that is, by phone or in person) should be documented in the woman's maternity notes. [Expert opinion]

Equality and diversity considerations

Good communication between healthcare professionals and women who may need 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 may need 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.