Individual research recommendation details

Recommendation ID

NG192/03

Question

Decision-to-birth interval (category 2 urgency): A prospective study to determine whether the decision-to-birth interval has an impact on maternal and neonatal outcomes when there is a category 2 level of urgency for caesarean birth.

Any explanatory notes
(if applicable)

Why this is important:
This research is important to inform the ongoing debate about the management of category 2 caesarean birth. The 'continuum of risk' in this setting has been recognised. However, most of the work in this area, looking at maternal and fetal outcomes, generally considers unplanned caesarean birth as a whole group without making any distinction between degrees of urgency. Furthermore, much of this work is retrospective. Most women who undergo intrapartum caesarean birth fall into the category 2 level of urgency and therefore specific information for this group could affect and benefit many women and contribute to the delivery of equity of care.

Delay in birth with a compromised fetus could result in major and long-term harm including cerebral palsy and other major long-term disability. The immediate and long-term effect on a family of the birth of a baby requiring lifelong specialised care and support is enormous. If such harm could be avoided by appropriate haste this would be an important improvement in outcome. However, if such haste is of no benefit then any related risk of adverse maternal outcome needs to be minimised.

A large amount of NHS and other state funding is used to provide continuing care for babies who are disabled as a result of delay in birth and in providing lifelong support for the child and their family. In addition, large sums of public money are spent on litigation and compensation in some of these cases through the CNST. If research helped to reduce the incidence of delay in birth this would reduce the costs of continuing care to the state and the burden to the child, their family and the wider community.

More realistic and more relevant expectations for the decision-to-birth interval based on evidence would inform debate within the legal system and could help to reduce the cost to the state of related litigation.

Source guidance details

Comes from guidance

Caesarean birth

Number

NG192

Date issued

March 2021

Other details