Quality standard
Quality statement 2: Request for a caesarean birth: maternity team involvement
Quality statement 2: Request for a caesarean birth: maternity team involvement
Quality statement
Pregnant women or pregnant people who request a caesarean birth (when there is no medical indication) have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.
Rationale
The purpose of this statement is to inform decisions about the planned mode of birth. It is important that the pregnant woman or pregnant person can talk to the most relevant member of the maternity team depending on what their question or concern is about their request for a caesarean birth. It is important that access to members of the maternity team is possible at any point during the pregnant woman or pregnant person's pregnancy and promptly arranged following a request.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that pregnant women or pregnant people who request a caesarean birth (when there is no medical indication) have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
Process
The proportion of pregnant women or pregnant people who request a caesarean birth (when there is no medical indication) who have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.
Numerator – the number in the denominator who have a documented discussion with at least 1 member of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.
Denominator – the number of pregnant women or pregnant people who request a caesarean birth when there is no medical indication.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.
What the quality statement means for different audiences
Service providers ensure that systems are in place for pregnant women or pregnant people who request a caesarean birth (when there is no medical indication) to have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.
Healthcare professionals ensure that pregnant women or pregnant people who request a caesarean birth (when there is no medical indication) have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.
Commissioners ensure that they commission services that have systems in place for all pregnant women or pregnant people who request a caesarean birth (when there is no medical indication) to have a documented discussion with members of the maternity team about the overall benefits and risks of a caesarean birth compared with vaginal birth.
Pregnant women or pregnant people who ask for a caesarean birth (when there is no medical reason) have a discussion with members of the maternity team (which is recorded in their notes) about the benefits and risks of a caesarean birth compared with a vaginal birth.
Source guidance
Caesarean birth. NICE guideline NG192 (2021, updated 2024), recommendations 1.2.26 and 1.2.27
Definitions of terms used in this quality statement
Documented discussion
The discussion should include the reasons for the request and ensure that the pregnant woman or pregnant person has accurate information (including written information) about the overall benefits and risks associated with different modes of birth, based on the section on planning mode of birth in NICE's guideline on caesarean birth. This discussion should be documented in the pregnant woman or pregnant person's antenatal notes. [Adapted from NICE's guideline on caesarean birth, recommendations 1.2.26 and 1.2.27]
Maternity team
The maternity team should include a consultant midwife or senior midwife, a consultant or senior obstetrician and other members such as an anaesthetist. [Adapted from NICE's guideline on caesarean birth, recommendation 1.2.26]
Equality and diversity considerations
Good communication between healthcare professionals and pregnant women or pregnant people 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 pregnant women or pregnant people with additional needs such as physical, sensory or learning disabilities, and to pregnant women or pregnant people who do not speak or read English. Pregnant women or pregnant people who request a caesarean birth should have access to an interpreter or advocate if needed. For pregnant women or pregnant people 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.