Quality standard

Quality statement 4: Consultant obstetrician involvement in decision making for planned caesarean birth

Quality statement 4: Consultant obstetrician involvement in decision making for planned caesarean birth

Quality statement

Pregnant women or pregnant people who may require a planned caesarean birth have consultant involvement in decision making.

Rationale

Consultant obstetricians are best placed to advise a pregnant woman or pregnant person who may need or want to plan a caesarean birth about the potential benefits and risks for each option based on their specific circumstances and needs. The involvement of a consultant is intended to ensure that the best possible outcomes are achieved for the pregnant woman or pregnant person and the baby.

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 may require a planned caesarean birth have consultant involvement in decision making.

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 may require a planned caesarean birth who have consultant involvement in decision making.

Numerator – the number in the denominator who have a consultant involved in decision making.

Denominator – the number of pregnant women or pregnant people who may require a planned caesarean birth.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient records.

Outcome

Women and people's satisfaction with the decision-making process.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example from patient surveys.

What the quality statement means for different audiences

Service providers ensure that systems are in place for pregnant women or pregnant people who may require a planned caesarean birth to have consultant involvement in decision making.

Healthcare professionals ensure that pregnant women or pregnant people who may require a planned caesarean birth have consultant involvement in decision making.

Commissioners ensure that they commission services that have systems in place for pregnant women or pregnant people who may require a planned caesarean birth to have consultant involvement in decision making.

Pregnant women or pregnant people who may need a planned caesarean birth have a consultant obstetrician involved in making the decision.

Source guidance

Caesarean birth. NICE guideline NG192 (2021, updated 2024), recommendation 1.3.3

Definitions of terms used in this quality statement

Pregnant women or pregnant people who may require a planned caesarean birth

This includes both pregnant women or pregnant people who have medical indications that would suggest that a planned caesarean birth would be the safest way of delivering the baby, and pregnant women or pregnant people who request a caesarean birth when there are no medical indications. [Adapted from NICE's guideline on caesarean birth, section 1.2, and expert opinion]

Decision making

The nature of the decision-making process and the extent to which the consultant will need to be involved in the process will vary between each pregnant woman or pregnant person and will depend on the complexity of their specific circumstances. [Expert opinion]

Equality and diversity considerations

Good communication between healthcare professionals and pregnant women or pregnant people 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 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 may need 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.