Quality standard
Quality statement 5: Timing of planned caesarean birth
Quality statement 5: Timing of planned caesarean birth
Quality statement
Pregnant women or pregnant people 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
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 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: 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 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 in the denominator who have the caesarean birth carried out at or after 39 weeks.
Denominator – the number of pregnant women or pregnant people having a planned caesarean birth who do not need an earlier delivery because of maternal or fetal indications.
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 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 or pregnant people 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 pregnant women or pregnant people 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.
Pregnant women or pregnant people 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 person who is pregnant.
Source guidance
Caesarean birth. NICE guideline NG192 (2021, updated 2024), 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 pregnant woman or pregnant person and the maternity team. The pregnant woman or pregnant person should be given a specific day and time at which the caesarean birth 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]