Quality standard

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

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

Quality statement

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

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 women or people in labour being considered for an unplanned caesarean birth who have a consultant obstetrician involved in the decision.

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

Denominator – the number of women or people in labour being considered for an unplanned caesarean birth.

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

Outcomes

a) Unplanned caesarean birth rates.

Data source: The NHS Digital Maternity services secondary uses data set collects data on delivery method, which includes the number of emergency caesarean births.

b) 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 audits.

What the quality statement means for different audiences

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

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

Women or people 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, updated 2024), 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 pregnant woman or pregnant person 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 pregnant women or pregnant person 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 pregnant woman or pregnant person's maternity notes. [Expert opinion]

Equality and diversity considerations

Good communication between healthcare professionals and women or people in labour 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.