Individual research recommendation details

Recommendation ID

NG192/02

Question

Decision-to-birth interval (category 1 urgency): What factors influence the decision-to-birth interval when there is a category 1 level of urgency for caesarean birth?

Any explanatory notes
(if applicable)

Why this is important:
'Crash' caesarean birth is a psychologically traumatic event for women and their partners, and is also stressful for clinical staff. Staff and resources might have to be obtained from other areas of clinical care. This should be done as efficiently and effectively as possible, minimising anxiety and ensuring the safety of the mother and her baby.

For category 1 caesarean birth there is a recognised urgency to deliver as quickly as is reasonably possible. Most research in this area is quantitative and looks at the impact of the decision-to-birth interval on various aspects of fetal and maternal outcomes rather than the interplay of factors that can affect this time period itself. Much of this evidence is retrospective. Although some work has been done in the UK to examine where the systematic delays are and how to avoid them, more work is needed to determine how to optimise the decision-to-birth interval. This work should use qualitative as well as quantitative research methods to assess which factors influence the decision-to-birth interval for a category 1 caesarean birth. Evaluation of these factors could be used to inform future NICE guidance, for example, specific guidance for management of category 1 caesarean birth. Such information could also be used by hospitals for maternity services planning, and at a team level would assist with audit and ongoing evaluation and training of the multidisciplinary team.

A large amount of NHS and other state funding is used to provide continuing care for babies who are disabled as a result of birth asphyxia 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 Clinical Negligence Scheme for Trusts (CNST). If research helped to reduce the incidence of birth asphyxia 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-delivery interval based on evidence would inform debate in 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