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The measures included within the Maternity and Newborn Patient Safety domain have been created in conjunction with the Towards Excellence Normalising Births workstream to support their plan of work.
SUMMARY REPORT Q4 1011
The indicators are as follows:
The percentage of normal births (defined as unassisted vaginal deliveries) is perhaps the most obvious indicator for ‘normalising births’ although it is important that this is considered alongside other indicators. The measurement and audit of normal birth rates are supported by the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and the Department of Health. Promoting normal birth is also a High Impact Action for nursing and midwifery (NHS Institute for Innovation and Improvement).
Percentage of normal births by NHS hospital trust
Elective and Non-Elective C-Sections:
Elective and non-elective C-Section were chosen as indicators following the BMJ article on the C-Section rate variance among English NHS Trusts (Oct 2010). The data showed that nearly 1 in 4 women had a C-Section. The national C-Section rate is 23.8% for women with singleton births. The article stated that C-Section rates varied between Trusts even after adjustments were made for differences between patient populations. Of the total number of C-Sections, 9.3% were elective and 14.5% were emergency.
Data for the East Midlands shows greater variation within elective C-Sections than non-elective and is therefore a useful indicator for review.
Percentage of deliveries where method was elective C-section by NHS hospital trust
Percentage of deliveries where method was non-elective C-section by NHS hospital trust
Singleton C-Section is a national evidence comparator. C-Section rates may vary by provider and an optimal rate can be difficult to determine. However, it is known that both under and over use can have a negative effect on safety. Evidence-based recommendations and innovative models of care can lead to lower C-Section rates without any reduction in safety. The application of best practice in pregnancy, labour and birth will achieve safe C-Section rates consistently below 20%.
Initially it was planned to measure overall C-Section rates plus single and multiple C-Section rates. However, the numbers of multiple C-Sections were so low that they were considered to be an unhelpful measure and little difference remained between overall and singleton C-Section. The latter has therefore been chosen as the most helpful measure.
Percentage of deliveries where method was C-section and singleton by NHS hospital trust
C-section rates are also being measured as part of the regional CQUIN scheme, which rewards trusts financially for making quality improvements. To find out more click here.