The Best Start - caesarean section rates: review report

Introduction

The Best Start Review Context

The Review of Maternity and Neonatal Services in Scotland was announced on 25 February 2015. The main aim was to ensure that every mother and baby continues to get the best care from Scotland's health service, giving all children the best start in life. The review examined choice, quality and safety of maternity and neonatal services, in consultation with the workforce, NHS Boards and service users.

The Best Start Review Report was published on 20 January 2017 and sets out the future vision for maternity and neonatal services in Scotland.^[2] The report also sets out what this vision will mean for the delivery of high quality and safe maternity and neonatal services across Scotland; how women, babies and families will receive the type of care they want and how staff will be supported to deliver that care. The 134 page report is based around 76 recommendations that will change the way that services are organised and delivered.

The Best Start – Caesarean Section Recommendation

Recommendation 17 within the Best Start Report relates to the rising rates of caesarean delivery. This report provides information about the rising caesarean section rate in Scotland and explores the factors contributing to the rising rates of caesarean section in Scotland by exploring the published data and evidence within Scotland, across the UK and wider where applicable. There are also areas highlighted for additional analysis to further understand the trends in caesarean section rates.

Recommendation 17 – Caesarean delivery should only be provided if clinically indicated and factors contributing to the rising caesarean section rate should be examined, from both the clinical, and women's perspective with optimal levels of intervention that balance risk and potential harm being identified.

Key Questions

The key areas for exploration set out in the project brief and covered in this report are outlined below:

1. Current rates and long-term trends in caesarean sections in Scotland, relative to the other counties of Great Britain and international comparisons where appropriate.

2. Rates of emergency vs elective caesarean sections (e.g. by board, by mothers age, by presentation, previous births etc.)

3. Rates of caesarean section alongside maternal mortality/morbidity and stillbirth/neonatal death rates and neonatal morbidity.

4. impact of changes to the NICE guidance in 2011 on c section rates.^[3]

5. Critical analysis of the rationale for differences in caesarean section rates, where evidence exists.

6. Evidence-informed actions to address non clinically indicated caesarean sections if evidence supports.