Focus on: caesarean section

The NHS Institute for Innovation and Improvement has launched a comprehensive new toolkit to assist maternity units in achieving low caesarean section rates while maintaining safe outcomes for mothers and babies.

‘Pathways to Success – a self improvement toolkit’ enables maternity services to self assess themselves against best practice identified in units with a low caesarean section rate and provide practical techniques to support sustainable changes.

The toolkit is designed to encourage multidisciplinary involvement, offering an opportunity for midwives, obstetricians, managers, support staff and users of maternity care to work together to improve their services within multidisciplinary workshops. It draws on the findings of the NHS Institute’s ‘Focus On: Caesarean Section ’ report, which identified key principles to promoting normality and reducing caesarean section rates. Working directly with maternity units across the country five key pathways were developed:

  • First pregnancy and labour
  • Vaginal birth after caesarean
  • Elective caesarean section
  • Organisational characteristics
  • Top ten characteristics

Constructed around each of the pathways, the toolkit comprises a series of practical, easy to use products and guides. These include:

  • a self-assessment tool (enables maternity units to define their own current service and identify the characteristics of the service they aspire to)
  • a self-improvement action plan (leads participants through the process of developing pathway specific plans, to enable them to make these changes happen)
  • Tools for improvement (describes a number of tools to support and assist services in making changes)
  • Measures for improvement (useful information on choosing suitable measures)
  • Workshop facilitators’ guidance (how trusts can facilitate their own multidisciplinary workshop and begin to use the pathways, tools and measures.)
  • a CDROM (with further tools and access to adapt documents)


“This is the first time there has been any practical suggestions about what to do to change and improve services” Midwife

“This is a great toolkit that should really help staff and user representatives in NHS trusts to think about what affects their unit’s Caesarean rate and work together on a range of related actions to facilitate normal birth and prevent unnecessary surgery” Mary Newburn, Head of Policy Research, National Childbirth Trust & Honorary Professor, Thames Valley University


Latest News

NHS Wales to implement c-section toolkit

The NHS Institute and the Welsh Assembly have agreed a contract to support the implementation of DQV’s ‘Pathways to Success Toolkit: Focus on normal birth and reducing Caesarean section rates’.

Under the agreement, DQV’s c-section team will facilitate the implementation of the toolkit in every NHS trust in Wales during 2009 at a total cost of £50,000.

Following implementation, each trust will be expected to produce an action plan for reducing unnecessary intervention.

Also visit the Welsh Assembly website for further information about the local implementation plan.


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