Caesarean section - promoting normal birth and reducing caesarean section rates

The Rapid Improvement Programme for caesarean section (CS) began in April 2008. The NHS Institute’s CS team worked with NHS maternity services to identify the practices and behaviours that contribute to achieving consistently low CS rates. This information was gained from visiting maternity units with a range of CS rates, observing practice and talking to staff and service users both formally and informally.

From this work the team developed the pathways to success self-improvement toolkit (NHS Institute, April 2007). The toolkit enables maternity services to assess where they fit currently into the spectrum of behaviours and characteristics that were identified during the project, and to decide on their goals and priorities in moving their service forward. The toolkit also provides practical support in making sustainable changes to maternity services.

Participating trusts

Twenty trusts were selected as part of this programme, two per strategic health authority. Each trust is working with the NHS Institute’s CS team who are  providing free support to embed the pathways to success toolkit. The NHS Institute are supporting the trusts in understanding where to focus improvement activity to promote normal birth and reduce caesarean section rates. In addition to being part of the programme, the trusts will also receive training in other NHS Institute areas including Productive Ward and Thinking Differently.

For a list of participating trusts click here.


The NHS Institute, in collaboration with each SHA, will support and facilitate the development of up to three network events for each SHA region in England. These one day events will provide opportunities for every trust within the SHA region, to share their experiences of promoting normal birth and reducing caesarean section rates within a supportive network. To view up coming events click here.

Please keep visiting the website for information about new events.


For further information about this programme contact Sophie Cowley at *

* Please note that the NHS Institute is an innovation and improvement organisation and is unable to give medical advice to patients or their carers