A groundbreaking project is shedding light on how midwives can start to stem the increase in Caesarean sections.
A group of 11 trusts in the NHS South East Coast region are for the first time monitoring normal birth rates among specific groups - particularly first time mothers and those who have previously undergone a Caesarean.
Previously, hospitals have not broken the data down into groups of mothers, limiting understanding into how to tackle the growing number of women who choose to have a Caesarean even when they are not medically necessary.
South East Coast’s work comes as national figures this month show Caesarean rates continue to rise in many areas, despite a national campaign to reduce them.
Initial findings from the region’s hospitals suggest the proportion of mothers who have previously had a Caesarean who try for a normal birth in a subsequent pregnancy ranges from 53 per cent in one trust to 37 per cent in another. This indicates that good practice can help mothers plan for a normal birth even if they have experienced a Caesarean.
Emma Luhr, a midwife based at Brighton and Sussex University Hospitals Trust and the region’s programme lead for maternity, said hospitals needed to try to aid a “cultural change” in mothers who expect to choose a Caesarean in the future.
The South East Coast data shows the proportion of normal births among first time mothers ranges from 91 per cent at one trust to just 82 per cent in another.
There is no reason to believe the variation is not replicated across the whole country. So far, South East Coast is the only region to explore the issue in depth.
Ms Luhr said units with low normal birth rates among first time mothers needed to avoid inadvertently encouraging mothers to expect a Caesarean. That could be achieved by focusing on midwife led care and discussing normal birth as early as possible before labour.
“Before this [data was available], units knew what their overall Caesarean section rates were but generally didn’t have an understanding of the contribution made by different groups,” Ms Luhr said.
The improvement programme has also brought together midwives and obstetricians from different units to discuss the work, motivate each other and share ideas.
Tony Kelly, consultant obstetrician at the Brighton trust and joint lead of the programme, said: “This data is entirely unique. Some units have been surprised at where they sit in comparison to others.”
He said the region’s quality observatory had developed a way of analysing and providing the information throughout the project.
Chief nursing officer for England Dame Christine Beasley last year said that midwives should promote normal birth to reduce costs while improving care quality, as one of her high impact actions.