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Protecting mothers and babies
  1. M J Cameron,
  2. J Corfe,
  3. W Evans,
  4. R Goodsell,
  5. S Hunt,
  6. D Nirmal,
  7. S Rajshekhar,
  8. J Tinsey
  1. Norfolk and Norwich University Hospital, Norwich, UK


Introduction In East Anglia 25% of babies are delivered by caesarean section (CS). Much work has focused on reduction of elective caesareans by vaginal birth after CS clinics and external cephalic version for breech. We describe a quality improvement programme to decrease emergency caesareans.

Objective Decrease emergency CS by 20% within 6 months without increasing other adverse obstetric indicators.

Setting Tertiary hospital delivering 5800 babies annually.

Methods Three interventions were used, viz:

  1. Introduction of ‘Safe HANDS’ meeting: safe handling of all neonatal deliveries. A daily multi-disciplinary team meeting on the delivery suite with discussion of CS cases occurring past 24 h and performance review.

  2. Maternity dashboard widely available to maternity staff.

  3. Introduction of weekly statistical process control charts (SPC) of emergency LSCS to maternity staff.

Interventions were implemented using plan, design, study, act format.

Results Pre-interventions mean weekly emergency CS number was 15. Introduction of maternity dashboard failed to show change. Introduction of Safe HANDS meeting and SPC charts resulted in reduction to 12 CS per week. Adverse obstetric indicators using composite scoring for anal sphincter injury, postpartum haemorrhage >1000 ml, cord pH <7.1, apgars <7 at 5 min, perinatal death and unanticipated admission to NICU did not increase.

Conclusions Introduction of daily meeting for performance review alongside weekly data presentation using SPC charts results in reductions in emergency CS in our population. The model is likely to be transferrable to other service providers within the NHS.

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