Objective At the time of the National Sentinel Caesarean Section Audit the caesarean section rate (CSR) was rising by 1% per year. This audit aims to compare our current practise with that described in the Sentinel audit.

Design Retrospective Study.

Setting The Queen Elizabeth Hospital Kings Lynn.

Population Caesarean sections from three months of 2011–12.

Methods Case note review.

Main outcomes The primary outcomes were the caesarean section rate (CSR), the indications, appropriateness of the indication, and whether fetal blood sampling, external cephalic version (ECV), vaginal birth after caesarean (VBAC) were offered

Results The CSR was unchanged at 22% (18% “Sentinel”), forceps 7% (2.9–5.7%) and Ventouse 5% (5.7–9.7%) with 1:1 midwifery care in 92% of deliveries. The primary CSR was 66%. The electives were 34% (37%) and emergencies 66% (63%).

Only 4.2% of indications were debatable and in Grade 2 (G2) and 3 (G3) caesareans. The G2 caesareans indications were 30.7% for abnormal cardiotocograph and 53.5% for failure to progress (FTP). Only 6.7% had fetal blood sampling (FBS). Elective caesarean indications included, declined vaginal birth after one caesarean (32.1%), vaginal birth after two caesareans not offered (18.9%) and declined external cephalic version (13.2%).

Conclusions The CRS has remained static over the last decade despite occasional peaks. The majority of caesareans during these peaks were justified. The CSR could be improved by reducing the primary indications by increasing the use of FBS and better management of failure to progress, and secondary indications by improved counselling for VBAC and ECV.