The National Sentinel caesarean Section Audit in the UK

Abstract

Concern over the rapidly rising rate of caesarean section led the World Health Organisation, in 1985, to release a statement suggesting that a caesarean section rate greater than 10–15% was excessive. This recommendation was based on the figures from countries with caesarean section rates of under 10% that also had some of the lowest perinatal mortality rates. It had little impact on the global trend. The UK Department of Health commissioned an audit into caesarean sections from the Royal College of Obstetricians and Gynaecologists (RCOG). This was undertaken in collaboration with the Royal College of Anaesthetists (RCA), the Royal College of Midwives and the National Childbirth Trust. Clinical audit standards were drawn up from stringently scrutinised reviews, published guidelines and other evidence-based sources. A questionnaire was produced that recorded clinical information, sought clinicians’ views and maternal opinions. The audit booklet was circulated to over 250 National Health Service consultant-led maternity units, 20 midwife-led units and three private maternity hospitals in the UK. Scotland was not included. The audit captured 99% of all births in a 3-month period between 2000 and 2001. Supplementary organisational surveys examined midwifery, obstetric and anaesthetic data. Nearly 92% of the organisations and 77% of the consultants surveyed responded. Over 30% of the mothers contacted returned survey material. The National Caesarean Section Audit Report,1 presented at the RCOG in October 2001, showed that the national caesarean section rate in the UK had risen to 22%, in line with the developed world and similar to the rate in the United States of America (USA) and Italy. France and Scandinavian countries have lower rates (see Table 1). This report gives a detailed insight into current practice related to caesarean section in one country.