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Focus on: caesarean section

The NHS Institute for Innovation and Improvement has launched a comprehensive new toolkit to assist maternity units in achieving low caesarean section rates while maintaining safe outcomes for mothers and babies.


Reducing c-section rates and improving outcomes at Blackpool Fylde and Wyre Hospitals.

Rising caesarean rates are a global concern. In the UK, c-section rates have increased from 12% in 1990 to 24% in 2008 with no improvement in outcomes for the baby.

Blackpool Fylde and Wyre Hopsitals NHS Foundation Trust has successfully reduced its caesarean rates from 28% to 22% and improved length of stay and patient experience since adopting the NHS Institute for Innovation and Improvement’s Pathways to Success toolkit.

This video looks at how using the toolkit in multi-disciplinary workshops has enabled the trust’s maternity team to improve communication and challenge existing practice to achieve results.



‘Pathways to Success – a self improvement toolkit’ enables maternity services to self assess themselves against best practice identified in units with a low caesarean section rate and provide practical techniques to support sustainable changes.

The toolkit is designed to encourage multidisciplinary involvement, offering an opportunity for midwives, obstetricians, managers, support staff and users of maternity care to work together to improve their services within multidisciplinary workshops. It draws on the findings of the NHS Institute’s ‘Focus On: Caesarean Section ’ report, which identified key principles to promoting normality and reducing caesarean section rates. Working directly with maternity units across the country five key pathways were developed:

  • First pregnancy and labour
  • Vaginal birth after caesarean
  • Elective caesarean section
  • Organisational characteristics
  • Top ten characteristics

Constructed around each of the pathways, the toolkit comprises a series of practical, easy to use products and guides. These include:

  • a self-assessment tool (enables maternity units to define their own current service and identify the characteristics of the service they aspire to)
  • a self-improvement action plan (leads participants through the process of developing pathway specific plans, to enable them to make these changes happen)
  • Tools for improvement (describes a number of tools to support and assist services in making changes)
  • Measures for improvement (useful information on choosing suitable measures)
  • Workshop facilitators’ guidance (how trusts can facilitate their own multidisciplinary workshop and begin to use the pathways, tools and measures.)
  • a CDROM (with further tools and access to adapt documents)


“This is the first time there has been any practical suggestions about what to do to change and improve services” Midwife

“This is a great toolkit that should really help staff and user representatives in NHS trusts to think about what affects their unit’s Caesarean rate and work together on a range of related actions to facilitate normal birth and prevent unnecessary surgery” Mary Newburn, Head of Policy Research, National Childbirth Trust & Honorary Professor, Thames Valley University


Dr Janet Baldwin interviewed on John Foster’s Breakfast Show, BBC Tees, Thursday 8 October 2009,  supports a local initiative at The James Cook hospital which supports women with high dependency pregnancies. Listen to the interview.

Listen to an interview with Dr Janet Baldwin about Caesarean sections.

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