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The South East Coast Normalising Birth programme focuses on developing ways of working within delivery units to encourage normal birth for all women. Increasing normal birth rates has a direct effect on mothers; they are more mobile after birth, able to bond quicker with their babies and have higher breastfeeding rates than those who undergo caesarean births. Data on crude caesarean rates are currently collected in most units which often only indicate that a caesarean was an elective or an emergency. Crucial to promoting normal birth is being able to target specific clinical groups of women who have undergone caesarean sections. By monitoring these groups by trust and identifying which require most scrutiny, the data can be used both within individual units and across the SHA to identify clinical variation, find reasons for this variation, share challenges and solutions and learn from units undertaking best practice. The Normalising Birth dashboard supports delivery of the programme by presenting complex clinical data in a way that is simple to understand, and benchmarking results to enable spread of best practice. Turn over to find out more…...

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tÜ~íÛë=áå=íÜÉ=kçêã~äáëáåÖ=_áêíÜ=Ç~ëÜÄç~êÇ\= The Normalising Birth dashboard is presented in two parts. The first shows an overall SHA position, aggregated across the financial year, on a small range of indicators. This includes some measures using modified Robson groups, which are groupings of deliveries based on key clinical features. The focus of the programme is on women who fall into group 1, who are in their first pregnancy and labour, and those in group 5, who are in second or subsequent pregnancy and labour and who have had a previous caesarean section. = 1.

The aggregate caesarean section rates in group 1, group 5 and overall for each delivery unit (bars), shown against the SHA rates (lines)

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A monthly measure of the ratio between elective and emergency caesarean sections

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The aggregate caesarean section rate in the first five groups, which represent the majority of deliveries

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The dashboard includes an option to look at the data either from the perspective of rates of caesarean section, or rates of vaginal birth (which includes instrumentally assisted delivery)

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The second part of the dashboard is trust specific and, importantly, shows the data over time, on a monthly basis, as opposed to the aggregate position displayed in the first part. Users are able to view their own trust’s results but also that of any other trust in the region, as well as an overall SHA position. Again, the number of indicators is quite small, and Robson groups are used extensively. Data is presented in a simple graphical format, but also includes a small table to summarise wider results.


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The monthly caesarean section rates in group 1, group 5 and overall for each delivery unit (bars), shown against the monthly SHA rates (lines). The overall caesarean section rate for the previous 6 months leading into the start of the programme is also shown (derived from central data sources).

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A monthly measure of the ratio between elective and emergency caesarean sections

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The number of sections carried out in each Robson group, next to the caesarean section rate within that group and the contribution this makes to the overall caesarean section rate, to enable targeting of high impact groups.

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The monthly group 1 rate plotted against the number of reported adverse incidents; these include admissions of the baby to special care, third and fourth degree tears, uterine rupture and five minute Apgar scores below 3.

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The dashboard includes an option to look at the data either from the perspective of rates of caesarean section, or rates of vaginal birth (which includes instrumentally assisted delivery) uuuuuu= R= N=

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^åÇ=ãçêÉÁKK>= The Normalising Birth dashboard is the main operational information tool supporting the programme but is complemented by a range of other dashboards and tools that enable midwives and obstetricians to make the most of the information they collect. Some of these are explained in our other leaflets, including the caesarean section cost explorer and the group 5 breakdown tool. Outside of the Normalising Birth programme the Quality Observatory also produces the maternity dashboard, which helps to support trusts in measuring clinical quality in maternity units over a wide range of measures.


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_ÉåÅÜã~êâáåÖ= kÉíïçêâáåÖ= `çää~Äçê~íáçå= aÉîÉäçéãÉåí=çÑ=jÉíêáÅë= aÉîÉäçéãÉåí=çÑ=pâáääë= aÉîÉäçéãÉåí=çÑ=qççäë= pí~íáëíáÅ~ä=qÉÅÜåáèìÉë= mêÉëÉåí~íáçå=C=fåíÉêéêÉí~íáçå= a~í~=pçìêÅÉë=C=`çääÉÅíáçåë= Quality Observatory NHS South East Coast York House 18-20 Massetts Road Horley,Surrey, RH6 7DE Phone: 01293 778899 E-mail: Quality.Observatory@SouthEastCoast.nhs.uk Website: www.QualityObservatory.nhs.uk To contact a team member: firstname.surname@southeastcoast.nhs.uk

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Normalising birth booklet 1  

This leaflet provides an overview of the dashboard developed with clinicians by the South East Coast Quality Observatory to support improvem...

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