Table 1 Quality indicators in caesarean section care

1) Quality indicators on planned CS

  a) General counseling, CS is not mentioned (vaginal birth is the normal conduct)

  1. Twin pregnancy and first child cephalic position

  2. Fetal macrosomia (<4.5 kg in maternal diabetes, <5 kg no maternal diabetes)

  3. Preterm labour, cephalic position

  4. Small for gestational age without fetal distress

  5. Previous shoulder dystocia without impaired perinatal outcome

  b) Counseling directed at vaginal birth (vaginal birth and CS are options, vaginal birth is preferred)

  6. Position of the placenta at 1-2 cm of the internal os

Request for CS without medical grounds:

  7. Explore reason for request

  8. Discuss (dis)advantages to CS birth

  9. In case of extreme fear: offer psychological counselling

  10. Preterm breech birth (frank, complete breech)

  c) Counseling mentioning both vaginal birth and CS as equal options

  11. Breech presentation at term

Previous CS (inform on risks and chance of successful vaginal birth after cesarean)

  12. Inform on low risk of uterine rupture

  13. Inform on high chance of successful vaginal birth after cesarean

  14. Inform on increased risk and lower success rate in case of need for labour induction

  d) Prevention of planned CS

  15. Offer external cephalic version in case of non-cephalic position

  16. Use of internal audit on CS

2) Quality indicators on emergency CS

  17. In case of suspected fetal distress use ST analysis or micro blood analysis

In case of non-progressive labour first stage:

  18. Rupture of membranes,

  19. Urinary catheterization,

  20. Use of pain medication, preferably epidural analgesia,

  21. Adequate contractions or augmentation of labour

In case of non-progressive labour second stage in nulliparous women:

  22. Active pushing recommended,

  23. Adequate contractions recommended,

  24. Consider vacuum extraction if the head is <1/5th palpable per

Abdomen

  25. Continuous support during labour for women with or without prior training

  26. Use of partogram

  27. Involvement of consultant obstetrician in decision making for CS