NHS caesarean section shame: Mothers and newborns at risk of serious harm due to lack of operating theatres

Research shows that a lack of operating rooms in maternity wards poses a major risk to mothers and newborn babies.

One in three midwives does not have a second, specially staffed delivery room available 24 hours a day, 7 days a week to perform emergency caesarean sections.

In some cases, this leads to delays in carrying out work that last beyond the safe period, resulting in documented safety incidents, the Health Service Journal found.

Maternity wards must have an operating room for emergency caesarean sections. These are often necessary if complications occur during labour.

But not everyone has a second operating room ready in case two operating rooms are needed at the same time. This problem is therefore regularly mentioned in safety reports.

One in three maternity wards does not have a second dedicated delivery room that is staffed 24 hours a day, 7 days a week and ready to perform emergency caesarean sections (stock image)

Information provided to HSJ by 81 hospitals, which together operate 99 maternity wards, showed that 33 wards did not have a separate second operating room and that many other wards did not have two operating rooms available at all times.

When asked what backup they had, these hospitals said that the normal arrangement is to transfer emergency caesareans to other operating rooms in the same location. However, most said that this could take up to 10 minutes.

Sixteen units indicated that it would take at least 20 minutes to assemble and prepare an additional surgical team for deployment. One unit said it would take up to an hour.

This was especially the case outside normal working hours, when maternity teams had to call in a specialist and other staff from home or call in staff from other departments in the hospital who were busy.

These problems may mean that hospitals are unable to deliver the baby within 30 minutes of the decision that a caesarean section is needed. This is the maximum recommended time by the National Institute for Health and Care Excellence for a category 1 caesarean section where there is a risk to the life of the mother or the baby.

Information provided to HSJ by 81 trusts, which together manage 99 maternity units, showed that 33 units did not have a separate second operating theatre and many other units did not have two operating theatres at all times (stock image)

According to NHS Digital, almost a quarter of women will need an emergency caesarean section.

Delaying the cesarean section can lead to complications and harm to the baby requiring lifelong care, such as cerebral palsy or sometimes even death.

Sometimes interventions are performed because the baby is in a difficult position and cannot be born vaginally, or because the mother is at risk.

East Suffolk and North Essex Foundation Trust said an on-call team had to be mobilised at Colchester Hospital when an extra maternity ward was needed. ‘Due to the high number of vacancies there is sometimes a delay, but this is no more than an hour.’

Gateshead Trust told HSJ that it would take ’30 to 40 minutes’ to mobilise a second operating theatre outside working hours on weekdays. However, the company later said that recent changes had put it ‘in a much better position from both an employee and health system perspective’ to provide timely caesarean sections when needed.

Twenty-six hospitals reported at least one serious incident related to timely access to fully staffed theaters in the past three years.

Many said no harm had been done by these incidents. However, the risks have been highlighted in both research and reports from the Care Quality Commission.

Ian Scudamore, vice-president of the Royal College of Obstetricians and Gynaecologists, suggested that more staff and more capital were needed.

He said: ‘These data confirm that maternity services are under pressure, with understaffing and inadequate accommodation, which can increase risk at times of high activity.

‘Every maternity ward is different and every institution requires a different operating room capacity.

‘Hospitals that have experienced delays in both planned and emergency caesarean sections and are seeking funding for additional operating theatre space and staff to address this should be supported.’

Several other trusts reported that they had taken emergency measures to create an additional theatre in case of emergency.

Wye Valley said an ‘interventional space’ was used, which did not have sufficient floor space and airflow to be classified as an operating theatre.

Worcestershire Acute Hospitals used a similar space and Salisbury District Hospital said an anaesthetic suite could be converted into a second operating theatre.

Others talked about “pausing” planned C-sections to make room for emergency procedures.

An NHS England spokesperson said: ‘In the exceptional situation where two women need emergency surgery at the same time, hospitals have put in place measures to allow this to happen safely.

‘The increasing complexity of care is placing additional demands on service delivery. That’s why we are conducting a review of maternity and neonatal care across the NHS to better understand and address capacity issues.’