This really is excellent news.

On September 5, I contacted the Care Quality Commission (CQC)’s press office to request a statement for inclusion in the report I was preparing.

On September 7, I received this, and more:

Heidi Smoult, CQC’s Deputy Chief Inspector of Hospitals, said,

The language used in our inspection reports when describing our assessments in this area is very important.  Having reviewed this language,  we acknowledge that in some cases, we have not got this right. We are issuing further guidance to our inspection teams to ensure that going forward the wording used in our reports is clear and reflects our position in ensuring safe maternity care rather than appearing to encourage one approach over another.

The Chief Inspector also said:

When we inspect maternity services, our judgements are based on whether women get safe care within an environment where they are supported to make informed choices about that care. Avoiding unnecessary intervention in any pregnancy, particularly low risk pregnancies, is very important, but this should never be at the expense of a woman’s or baby’s health. It is vital that the approach taken is safe and informed by robust risk assessments with appropriate escalation pathways in place in accordance with the woman’s wishes. 

Where we find caesarean section rates are an outlier above or below the national average, we will raise this with trusts and seek assurances that the appropriate safe pathways are available to all women who may wish a vaginal birth or who may wish or require a caesarean section – but it is absolutely not our view that trusts should be encouraged to reduce caesarean rates. It is about making sure the care provided is safe, personalised and appropriate.

Maternal request

I wanted to confirm with the press office what this meant for maternal request support, and was assured that this is covered under “[We will] seek assurances that the appropriate safe pathways are available to all women who may wish a vaginal birth or who may wish or require a caesarean section…

If a Trust’s caesarean rate rises due to an increase in maternal request, and NICE recommendations were being followed, this is an acceptable reason.

The CQC spokesperson also assured me that, “CQC don’t believe that targets for caesarean section should be in place and therefore don’t inspect against targets. We do consider how caesarean rates compare with other hospitals nationally and then follow up on those which may be outliers either above or below the national average to check that the appropriate safe pathways are in place and are adhered to.

This news may take some time to filter through to all NHS Trusts, and more importantly, into improving maternity care practice (it may be years before CQC inspectors next visit some Trusts), but it is undoubtedly an important step forward.

CQC Report

My report, Five Years of Care Quality Commission (CQC) Maternity Inspections (2013-2018) was covered by Chris Smyth, Health Editor of The Times:

(September 8)
Natural-birth targets ‘put lives of mothers at risk’

(September 11)
Hospital inspectors ordered to stop criticising caesarean rates


  • Written by author and journalist Pauline Hull