A lack of operating theatres in maternity units is putting mums and newborn babies at risk of serious harm, an investigation reveals.
One in three do not have a second dedicated obstetric theatre staffed and ready to perform emergency C-sections 24 hours a day, seven days a week.
This is delaying operations beyond the safe period in some cases and resulting in documented safety incidents, the Health Service Journal found.
Maternity units are required to have a theatre for emergency C-sections, which is often needed when there are complications during birth.
But not all have a second theatre ready in case two are needed at the same time, with the issue emerging as a repeated factor in safety reports.
One in three maternity units do not have a second dedicated obstetric theatre staffed and ready to perform emergency C-sections 24 hours a day, seven days a week (stock image)
Information provided to HSJ by 81 trusts, running 99 maternity units between them, revealed 33 units had no dedicated second theatre, and many others did not have two theatres staffed at all times.
Asked what backup they had, these trusts said the normal arrangements were to transfer emergency C-sections to other theatres on the same site – but most said this could take up to 10 minutes.
Sixteen units said it would take at least 20 minutes to assemble an additional theatre team and be ready to operate and one said it would take up to an hour.
This was particularly the case out of normal hours, where maternity teams may have to call in a consultant and other staff from home or call staff from other parts of the hospital who may be busy.
The issues mean trusts may not be able to deliver the baby within 30 minutes of the decision a Caesarean is needed, which is the National Institute for Health and Care Excellence’s recommended maximum for a category one C-section where there is a risk to the life of the mother or baby.
Information provided to HSJ by 81 trusts, running 99 maternity units between them, revealed 33 units had no dedicated second theatre, and many others did not have two theatres staffed at all times (stock image)
Nearly a quarter of women require emergency Caesareans, according to NHS Digital.
Delaying the section can lead to complications and harm for the baby requiring lifelong care, such as cerebral palsy, or sometimes death.
Some are carried out because the baby has moved into a difficult position and cannot be born vaginally, or because the mother is at risk.
East Suffolk and North Essex Foundation Trust said when it needed an additional obstetric theatre, it had to mobilise an on-call team at Colchester Hospital, and ‘due to significant vacancies, sometimes there is a delay but of no more than an hour’.
Gateshead Trust told HSJ it would take ’30 or 40 minutes’ to mobilise a second theatre outside of weekday working hours, although it later said recent changes put it ‘in a much better position from both a workforce and estate perspective’ to provide timely C-sections when needed.
Twenty-six of the trusts said they had at least one serious incident report related to timely access to fully-staffed theatres in the past three years.
Many said no harm had resulted from these incidents. However, the risks have been highlighted both in inquests and Care Quality Commission reports.
Ian Scudamore, vice president of the Royal College of Obstetricians and Gynaecologists suggested more staff and more capital funding were needed.
He said: ‘These data reinforce that maternity services are stretched, with understaffed teams and inadequate estates potentially increasing risk at times of high activity.
‘Each maternity unit is different, and trusts will need different theatre capacity.
‘Trusts that have identified delays in both planned and emergency caesarean births and that are seeking funding for additional theatre space and staffing to address this should be supported.’
Several other trusts reported makeshift arrangements to provide an additional theatre in an emergency.
Wye Valley said it used an ‘intervention room’, which did not have enough floor space with adequate air flow to be classified as a theatre.
Worcestershire Acute Hospitals used a similar room, and Salisbury District Hospital said an anaesthetic room could be converted into a second theatre.
Others talked of ‘pausing’ planned C-section lists to make way for emergency procedures.
An NHS England spokesperson said: ‘In the unusual situation where two women require emergency operations at the same time, hospitals will have arrangements in place to facilitate this safely.
‘Increasing complexity of care is placing additional demand on services, and we are conducting a review of maternity and neonatal provision across the NHS to better understand and address any capacity challenges.’
