Lack of operating theatres in maternity units puts mothers and newborns at risk of serious harm, research reveals.
One in three hospitals does not have a second specialized obstetric operating room, with staff trained and prepared to perform emergency cesarean sections 24 hours a day, seven days a week.
This is delaying operations beyond the safe period in some cases and leading to documented safety incidents, the Health Service Journal found.
Maternity units must have an operating room to perform emergency caesarean sections, which are often necessary when there are complications during delivery.
But not everyone has a second theater ready in case two are needed at the same time, and the issue emerges as a recurring factor in security reports.
One in three maternity units does not have a second specialized obstetric operating room, staffed and prepared to perform emergency Caesarean sections 24 hours a day, seven days a week (archive image)
Information provided to HSJ by 81 trusts, which run 99 maternity units in total, revealed that 33 units did not have a dedicated second operating theatre and many others did not have two operating theatres staffed at all times.
When asked what support they had in place, these trusts said normal arrangements were to transfer emergency caesareans 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 additional theater equipment and be ready to operate and one said it would take up to an hour.
This was particularly so outside of normal hours, when maternity teams might have to call a consultant and other staff from home or call staff from other parts of the hospital who might be busy.
The problems mean trusts may not be able to deliver a baby within 30 minutes of deciding a caesarean is necessary, which is the maximum recommended by the National Institute for Health and Care Excellence for a category one caesarean where there is a risk to the life of the mother or baby.
Information provided to HSJ by 81 trusts, which run 99 maternity units in total, revealed that 33 units did not have a dedicated second operating theatre and many others did not have two operating theatres staffed at all times (file image)
Almost a quarter of women need emergency caesarean sections, according to NHS Digital.
Delaying a cesarean section can lead to complications and damage to the baby that will require lifelong care, such as cerebral palsy or sometimes death.
Some are performed because the baby has moved into a difficult position and cannot be delivered vaginally or because the mother is at risk.
East Suffolk and North Essex Foundation Trust said that when it needed an additional obstetric operating theatre it had to mobilise an on-call team from Colchester Hospital and “due to significant vacancies there is sometimes a delay, but of no more than an hour”.
Gateshead Trust told HSJ it would take “30 or 40 minutes” to mobilise a second operating theatre outside of weekday working hours, although it later said recent changes put it “in a much better position from a workforce and estate perspective” to provide timely caesarean sections when needed.
Twenty-six of the trusts said they had had at least one serious incident report relating to timely access to fully staffed theatres in the past three years.
Many said these incidents had caused no harm, but the risks have been highlighted in both inquiries and in reports by the Care Quality Commission.
Ian Scudamore, vice-president of the Royal College of Obstetricians and Gynaecologists, suggested that more staff and more capital funding were needed.
She said: ‘These data reinforce the idea that maternity services are overstretched, with understaffed teams and inadequate facilities, potentially increasing risk at times of high activity.
‘Each maternity unit is different and trusts will need different operating theatre capacity.
‘Trusts that have identified delays in both planned and emergency caesarean births and are seeking funding for additional theatre space and staff to address this issue should be supported.’
Several other foundations reported makeshift arrangements to provide additional theatre in case of emergency.
Wye Valley said it used an “intervention room”, which did not have enough floor space or adequate airflow to be classed as a theatre.
Acute hospitals in Worcestershire used a similar room and Salisbury District Hospital said an anaesthetic room could be converted into a second operating theatre.
Others talked about “pausing” lists of planned Caesarean sections 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.
‘The increasing complexity of care is creating additional demand for services, and we are conducting a review of maternity and neonatal service provision across the NHS to better understand and address any capacity challenges.’