Normalising Birth programme

The journey –

The aim of the Normalising Birth programme was to address the clinical variation in deliveries across the 11 acute trusts in the South East Coast region. It was important in the early stages to develop a clear understanding of why the variation in birth intervention (primarily Caesarean sections) existed, and to identify those units who were performing well. From here, best practice could be spread.

Care providers have been pressurised to respond to data on Caesarean rates by lowering them, however, this data was regarded by the project manager as a somewhat blunt indicator of the quality of maternity care. The vision was to explore this clinical variation in more meaningful ‘sub-groups’. A detailed exploration was seen as a potentially powerful tool for initiating change and improvement across the region.



A significant achievement of the programme is a unique dataset which now exists, illustrating the regional clinical variation in intervention, at a more meaningful level of detail. Trusts are now able to look at their own performance in direct comparison to that of other trusts, something which has provided additional clarity in analysing their own performance and working culture.

The development and use of this data has been instrumental in helping trusts to learn collaboratively and share best practice, for example in supporting or advising other units facing similar challenges.

A further achievement has been the increase in enthusiasm for new, larger projects arising from the collaborative nature of the programme and resulting increase in confidence created through the group process.


Patient setting

In-patient   X Out-patient Community based
Mental health Chronic illness Cross-systems


Clinical area

Staying healthy Maternity and newborn X Children and young people Acute care
Planned care   X Mental health Long-term conditions End of life


Information, tools and techniques used

No specific change model was followed, although elements of the PDSA (Plan, Do, Study, Act) cycle were used.


Clinical network meetings were facilitated by staff from NHSI specialising in the maternity pathway. The clinical group also provided invaluable peer support for each other, sharing tested methodologies in the process.



All acute trusts in the South East Coast area (Kent, Surrey and Sussex) were involved.



The project ran from April 2010 until March 2012, when funding came to an end.  Information is still added to the programme’s database however, and this continues to be analysed.


Contact details and further information

Normalising Birth was led by Tony Kelly

Posted on Jan 16th, Cat: , , , Tags: , Comments: Comments are off for this post

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