Quality standards for care during labour

The National Institute for Health and Care Excellence (NICE) have published a new “Quality standards” document on care of women during labour and birth.  This document sets out priorities for all women who go into labour (whether they and their babies are at low risk or go on to develop complications) using 7 key statements, which are summarised below:

Statement 1. Women at low risk of complications during labour are given the choice of all 4 birth settings (home, in a midwife‑led unit that is either attached to hospital or in a different place, or on a labour ward in hospital) and are given information about local birth outcomes.

Statement 2. Women in established labour have one‑to‑one care and support from an assigned midwife.

Statement 3. Women at low risk of complications do not have electronic monitoring of the baby’s heartbeat as part of the initial assessment of labour.

Statement 4. Women at low risk of complications who have this monitoring because of certain concerns have it removed if the trace is normal for 20 minutes.

Statement 5. Women at low risk of complications are not offered drugs to speed up labour.

Statement 6. Women do not have the cord clamped earlier than 1 minute after the birth unless there is concern for the baby’s well being.

Statement 7. Women have skin‑to‑skin contact with their babies after the birth.

RCM director for midwifery Louise Silverton said: “These are very welcome standards and we expect maternity services to take notice of and put them into practise. It is no good having these standards if they are not being implemented…The focus on skin-to-skin contact and delayed cord clamping is also very welcome. Both of these are very important for the health and wellbeing of the baby. We also support the push for fewer and unnecessary interventions in labour. They are often not supported by evidence and when their use is not indicated, can hinder, not help the woman and her labour to progress.”

Full NICE document may be viewed here

RCM response can be seen here