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More choice and fewer interventions needed in straightforward birth, says NICE

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The National Institute for Health and Care Excellence has issued a new quality standard that sets out priorities to help improve the quality of care of pregnant women and babies during labour, which strongly advocates one-to-one support, choice of birth setting and fewer interventions.

Although NICE has confirmed that midwife-led care is just as safe as giving birth under the supervision of obstetricians, a recent report from the National Childbirth Trust and the Women’s Institute found only 12% of women had been given the full choice of where to give birth.

“What we want is to support maternity services across the country to provide consistent, safe and high quality care”

Gillian Leng

The new NICE quality standard for intrapartum care emphasised the need for women at low risk of complications to be given the full choice of birth settings – at home, a midwife-led unit that is freestanding or alongside a hospital, or in an obstetrician-led labour ward.

It called for commissioners to collect data on how well women and babies were doing in all settings locally, so it can be used to help women make an informed decision.

The quality standard also said women with low risk of complications should be “spared” from unnecessary medical procedures if labour was progressing normally – for example, electronic monitoring of the baby’s heartbeat or medicines to help speed up labour.

In addition, the standard sets out priorities for all women going into labour, whether they and their babies were at low risk or developed complications.

They included assigning a midwife to look after just one woman in labour, leaving a baby’s umbilical cord for at least one minute before clamping and cutting, and encouraging women to have skin-to-skin contact with their babies as soon as possible.

NICE

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Gillian Leng

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE, said: “The quality standard includes statements for obstetricians and midwives on what care is most important, from initial checks to appropriate procedures.

“What we want is to support maternity services across the country to provide consistent, safe and high quality care for women and babies throughout their labour,” she said.

Tracey Cooper, consultant midwife at Lancashire Teaching Hospitals NHS Trust and a member of the committee that developed the quality standard, said women should have the right information about local services to help them choose where to have birth.

“It also provides opportunities for midwives to work in different ways, in different birth settings creating more opportunities and job satisfaction,” she said.

“It highlights the importance of providing one-to-one care in labour, of keeping mum and baby together during this important period of both their lives through delaying separation of the cord and immediate skin to skin contact from birth,” she added.

“These are very welcome standards and we expect maternity services to take notice of and put them into practice”

Louise Silverton

The standard was developed following consultation with key maternity care organisations on current practice and what needed to be done to provide women and babies with better quality care.

Louise Silverton, director for midwifery at the Royal College of Midwives, said: “These are very welcome standards and we expect maternity services to take notice of and put them into practice. It is no good having these standards if they are not being implemented.”

However, Ms Silverton warned that many women were unable to give birth where they chose, because of poor access to the type of unit they wanted or insufficient midwives.

She added: “We also know from maternity surveys that too many women are uncertain that their choice will be available when labour starts, or report being left alone in labour when they should be receiving one-to-one care from a midwife.

“The focus on skin-to-skin contact and delayed cord clamping is very welcome,” she said. “We also support the push for fewer and unnecessary interventions in labour.”

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