Women in labour 'need one-to-one care'

Publication Date:26/09/2007

Pregnant women should have one-to-one care from the same midwife during labour and birth, according to new NHS guidelines. The guidelines say that this should reduce the numbers of unnecessary medical procedures during childbirth, so women are more likely to have a normal birth.

What do we know already?

Women's experiences of labour and childbirth may vary a lot around the country, depending on the maternity services offered in their local area. While there is general agreement about what is 'best practice' in caring for women, there have been no national guidelines telling NHS maternity services what levels of service they should provide.

Many women admitted to hospital have different midwives caring for them because of shift changes. Yet research shows that having one-to-one care from the same person throughout labour increases women's chances of having a natural birth, without the need for forceps or a caesarean section. And being able to labour in water, in either a birthing pool or a bath, can help make labour less painful.

Many maternity services already offer these things, but not all of them do.

What does the new report say?

The group that drew up the guidelines say there is no single way of giving birth that is right for everyone, but that women need enough information and help to decide what is best for them personally.

These are some of the recommendations:

Women in labour should have supportive, one-to-one care from the same person, usually a midwife.
Medical procedures should not be suggested if labour is going normally and the mother and baby are doing well.
Women should be given full information and advice about pain relief, including the opportunity to labour in a birthing pool or bath.
Women should be advised that epidural pain relief may lengthen the labour. But women should have the opportunity to choose this if they want it. Epidurals are usually only available in hospital.
Babies' heartbeats should be checked by the midwife regularly through labour, but women don't need to be connected to a monitoring machine unless there are complications. However, if a woman prefers to be connected to a monitoring machine, that's fine.

The guideline also sets out advice for midwives and doctors about which checks should be done at which point. It gives clear advice about when medical procedures may be needed, and when specialist doctors (obstetricians) should be involved.

Doctors are less likely to be involved in normal deliveries as a result of this advice. Also, the guideline says medical procedures to speed up labour should be used less. So long as the woman and baby are doing well, midwives will wait longer than under earlier guidelines before suggesting medical procedures to speed labour up.

The average length of labour for a woman giving birth for the first time is eight hours. But this can be as long as 18 hours, while still being considered normal.

Where does the report come from?

The recommendations come from the National Institute for Health and Clinical Excellence (NICE), which was set up to advise the government about healthcare. The group who wrote the guidelines included midwives, obstetricians and representatives from support groups for women who have had bad experiences of childbirth.

What does this mean for me?

If you are expecting a baby, or planning a baby, this guideline tells you what sort of care you can expect from the NHS. Primary care trusts, which plan services for local areas, are expected to start making changes to services straight away, to make sure they come up to the standards set by NICE.

The guidelines are only for the care of women who give birth between 37 and 42 weeks, and who are expected to have a normal vaginal birth. They don't cover the care of women who experience complications, such as premature birth or their unborn baby not growing properly, or who have serious conditions such as pre-eclampsia or diabetes.

What should I do now?

You can find out more about the recommendations in the report by reading Understanding NICE guidance: care of women and their babies during labour, available from the NICE website (http://www.nice.org.uk). You can order a print copy from 0870 155 5455. If you are pregnant, you may want to talk to your midwife or doctor about the services they provide.

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