National Institute for Health and Clinical Excellence (NICE)
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NICE guidelines published to improve women’s experience of labour

The National Institute for Health and Clinical Excellence (NICE) and the National Collaborating Centre for Women’s and Children’s Health have today (26 September 2007) issued guidance providing clear and consistent advice to doctors and midwives on how to support and care for women in labour. The guideline supports normal birth (that is a spontaneous vaginal birth where mother and baby are healthy afterwards) as well as setting out what to do if labour does not progress normally.


All recommendations in the guideline are underpinned by the principle that women are provided with information and advice so they are in control of what happens to them during labour and are able to make decisions that are right for them and their baby.


The key recommendations include:


• A woman in established labour should receive supportive one-to-one care.
• Clinical intervention should not be offered or advised where labour is progressing normally and the woman and baby are well.
• The opportunity to labour in water is recommended for pain relief.
• Before choosing epidural analgesia, women should be informed about the risks and benefits and the implications for their labour.
• Instrumental birth is an operative procedure that should be undertaken with tested effective anaesthesia.
• If genital trauma is identified following birth, further systematic assessment should be carried out, including a rectal examination.
• Women should be given the information and support to make an informed decision about where to give birth that is right for her and her baby

Andrea Sutcliffe, Executive lead for the guideline, and deputy chief executive, NICE said: “We want to make sure every woman’s experience of birth is as good as it can be and have used the best available evidence to set a national standard on how midwives and doctors can make labour a positive experience for women. Currently, the care of women in labour may be varied across the country - these guidelines set the standards of care that every woman should receive.”

Sara Kenyon, GDG chair and senior research fellow, said: “Birth is a life changing experience, but it is also a normal and natural part of life. This guideline respects the normal process of labour and birth and ensures women get the care and support they need. The evidence tells us that giving women balanced information and ensuring they are in control of what happens during their labour, enables them to make decisions that are right for them and their baby. This means they are more likely to have a positive birth experience, and this is important for themselves and their babies’ future.”

Maureen Treadwell of the Birth Trauma Association, said: “This guideline puts women at the centre of decision-making about their own maternity care and will impact on every woman who is planning a birth. The recommendations in this guideline allow women to make the choices that are right for them as individuals, based on the best available information. There is no ‘right’ way to give birth; only a way that is right for an individual woman. I know, from my own organisation, that birth is not always straightforward. However, where women receive excellent support, good information and feel in control of what is going on, and where analgesia for medical procedures is adequate and effective, then a complicated birth need not be a traumatic one, but a positive experience. This guideline will be pivotal in developing best practice and ensuring that the majority of women remember labour and birth as the positive experience that it should be.”

Dr Julia Sanders, consultant midwife, said: “Women and midwives alike always hope labour and birth will be normal with both mother and baby being healthy afterwards. This guideline is about ensuring that women who need additional care in labour receive it. Continuous supportive, one-to-one care and emotional support during labour is what women want and expect. Importantly, we know that this level of care during labour reduces the numbers of women needing a caesarean section or instrumental birth (such as forceps). The care recommended in this guideline will go
a long way to ensuring that many more women in England and Wales achieve the birth they desire and the very highest standard of care in labour that they deserve.”

Mr Stephen Walkinshaw, consultant in obstetrics, said: “As an obstetrician in one of the busiest maternity units in England, I know that these guidelines will really benefit the midwives and doctors looking after women during labour, as well as the women themselves. The guideline respects the normal labour process and recognises that it varies. It provides us with clearer definitions of what is normal and what isn’t, a more rounded approach to transfers of care between birth settings and evidence-based actions for the management of delay in labour, including instrumental birth. I hope it will lead, as we intend, to less involvement of doctors in what is a normal process, and allow us to concentrate on those women whose labour clearly falls outside these limits and who need specialist help.”

Notes to editors
About the guidance


1. The guideline, ‘Intrapartum care: care of healthy women and their babies during childbirth’ is available at www.nice.org.uk/CG55  (from 26 September)

2. NICE is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3. NICE produces guidance in three areas of health:

public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS.

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