More choice and fewer interventions, NICE sets out priorities for straightforward births

10 Dec 2015 03:04 PM

NICE has issued a new quality standard which sets out priorities to help improve the quality of care of pregnant women during labour, and of their babies.

Around 700,000 women give birth in England each year and many will have a straightforward birth1, 2. Although NICE has confirmed that midwife-led care is just as safe as giving birth in hospital under the supervision of obstetricians, a 2013 report from the NCT (National Childbirth Trust) and the Women's Institute (WI) found that only 12% of women had been given the full choice of where to give birth.

The NICE quality standard for intrapartum care emphasises the need for women at low risk of complications to be given the full choice of birth settings. This could be at home, in a midwife-led unit which is freestanding or alongside a hospital, or in an obstetrician-led labour ward. It calls for commissioners to collect data on how well women and babies are doing in all settings locally so this can be used to help women make an informed decision.

The quality standard also calls for women with low risk of complications to be spared from unnecessary medical procedures if their labour is progressing normally. This includes electronic monitoring of the baby’s heartbeat or medicines to help speed up labour.

The quality standard also 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, including:

• Assigning a midwife to look after just one woman in labour, known as one-to-one care.
• Leaving a baby’s umbilical cord for at least 1 minute before clamping and cutting it, unless there are concerns about the baby.
• Encouraging women to have skin-to-skin contact with their babies as soon as possible after birth.

Professor Gillian Leng, deputy chief executive and director of health and social care at NICE: “With this new quality standard, we are highlighting key areas to prioritise to improve care so we make sure each woman and her baby has a good experience. The quality standard includes statements for obstetricians and midwives on what care is most important, from initial checks to appropriate procedures. It also highlights the support which should be provided to women to help them make informed choices and make sure they cope well immediately after a birth.

“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.”

Tracey Cooper, Consultant Midwife at Lancashire Teaching Hospitals Trust and a member of the committee that developed the quality standard, said: “For women who are not expected to have complications, we know that giving birth in freestanding or alongside midwife-led units is safer than hospital and that home birth is equally as safe as a freestanding or alongside midwife-led unit for the babies of low risk pregnant women who have already had at least 1 child previously. Women should have the ultimate choice and this quality standard highlights the importance for women to have the right information about their local services to help them make that choice.

“It also provides opportunities for midwives to work in different ways, in different birth settings creating more opportunities and job satisfaction. 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. The standards aim to ensure women and their families experience an informed positive birth experience."

Oxfordshire mother-of-three, Sarah Fishburn who sat on the committee that developed the quality standard, said: “For me, the advice and support I had from midwives and doctors made a big difference to how I made choices about the birth of each one of my children. My most positive experience came when I was planning a home birth. I was looked after by an amazing, well-informed midwife and a very supportive consultant obstetrician who both supported me to make the choices that were important to me. This quality standard stresses how providing women with clear, up-to-date information on outcomes about choices such as where they give birth is key to helping them make decisions they can be confident in.” 

The quality standard was developed following consultation with key organisations in the area of maternity care to provide their views on current practice and what needs to be done to provide women and babies with better quality care.

For more information call the NICE press office on 0300 323 0142 or out of hours on 07775 583 813.

Notes to Editors

Further information

1. Office for National Statistics. Births in England and Wales, 2014. 2015.
2. Sandall J et al. The efficient use of the maternity workforce and the implications for safety and quality in maternity care: a population-based, cross-sectional study. 2014.
3. NCT. Support Overdue: Women’s experiences of maternity services. 2013
4. The quality standard is available at /guidance/qs105.

About NICE quality standards

NICE quality standards aim to help commissioners, health care professionals, social care and public health practitioners and service providers improve the quality of care that they deliver.

NICE quality standards are prioritised statements designed to drive measurable quality improvements within a particular area of health or care. There is an average of 6-8 statements in each quality standard.

Quality standards are derived from high quality evidence-based guidance, such as NICE guidance or guidance from NICE accredited sources, and are produced collaboratively with health care professionals, social care and public health practitioners, along with their partner organisations, patients, carers and service users.

NICE quality standards are not mandatory but they can be used for a wide range of purposes both locally and nationally. For example, patients and service users can use quality standards to help understand what high-quality care should include. Health care professionals and social care and public health practitioners can use quality standards to help deliver high quality care and treatment.

NICE quality standards are not requirements or targets, but the health and social care system is obliged to have regard to them in planning and delivering services, as part of a general duty to secure continuous improvement in quality.

Quality standard topics are formally referred to NICE by NHS England (an executive non-departmental public body, established in October 2012) for health-related areas, and by the Department of Health and Department for Education for areas such as social care and public health.

About NICE

The National Institute for Health and Care Excellence (NICE) is the independent body responsible for driving improvement and excellence in the health and social care system. We develop guidance, standards and information on high-quality health and social care. We also advise on ways to promote healthy living and prevent ill health.

Our aim is to help practitioners deliver the best possible care and give people the most effective treatments, which are based on the most up-to-date evidence and provide value for money, in order to reduce inequalities and variation.

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