Intrapartum care

Context

Giving birth is a life-changing event. The care that a woman receives during labour has the potential to affect her – both physically and emotionally, in the short and longer term – and the health of her baby. Good communication, support and compassion from staff, and having her wishes respected, can help her feel in control of what is happening and contribute to making birth a positive experience for the woman and her birth companion(s).

This guideline covers the care of women who go into labour at term (37+0 to 41+6 weeks). About 600,000 women give birth in England and Wales each year, of whom about 40% are having their first baby. Most of these women are healthy and have a straightforward pregnancy. Almost 90% of women will give birth to a single baby after 37 weeks of pregnancy, with the baby presenting head-first. About two-thirds of women go into labour spontaneously. Therefore, most women giving birth in England and Wales are covered by this guideline.

Since the original guideline was published in 2014, the number of women giving birth in England and Wales each year has decreased, but the rate of intervention (births with forceps or ventouse and caesarean birth) has increased slightly, and there has been some reconfiguration of services. In 2019 to 2020, 57% of births were spontaneous vaginal births, 12% needed the use of forceps or ventouse and 31% of women had a caesarean birth (including planned and unplanned).

It is important that the woman is given information and advice about all available settings when she is deciding where to have her baby, so that she is able to make a fully informed decision. This includes information about outcomes for the different settings. It is also vital to recognise when transfer of care from midwifery-led care to obstetric-led care is indicated because of increased risk to the woman and/or her baby resulting from complications that have developed during labour.

Uncertainty and inconsistency of care has been identified in a number of areas, such as choosing place of birth, care during the latent first stage of labour, fetal assessment and monitoring during labour (particularly cardiotocography compared with intermittent auscultation) and management of the third stage of labour. These and other related topics are addressed in the guideline. The recommendations on fetal monitoring have been removed from this guideline and can now be found in the separate NICE guideline on fetal monitoring in labour.

The guideline is intended to cover the care of women with uncomplicated pregnancies entering labour at low risk of developing intrapartum complications. In addition, recommendations are included that address the care of women who start labour as low risk but who go on to develop complications. These include the care of women with prelabour rupture of membranes at term, care of the woman and baby when meconium is present and the management of retained placenta and postpartum haemorrhage.