Quality standard

Quality statement 2: One-to-one care

Quality statement 2: One-to-one care

Quality statement

Women in established labour have one-to-one care and support from an assigned midwife.

Rationale

One-to-one care will increase the likelihood of the woman having a 'normal' vaginal birth without interventions, and will contribute to reducing both the length of labour and the number of operative deliveries. Care will not necessarily be given by the same midwife for the whole labour.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.

Structure

Evidence of midwifery staff available to provide one-to-one care to women in established labour in each birth setting.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from staffing records.

Process

Proportion of women in established labour who receive one-to-one care from an assigned midwife.

Numerator – the number of women in the denominator who receive one-to-one care from an assigned midwife.

Denominator – the number of women in established labour.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. This may also include monitoring midwifery staffing levels as described in the NICE guideline on safe midwifery staffing for maternity settings.

Outcome

a) Neonatal morbidity.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from antenatal care records on provider systems. Trusts report on neonatal mortality as part of reporting on perinatal mortality rates using the MBRRACE-UK National Perinatal Mortality Review Tool for ongoing audit. NHS Digital's Maternity Services Data Set includes data on neonatal mortality and the Maternity Services Dashboard can be used to monitor performance and compare services.

b) Maternal morbidity.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records. MBRRACE-UK Confidential Enquiries into Maternal Deaths and Morbidity and the National Maternity and Perinatal Audit (NMPA) report on maternal morbidity. Indicators from MBRRACE-UK and the NMPA are available via the Maternity Services Dashboard.

c) Maternal satisfaction and experience of care.

Data source: National data is collected as part of the Care Quality Commission's Maternity Survey, section C ('Your labour and the birth of your baby'). Data can also be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient satisfaction surveys.

What the quality statement means for different audiences

Service providers (for all 4 birth settings) ensure that recommended midwifery staffing ratios are maintained so that women in established labour have one-to-one care and support from an assigned midwife.

Healthcare professionals (assigned midwives) give one-to-one care to each woman in established labour and are solely dedicated to the care of that woman.

Commissioners (integrated care systems) commission services that have systems in place to maintain recommended midwifery staffing ratios, so that women in established labour have one-to-one care and support from an assigned midwife.

A woman in labour is cared for by a midwife who is looking after just her – this is called 'one-to-one care'. She might not have the same midwife for the whole of labour. One-to-one care aims to ensure that the woman has a good experience of care and reduces the likelihood of problems for her and her baby.

Source guidance

Definitions of terms used in this quality statement

Established labour

Labour is established when:

  • there are regular painful contractions and

  • there is progressive cervical dilatation from 4 cm.

[Adapted from NICE's guideline on intrapartum care, recommendation 1.8.1]