Quality standard

Quality statement 1: Choosing birth setting

Quality statement 1: Choosing birth setting

Quality statement

Women at low risk of complications during labour are given the choice of all 4 birth settings and information about local birth outcomes.

Rationale

Women at low risk of complications during labour and birth need information that is specific to their local or neighbouring area about safety and outcomes for women and babies in the different birth settings. This information will help women to make informed choices about where to have their baby.

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

a) Evidence of local arrangements to provide women at low risk of complications with a choice of all 4 birth settings.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, such as from service specifications and protocols.

b) Evidence of local arrangements to provide women at low risk of complications with local information about birth outcomes.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, such as patient leaflets and information available on local NHS and service provider websites.

Process

a) Proportion of women at low risk of complications with a recorded discussion at their 16‑week antenatal appointment of their preferred choice of birth setting.

Numerator – the number in the denominator with a recorded discussion at their 16‑week antenatal appointment of their preferred choice of birth setting.

Denominator – the number of women at low risk of complications attending a 16‑week antenatal appointment.

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

b) Proportion of women at low risk of complications with a recorded discussion at their 16‑week antenatal appointment about local birth outcomes.

Numerator – the number in the denominator with a recorded discussion at their 16‑week antenatal appointment about local birth outcomes.

Denominator – the number of women at low risk of complications attending a 16‑week antenatal appointment.

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

Outcome

Maternal experience and satisfaction with place of birth.

Data source: National data is collected as part of the Care Quality Commission's Maternity Survey, question B3 ('Were you offered a choice about where to have 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 (community, primary and secondary care services) raise awareness of maternity pathways and ensure that systems and tools are in place to offer women at low risk of complications a choice of all 4 birth settings and local information about birth outcomes to support them to make informed decisions about where to have their baby.

Healthcare professionals (such as midwives and obstetricians) provide women at low risk of complications with local information about birth outcomes and rates of transfer to an obstetric unit for all birth settings, and support them to make informed decisions about where to have their baby. Healthcare professionals can adapt and use NICE's resource for midwives on choosing place of birth to do this.

Commissioners (integrated care systems) commission maternity services to ensure that all 4 birth settings are available in the local or a neighbouring area to women at low risk of complications. Commissioners also ensure that services provide local information about outcomes for women and babies and rates of transfer to an obstetric unit for all birth settings to support women to make informed decisions about where to have their baby. Commissioners coordinate collection of outcome data in local and neighbouring areas to help service providers and healthcare professionals give information to women.

Women at low risk of having problems during labour and birth have a choice of 4 places where they can have their baby – at home, in a midwife-led unit that is either next to a hospital obstetric unit or in a different place, or in an obstetric unit ('labour ward'). To help women make an informed choice, they are given information by their midwife about birth outcomes and rates of transfer to an obstetric unit for their local or neighbouring area. Birth outcomes are things like the chances of needing a ventouse or forceps birth, caesarean birth or episiotomy, and the risk of serious medical problems for the baby.

Source guidance

Definitions of terms used in this quality statement

4 birth settings

The 4 settings where a woman at low risk of complications may choose to have her baby are: at home, in a freestanding midwifery unit, in an alongside midwifery unit and in an obstetric unit. [NICE's guideline on intrapartum care, recommendation 1.3.3]

Local birth outcomes

Outcomes for women for each planned place of birth include rates of spontaneous vaginal birth, transfer to obstetric unit, obstetric intervention and delivering a baby with or without serious medical problems. [Adapted from NICE's guideline on intrapartum care, recommendation 1.3.7]