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Intrapartum care: care of healthy women and their babies during childbirth [CG190]

Measuring the use of this guidance

Recommendation: 1.1.2

Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth: Advise low‑risk multiparous women that planning to give birth at home or in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. Advise low‑risk nulliparous women that planning to give birth in a midwifery‑led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit. Explain that if they plan birth at home there is a small increase in the risk of an adverse outcome for the baby.

What was measured: Percentage of women who answered 'yes' to the statement 'I was offered a choice of giving birth in a midwife led unit or birth centre'.
Data collection end: February 2015
41%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes' to the statement 'I was offered a choice of giving birth in a consultant led unit'.
Data collection end: February 2015
18%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes' to the statement 'I was offered a choice of giving birth at home'.
Data collection end: February 2015
39%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes' to the statement 'I was offered a choice of giving birth in a midwife led unit or birth centre'.
Data collection end: February 2017
42%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes' to the statement 'I was offered a choice of giving birth in a consultant led unit'.
Data collection end: February 2017
18%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes' to the statement 'I was offered a choice of giving birth at home'.
Data collection end: February 2017
38%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.1.6

Commissioners and providers should ensure that all 4 birth settings are available to all women (in the local area or in a neighbouring area). [2014]

What was measured: The proportion of trusts and boards offering all 4 birth settings.
Data collection end: August 2017
22%
Number that met the criteria: 34 / 155
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit

What was measured: The proportion of trusts who have an obstetric unit.
Data collection end: May 2016
99%
Number that met the criteria: 132 / 134
Area covered: England
Source: Walsh D, Spiby H, Grigg CP (2018) Mapping midwifery and obstetric units in England. Midwifery 56, 9-16

What was measured: The proportion of trusts who have a 'freestanding midwifery unit'.
Data collection end: May 2016
29%
Number that met the criteria: 39 / 134
Area covered: England
Source: Walsh D, Spiby H, Grigg CP (2018) Mapping midwifery and obstetric units in England. Midwifery 56, 9-16

What was measured: The proportion of Trusts with an obstetric unit, who have at least one 'alongside midwifery unit'.
Data collection end: May 2016
65%
Area covered: England
Source: Walsh D, Spiby H, Grigg CP (2018) Mapping midwifery and obstetric units in England. Midwifery 56, 9-16


Recommendation: 1.2.1

Treat all women in labour with respect. Ensure that the woman is in control of and involved in what is happening to her, and recognise that the way in which care is given is key to this. To facilitate this, establish a rapport with the woman, ask her about her wants and expectations for labour, and be aware of the importance of tone and demeanour, and of the actual words used. Use this information to support and guide her through her labour.

What was measured: Percentage of women who answered 'yes, always' to the question 'Thinking about your care during labour and birth, were you involved enough in decisions about your care?'
Data collection end: February 2013
74%
Data collection end: February 2015
75%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes, always' to the question 'Thinking about your care during labour and birth, were you treated with respect and dignity?'
Data collection end: February 2013
85%
Data collection end: February 2015
87%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes, always' to the question 'Thinking about your care during labour and birth, were you involved enough in decisions about your care?'
Data collection end: February 2017
77%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes, always' to the question 'Thinking about your care during labour and birth, were you treated with respect and dignity?'
Data collection end: February 2017
88%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Proportion of women who reported having concerns about safety during labour and birth that were not taken seriously.
Data collection end: May 2015
6.3%
Data collection end: May 2016
5.5%
Data collection end: May 2017
6.3%
Area covered: England
Source: NHS Safety Thermometer: Maternity


Recommendation: 1.2.2

To establish communication with the labouring woman, healthcare professionals should: • Greet the woman with a smile and a personal welcome, establish her language needs, introduce themselves and explain their role in her care. • Maintain a calm and confident approach so that their demeanour reassures the woman that all is going well. • Knock and wait before entering the woman's room, respecting it as her personal space, and ask others to do the same. • Ask how the woman is feeling and whether there is anything in particular she is worried about • If the woman has a written birth plan, read and discuss it with her. • Assess the woman's knowledge of strategies for coping with pain and provide balanced information to find out which available approaches are acceptable to her. • Encourage the woman to adapt the environment to meet her individual needs. • Ask her permission before all procedures and observations, focusing on the woman rather than the technology or the documentation. • Show the woman and her birth partner how to summon help and reassure her that she may do so whenever and as often as she needs to. When leaving the room, healthcare professionals should let her know when they will return. • Involve the woman in any handover of care to another professional, either when additional expertise has been brought in or at the end of a shift.

What was measured: Women who had their birth plan discussed with them
Data collection end: December 2010
68%
Area covered: Local
Source: Anantharchagan A, Chandrasekaran N, Nair V (2012) Intrapartum care: do we bother? An audit of practice in a District General Hospital. British Journal of Obstetrics and Gynaecology Vol 119 Supp 1 pp73-74

What was measured: Percentage of women who answered 'yes, all of the staff introduced themselves' to the question 'Did the staff treating and examining you introduce themselves?'
Data collection end: February 2013
83%
Data collection end: February 2015
84%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.2.3

Encourage and help the woman to move and adopt whatever positions she finds most comfortable throughout labour.

What was measured: Percentage of women who answered 'yes, most of the time' to the question 'During your labour, were you able to move around and choose the position that made you most comfortable?'
Data collection end: February 2015
70%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes, most of the time' to the question 'During your labour, were you able to move around and choose the position that made you most comfortable?'
Data collection end: February 2017
70%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.2.4

Encourage the woman to have support from birth companion(s) of her choice.

What was measured: Percentage of women who answered 'yes' to the question 'If your partner or someone else close to you was involved in your care during labour and birth, were they able to be involved as much as they wanted?'
Data collection end: February 2013
95%
Data collection end: February 2015
95%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes' to the question 'If your partner or someone else close to you was involved in your care during labour and birth, were they able to be involved as much as they wanted?'
Data collection end: February 2017
96%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.3.5

Consider a face‑to‑face early assessment of labour for all low‑risk nulliparous women, either: - at home (regardless of planned place of birth) or - in an assessment facility in her planned place of birth (midwifery‑led unit or obstetric unit), comprising one‑to‑one midwifery care for at least 1 hour. [2014]

What was measured: The proportion of trusts and boards offering women assessment in early labour at their planned place of birth.
Data collection end: August 2017
94%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit

What was measured: The proportion of trusts and boards offering women at low risk of complications assessment in early labour at home, regardless of their planned place of birth.
Data collection end: August 2017
13%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit


Recommendation: 1.4.2

Carry out an initial assessment to determine if midwifery‑led care in any setting is suitable for the woman, irrespective of any previous plan. The assessment should comprise the following: •Observations of the woman: ◦ Review the antenatal notes (including all antenatal screening results) and discuss these with the woman. ◦ Ask her about the length, strength and frequency of her contractions. ◦ Ask her about any pain she is experiencing and discuss her options for pain relief. ◦ Record her pulse, blood pressure and temperature, and carry out urinalysis. ◦ Record if she has had any vaginal loss. •Observations of the unborn baby: ◦Ask the woman about the baby's movements in the last 24 hours. ◦Palpate the woman's abdomen to determine the fundal height, the baby's lie, presentation, position, engagement of the presenting part, and frequency and duration of contractions. •Auscultate the fetal heart rate for a minimum of 1 minute immediately after a contraction. Palpate the woman's pulse to differentiate between the heart rates of the woman and the baby. In addition (see also recommendation 1.4.5): • If there is uncertainty about whether the woman is in established labour, a vaginal examination may be helpful after a period of assessment, but is not always necessary. • If the woman appears to be in established labour, offer a vaginal examination.

What was measured: Women who had an initial set of observations recorded
Data collection end: December 2010
95%
Area covered: Local
Source: Anantharchagan A, Chandrasekaran N, Nair V (2012) Intrapartum care: do we bother? An audit of practice in a District General Hospital. British Journal of Obstetrics and Gynaecology Vol 119 Supp 1 pp73-74

What was measured: Women who had an initial abdominal examination recorded
Data collection end: December 2010
85%
Area covered: Local
Source: Anantharchagan A, Chandrasekaran N, Nair V (2012) Intrapartum care: do we bother? An audit of practice in a District General Hospital. British Journal of Obstetrics and Gynaecology Vol 119 Supp 1 pp73-74


Recommendation: 1.7.1

Provide a woman in established labour with supportive one‑to‑one care. [2007]

What was measured: Proportion of sites reporting that all women had one to one midwifery care in labour.
Data collection end: August 2017
54%
Number that met the criteria: 127 / 236
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit


Recommendation: 1.7.2

Do not leave a woman in established labour on her own except for short periods or at the woman's request.

What was measured: Percentage of women who answered 'yes, during the later stages of labour' to the question 'Were you (and/or your partner or a companion) left alone by midwives or doctors at a time when it worried you?'
Data collection end: February 2013
9%
Data collection end: February 2015
9%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes, all of the staff introduced themselves' to the question 'Did the staff treating and examining you introduce themselves?'
Data collection end: February 2017
86%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Percentage of women who answered 'yes, during the later stages of labour' to the question 'Were you (and/or your partner or a companion) left alone by midwives or doctors at a time when it worried you?'
Data collection end: February 2017
8%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: Proportion of women who reported being left alone at a time that worried them.
Data collection end: May 2015
3.6%
Data collection end: May 2016
3.1%
Data collection end: May 2017
2.2%
Area covered: England
Source: NHS Safety Thermometer: Maternity


Recommendation: 1.8.4

Offer the woman the opportunity to labour in water for pain relief. [2007]

What was measured: Proportion of labour wards with at least one plumbed-in birth pool.
Data collection end: August 2017
82%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit

What was measured: Proportion of midwife-led units with at least one plumbed-in birth pool.
Data collection end: August 2017
91%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit


Recommendation: 1.12.5

Use a pictorial record of labour (partogram) once labour is established.

What was measured: Women who had a partogram recorded
Data collection end: December 2010
82%
Area covered: Local
Source: Anantharchagan A, Chandrasekaran N, Nair V (2012) Intrapartum care: do we bother? An audit of practice in a District General Hospital. British Journal of Obstetrics and Gynaecology Vol 119 Supp 1 pp73-74


Recommendation: 1.13.15

Do not carry out a routine episiotomy during spontaneous vaginal birth. [2007]

What was measured: Proportion of women who have a spontaneous vaginal birth of a singleton, cephalic baby at term and who have an episiotomy.
Data collection end: March 2016
8.5%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit


Recommendation: 1.15.6

Encourage women to have skin‑to‑skin contact with their babies as soon as possible after the birth.

What was measured: Percentage of women who answered 'yes' to the question 'Did you have skin to skin contact (baby naked, directly on your chest or tummy) with your baby shortly after the birth?'
Data collection end: February 2013
90%
Data collection end: February 2015
90%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.

What was measured: The proportion of women at 37 weeks gestation or more who had skin-to-skin contact within 1 hour of birth.
Data collection end: December 2016
80%
Area covered: England
Source: Maternity Services Monthly Statistics, England - Experimental statistics.

What was measured: Proportion of babies born between 34 weeks and 42 weeks who receive skin to skin contact within one hour of birth.
Data collection end: March 2016
79.8%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit

What was measured: Proportion of babies born between 34 weeks and 36 weeks who receive skin to skin contact within one hour of birth.
Data collection end: March 2016
55%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit

What was measured: Proportion of babies born between 37 weeks and 42 weeks who receive skin to skin contact within one hour of birth.
Data collection end: March 2016
81.3%
Area covered: Great Britain
Source: The National Maternity and Perinatal Audit

What was measured: Percentage of women who answered 'yes' to the question 'Did you have skin to skin contact (baby naked, directly on your chest or tummy) with your baby shortly after the birth?'
Data collection end: February 2017
92%
Area covered: England
Source: Care Quality Commission. Survey of women's experiences of maternity care.


Recommendation: 1.15.9

Encourage initiation of breastfeeding as soon as possible after the birth, ideally within 1 hour.

What was measured: Public Health Outcomes Framework indicator 2.02i: Proportion of all mothers who breastfeed their babies in the first 48hrs after delivery.
Data collection end: March 2015
74.3%
Area covered: England
Source: Public Health England. Public Health Outcomes Framework



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