Risk assessment and planning are key components of individualised care for pregnant women, so that any factors likely to affect the pregnancy or birth can be identified in a timely manner. This guideline deals with care for women at higher risk of complications in labour and birth, either because of an existing medical condition or because obstetric complications develop. With appropriate risk assessment and care planning, care can be delivered to maximise the chances of good outcomes for both the woman and her baby. Assessment and planning start at the antenatal booking appointment and continue throughout pregnancy at each antenatal contact. During labour, routine monitoring of the woman and her unborn baby and of the progress of labour is a continuation of the risk-screening process. Findings from these assessments will affect the plan of care for labour, and may result in changes to the plan being made antenatally or during labour if new complications are identified.

A pregnancy is 'high risk' when the likelihood of an adverse outcome for the woman or the baby is greater than that of the 'normal population'. A labour is 'high risk' when the likelihood of an adverse outcome related to labour (for the woman or the baby) is greater than that of the 'normal population'.

The level of risk may be determined before pregnancy or arise during pregnancy or during labour, and can affect the woman or the baby:

  • A woman may have an existing medical condition that can be made worse by physiological changes that occur in labour.

  • Obstetric (pregnancy-related) problems can develop that increase the risk of adverse labour and/or birth outcomes.

  • A woman can enter labour with no identified complications and be considered at low risk of complications, but problems may arise during labour that can be associated with adverse outcomes.