Quality standard

Quality statement 5: Interventions during labour

Quality statement

Women at low risk of complications are not offered amniotomy or oxytocin if labour is progressing normally.

Rationale

For women at low risk of complications, amniotomy and oxytocin do not reduce the incidence of caesarean birth, increase the incidence of spontaneous vaginal births or contribute to improved neonatal outcomes. They are therefore unnecessary for women at low risk of complications if labour is progressing normally.

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 local arrangements to ensure that women at low risk of complications who are in labour that is progressing normally do not have amniotomy or oxytocin.

Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local protocols on the use of amniotomy and oxytocin.

Process

Proportion of women at low risk of complications whose labour is progressing normally who do not have amniotomy or oxytocin.

Numerator – the number in the denominator who do not have amniotomy or oxytocin.

Denominator – the number of women at low risk of complications whose labour is progressing normally.

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

Outcome

a) The number of women whose labour progressed normally who had amniotomy or oxytocin.

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

b) 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 (all 4 birth settings) have protocols in place to ensure that women at low risk of complications whose labour is progressing normally are not offered amniotomy or oxytocin.

Healthcare professionals (midwives and obstetricians) do not offer amniotomy or oxytocin to women at low risk of complications whose labour is progressing normally.

Commissioners (integrated care systems) specify and check that service providers have protocols in place to ensure that women at low risk of complications whose labour is progressing normally are not offered amniotomy or oxytocin.

Women who are at low risk of having problems and whose labour is progressing normally are not offered amniotomy (having their waters broken) or oxytocin (a medicine given through a drip that speeds up labour).

Source guidance

Intrapartum care. NICE guideline NG235 (2023), recommendations 1.8.33 and 1.8.34

Definitions of terms used in this quality statement

Normal labour and normal progression of labour

The NICE full guideline on intrapartum care adopts the World Health Organization definition of a normal labour: 'labour is normal when it is spontaneous in onset, low risk at the start and remaining so throughout labour and birth. The baby is born spontaneously and in the vertex position between 37 to 42 completed weeks of pregnancy. After birth the woman and baby are in good condition'.