Key priorities for implementation

Key priorities for implementation

The following recommendations have been identified as priorities for implementation. The full list of recommendations is in section 1.

Place of birth

  • 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. [new 2014]

  • Commissioners and providers[1] should ensure that all 4 birth settings are available to all women (in the local area or in a neighbouring area). [new 2014]

  • Providers, senior staff and all healthcare professionals should ensure that in all birth settings there is a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to and is cared for with compassion, and that appropriate informed consent is sought. [new 2014]

  • Senior staff should demonstrate, through their own words and behaviour, appropriate ways of relating to and talking about women and their birth companion(s), and of talking about birth and the choices to be made when giving birth. [new 2014]

  • Maternity services should

    • provide a model of care that supports one‑to‑one care in labour for all women and

    • benchmark services and identify overstaffing or understaffing by using workforce planning models and/or woman‑to‑midwife ratios. [new 2014]

  • Commissioners and providers[1] should ensure that there are:

    • robust protocols in place for transfer of care between settings (see also section 1.6)

    • clear local pathways for the continued care of women who are transferred from one setting to another, including:

      • when crossing provider boundaries

      • if the nearest obstetric or neonatal unit is closed to admissions or the local midwifery‑led unit is full. [new 2014]

Measuring fetal heart rate as part of initial assessment

  • Do not perform cardiotocography on admission for low‑risk women in suspected or established labour in any birth setting as part of the initial assessment. [new 2014]

Interpretation of cardiotocograph traces

  • Do not make any decision about a woman's care in labour on the basis of cardiotocography findings alone. [new 2014]

First stage of labour

  • Do not offer or advise clinical intervention if labour is progressing normally and the woman and baby are well. [2007]

Third stage of labour

  • After administering oxytocin, clamp and cut the cord.

    • Do not clamp the cord earlier than 1 minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heartbeat below 60 beats/minute that is not getting faster.

    • Clamp the cord before 5 minutes in order to perform controlled cord traction as part of active management.

    • If the woman requests that the cord is clamped and cut later than 5 minutes, support her in her choice. [new 2014]



[1] This can also include networks of providers.

  • National Institute for Health and Care Excellence (NICE) accreditation logo