Introduction

This quality standard covers the care of women who go into labour at term (37+0 weeks to 41+6 weeks) and their babies during labour and immediately after the birth. It covers both women who go into labour at low risk of intrapartum complications and women who go on to develop complications.

A NICE guideline on the intrapartum care for women at high risk of complications is under development and is due to be published in 2017. When that guideline is published, this quality standard will be updated to include prioritised quality statements for the intrapartum care of women at high risk of complications.

For more information see the intrapartum care topic overview.

Why this quality standard is needed

Around 700,000 women give birth in England and Wales each year, of whom about 40% are having their first baby. Most of these women have a straightforward pregnancy and birth.

It is important that a woman is given information and advice about all available birth settings when she is deciding where to have her baby, so that she can make a fully informed decision. This includes information about outcomes for the different settings.

Uncertainty and inconsistency of care for women giving birth have been identified in a number of areas, such as choosing place of birth, care during the latent first stage of labour, fetal assessment and monitoring during labour (particularly cardiotocography compared with intermittent auscultation) and management of the third stage of labour.

The quality standard is expected to contribute to improvements in the following outcomes:

  • maternal mortality and morbidity

  • neonatal mortality and morbidity

  • breastfeeding uptake

  • positive experience of and satisfaction with care

  • treating and caring for people in a safe environment and protecting them from avoidable harm.

How this quality standard supports delivery of outcome frameworks

NICE quality standards are a concise set of prioritised statements designed to drive measurable improvements in the 3 dimensions of quality – patient safety, patient experience and clinical effectiveness – for a particular area of health or care. They are derived from high-quality guidance, such as that from NICE or other sources accredited by NICE. This quality standard, in conjunction with the guidance on which it is based, should contribute to the improvements outlined in the following 2 outcomes frameworks published by the Department of Health:

Tables 1 and 2 show the outcomes, overarching indicators and improvement areas from the frameworks that the quality standard could contribute to achieving.

Table 1 NHS Outcomes Framework 2015–16

Domain

Overarching indicators and improvement areas

1 Preventing people from dying prematurely

Overarching indicator

1a Potential years of life lost (PYLL) from causes considered amenable to healthcare

i Adults

ii Children and young people

1c Neonatal mortality and stillbirths

Improvement areas

Reducing deaths in babies and young children

1.6i Infant mortality (Public Health Outcomes Framework 4.1*)

4 Ensuring that people have a positive experience of care

Overarching indicators

4b Patient experience of hospital care

Improvement areas

Improving hospitals' responsiveness to personal needs

4.2 Responsiveness to in-patients' personal needs

Improving women and their families' experience of maternity services

4.5 Women's experience of maternity services

5 Treating and caring for people in a safe environment and protecting them from avoidable harm

Overarching indicators

5a (previously 5c) Deaths attributable to problems in healthcare

5b Severe harm attributable to problems in healthcare

Improvement areas

Improving the safety of maternity services

5.5 Admission of full-term babies to neonatal care (definition and quality statement amended)

Alignment across the health and social care system

* Indicator is shared.

Table 2 Public health outcomes framework for England, 2013–16

Domain

Objectives and indicators

2 Health improvement

Objective

People are helped to live healthy lifestyles, make healthy choices and reduce health inequalities

Indicators

2.2 Breastfeeding

4 Healthcare public health and preventing premature mortality

Objective

Reduced numbers of people living with preventable ill health and people dying prematurely, while reducing the gap between communities.

Indicators

4.1 Infant mortality*

4.3 Mortality rate from causes considered preventable**

Alignment with NHS Outcomes Framework

* Indicator is shared.

** Indicator is complementary.

Patient experience and safety issues

Ensuring that care is safe and that people have a positive experience of care is vital in a high-quality service. It is important to consider these factors when planning and delivering services relevant to intrapartum care.

NICE has developed guidance and an associated quality standard on patient experience in adult NHS services (see the NICE pathway on patient experience in adult NHS services, which should be considered alongside this quality standard. They specify that people receiving care should be treated with dignity, have opportunities to discuss their preferences, and are supported to understand their options and make fully informed decisions. They also cover the provision of information to patients and service users. Quality statements on these aspects of patient experience are not usually included in topic-specific quality standards. However, recommendations in the development sources for quality standards that affect patient experience and are specific to the topic are considered during quality statement development.

Coordinated services

The quality standard for intrapartum care specifies that services should be commissioned from and coordinated across all relevant agencies encompassing the whole maternity care pathway. A person-centred, integrated approach to providing services is fundamental to delivering high-quality care to women in labour.

The Health and Social Care Act 2012 sets out a clear expectation that the care system should consider NICE quality standards in planning and delivering services, as part of a general duty to secure continuous improvement in quality. Commissioners and providers of health and social care should refer to the library of NICE quality standards when designing high-quality services. Other quality standards that should also be considered when choosing, commissioning or providing a high-quality intrapartum care service are listed in related quality standards.

Training and competencies

The quality standard should be read in the context of national and local guidelines on training and competencies. All healthcare professionals involved in assessing, caring for and treating women during labour should have sufficient and appropriate training and competencies to deliver the actions and interventions described in the quality standard. Quality statements on staff training and competency are not usually included in quality standards. However, recommendations in the development source(s) on specific types of training for the topic that exceed standard professional training are considered during quality statement development.

Role of families and carers

Quality standards recognise the important role families and carers have in supporting women in labour. If appropriate, healthcare professionals should ensure that family members and carers are involved in the decision-making process about investigations, treatment and care.