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 section, 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

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: Local data collection.

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: Local data collection.

Outcome

a) The number of women in labour that is progressing normally having amniotomy or oxytocin.

Data source: Local data collection.

b) Maternal satisfaction and experience of care.

Data source: Local data collection.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (for 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 (clinical commissioning groups) 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.

What the quality statement means for women and their companions

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

Definitions of terms used in this quality statement

Normal labour and normal progression of labour

The NICE full guideline on intrapartum care for healthy women and babies 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 37–42 completed weeks of pregnancy. After birth woman and baby are in good condition'.