Quality standard

Quality statement 1: Involving women in care planning

Quality statement

Pregnant women with existing medical conditions or obstetric complications are involved in developing and reviewing their individualised intrapartum care plan.

Rationale

Involving a woman in developing and reviewing her intrapartum care plan enables her to discuss and make choices about her care. It allows her to be given information and opportunities for discussion to support shared decision making. Involvement of the woman allows the care plan to be tailored to her conditions or obstetric complications, her experience of these, and her preferences for labour and birth. The woman should be involved in updating the plan during pregnancy and on admission for birth to reflect changes in her conditions or obstetric complications.

Quality measures

Structure

a) Evidence of local processes to provide opportunities for pregnant women with existing medical conditions or obstetric complications to discuss and make decisions on the intrapartum management of their medical conditions or obstetric complications.

Data source: Local data collection, for example, documented procedures, service specifications and staff training on communication skills.

b) Evidence of local processes to ensure that pregnant women with existing medical conditions or obstetric complications are supported to develop an intrapartum care plan.

Data source: Local data collection, for example, service protocols and records for training in communication skills, multidisciplinary working and shared decision making.

c) Evidence of local arrangements to ensure that pregnant women with existing medical conditions or obstetric complications are supported to review their intrapartum care plan throughout pregnancy, including when their conditions change, and on admission for birth.

Data source: Local data collection, for example, service protocols and records for training in communication skills and shared decision making.

Process

a) Proportion of pregnant women with existing medical conditions or obstetric complications with an individualised intrapartum care plan who reported that they were involved as much as they wanted to be in discussing and making decisions about their care when developing the plan.

Numerator – the number in the denominator who reported that they were involved as much as they wanted to be in discussing and making decisions about their care when developing the plan.

Denominator – the number of pregnant women with existing medical conditions or obstetric complications with an individualised intrapartum care plan.

Data source: Local data collection, for example, patient surveys.

b) Proportion of pregnant women with existing medical conditions or obstetric complications with an individualised intrapartum care plan, who reported that they were involved as much as they wanted to be in discussing and making decisions about their care when reviewing the plan on admission for birth.

Numerator – the number in the denominator who reported that they were involved as much as they wanted to be in discussing and making decisions about their care when reviewing the plan on admission for birth.

Denominator – the number of pregnant women with existing medical conditions or obstetric complications with an individualised intrapartum care plan.

Data source: Local data collection, for example, patient surveys.

c) Proportion of pregnant women with existing medical conditions or obstetric complications with an individualised intrapartum care plan, who reported that they were involved as much as they wanted to be in discussing and making decisions about their care when updating the plan when their medical condition changed.

Numerator – the number in the denominator who reported that they were involved as much as they wanted to be in discussing and making decisions about their care when updating the plan when their medical condition changed.

Denominator – the number of pregnant women with existing medical conditions or obstetric complications with an individualised intrapartum care plan.

Data source: Local data collection, for example, patient surveys.

Outcome

Proportion of pregnant women with existing medical conditions or obstetric complications who felt that they were involved in preparing and reviewing their intrapartum care plan.

Numerator – the number in the denominator who were satisfied with their involvement in preparing and reviewing their intrapartum care plan.

Denominator – the number of pregnant women with existing medical conditions or obstetric complications and an intrapartum care plan.

Data source: Local data collection, for example, a patient (maternity) experience survey.

What the quality statement means for different audiences

Service providers (NHS hospital trusts) ensure that systems are in place for pregnant women with existing medical conditions or obstetric complications to take part in shared decision making and be involved in developing and reviewing individualised plans for their intrapartum care. They also ensure that staff are trained in how to involve pregnant women in developing the plan and shared decision making.

Healthcare professionals (such as obstetric physicians, clinicians with expertise in managing medical conditions during pregnancy and midwives) ensure that during pregnancy women with existing medical conditions or obstetric complications are involved in developing and reviewing their intrapartum care plan. To help support involvement, healthcare professionals should provide the woman with information about, and opportunities to discuss, her medical conditions or obstetric complications, and discuss how they might affect intrapartum care for her and her baby.

Commissioners (clinical commissioning groups) ensure they commission services that involve pregnant women with existing medical conditions or obstetric complications in developing and reviewing their intrapartum care plan during pregnancy. Women should be provided with opportunities for discussion to support their involvement.

Pregnant women with medical conditions or complications during pregnancy or birth are cared for by staff who give them opportunities to discuss how their medical conditions or complications may affect their care and the care of their baby. Women can make choices about their care.

Definitions of terms used in this quality statement

Involved in developing and reviewing the individualised intrapartum care plan

This can include:

  • providing tailored information in a way that can be understood

  • discussion of different care options, including risks and benefits

  • providing opportunities to ask questions

  • discussing preferences and expectations for labour and birth

  • discussing the woman's experience and knowledge of her existing condition

  • taking into account previous discussions, planning, decisions and choices

  • making decisions together about the woman's care.

[Adapted from NICE's guideline on intrapartum care for women with existing medical conditions or obstetric complications and their babies, recommendation 1.1.2, evidence reviews A and B, and NICE's statement on shared decision making]

Existing medical conditions

Medical conditions within the scope of this quality standard include:

  • heart disease

  • asthma (dependent on severity)

  • bleeding disorders

  • neurological conditions

  • obesity (BMI [kg/m2] 30 or over)

  • acute kidney injury or chronic kidney disease.

[NICE's guideline on intrapartum care for women with existing medical conditions or obstetric complications and their babies, evidence review B and expert opinion]

Obstetric complications

A complication arising during pregnancy, including complications relating to a previous pregnancy. Obstetric complications within the scope of this quality standard include:

  • pyrexia (high temperature or fever)

  • sepsis

  • intrapartum haemorrhage

  • breech presentation

  • suspected small-for-gestational-age baby

  • suspected large-for-gestational-age baby

  • previous caesarean section

  • labour after 42 weeks of pregnancy.

[NICE's guideline on intrapartum care for women with existing medical conditions or obstetric complications and their babies, recommendation 1.11.1]

Equality and diversity considerations

Pregnant women with existing medical conditions or obstetric complications should be provided with information to support intrapartum care planning that they can easily read and understand themselves, or with support, so they can communicate effectively with healthcare professionals. The information should be accessible to women who do not speak or read English and it should be culturally appropriate. Women should have access to an interpreter, link worker or advocate if needed. The interpreter, link worker or advocate should not be a member of the woman's family, her legal guardian or her partner, and they should communicate with the woman in her preferred language.

For women with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.