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EMAK · Century Club Joined: 26 Nov 2006 Posts: 572

RCOG statement on NICE Clinical Guideline 55 Intrapartum care - Care of healthy women and their babies during childbirth

The Royal College of Obstetricians and Gynaecologists (RCOG) welcomes guidelines on the care of healthy mothers and their babies during the intrapartum period and any effort which works towards ensuring safe childbirth.

The RCOG supports normal birth but recognises that complications during childbirth are unpredictable and can occur even in low-risk births. Although rare in the low risk population, delay in attending to an emergency can result in life-threatening consequences for the mother and her baby.

When emergencies do occur when delivering at home or in a stand-alone midwifery unit, the transfer time to the hospital is crucial to minimising risks and enhancing safety.

Studies from Scotland and elsewhere have indicated that 30% of first-time mothers assessed as ‘low risk’ require transfer to an obstetric unit at some stage during labour. Evidence shows that in rural settings, distance to the local hospital is sometimes a barrier to the provision of emergency care and the average transfer time can be as long as two hours or more. More transfers using ambulances at a time when Ambulance Services are already finding it difficult to cope with the demand adds pressure to the system.

In city centres, the time taken to get the mother in an ambulance and then through traffic to the hospital may be longer than anticipated.

The RCOG favours co-located midwifery units which guarantee access to a multidisciplinary team of specialists, should the need arise. Co-located units do not tax the ambulance service and provide access to delivery in a midwifery set-up with one-to-one care and birthing pool facilities. It also provides women with the option to request an epidural for pain relief. It avoids long waiting times and a possible ‘rough’ ride in an ambulance when mothers are already in pain or in the second stage of labour.

Team care throughout pregnancy is likely to give more [color=violet]reassurance,higher quality of care, safety and continuity. This should result in better outcomes and increased satisfaction.

The RCOG believes that women should be supported in their choice of the place of birth. However, for some women, hospitals remain the safest place to deliver. Women should discuss the range of options that are available to them, including the risks involved, with their GPs, midwives and obstetricians so they can make an informed choice.

It is also important to note that in order for the Department of Health to deliver its promise of choice in NHS maternity services, it is imperative for maternity units to be well staffed by consultants and midwives so that appropriate care can be provided to women and their babies during the intrapartum period. This need is all the more urgent given that the number of births in the UK is increasing each year.

26 September 2006

Read the guideline on the NICE website at www.guidance.nice.org.uk/CG55