NHS in Britain aims to improve women's experience of childbirth

Sep 26 2007

According to new National Health Service (NHS) guidelines for England and Wales women need to be given greater control over where and how they give birth.

The NHS guidelines say women's experience of childbirth varies dramatically with some women treasuring their experience while others are traumatised by either too much or too little intervention, such as having their waters broken, the use of forceps or emergency caesareans.

The guidelines say women must have the option as to where they give birth, at home or in a hospital.

If the birth is in a hospital, intervention should be kept to a minimum where it is safely possible, but women who request a medicalised birth must be offered one, and adequate pain relief, including epidurals, must be made available.

The new government guidelines also say that clinical intervention, such as drugs to induce labour, should not be offered where delivery is progressing normally.

Andrea Sutcliffe of the National Institute for Health and Clinical Excellence (NICE) says they want to ensure every woman's experience of birth is as good as it can be.

NICE have used the best evidence available to set a national standard on how midwives and doctors can make labour a positive experience for women, says Sutcliffe.

But critics are skeptical as to how such improvements can be implemented without increased resources.

That all women in established labour receive "supportive one-to-one care" if that is what they request, is one of the key guidelines.

They will also be guaranteed a named midwife to care for them throughout their pregnancy.

This recommendation has come about because many women have complained they were all too often left on their own for extended periods of time during labour.

The heart of the new recommendations is for the woman in labour and hospital staff to communicate effectively and midwives to clearly establish what the mother wants and to make clear she conveys her wishes at all times.

Dr. Julia Sanders, a consultant midwife who helped draw up the guidelines says birth plans, which frequently become forgotten as events overtake them, should be read and discussed so that the woman is able to communicate effectively her wishes throughout labour, and even if things do not proceed as anticipated, the mother will still feel she had a better experience.

Under the new guidelines women who want a natural birth should be able to have one; those who don't should not be made to feel like they are making the wrong choice.

If dilation is less than 1cm each hour, this will not be seen as problematic unless the woman herself is in great pain and feels the process needs to be speeded up.

Women should be given the opportunity to labour in water, as this is often far more comfortable and hospitals are urged to make sure the facilities are in place for this: three pools for 1,000 births a year is seen as adequate provision.

Medical pain relief must be offered as a matter of course even though some midwives object to epidurals because mother and baby then need closer monitoring and it can slow down the labour.

The government has pledged that from 2009, all women who want to should be able to give birth at home and the new guidelines reiterate that women must be given that choice.

Apparently enough staff and more midwives than ever before are being trained.

However for some women, hospitals remain the safest place to deliver, and the guidelines advise that though the likelihood of having a normal birth with less intervention is higher when the birth takes place at home, should something go wrong the outcome for both mother and baby could be worse than if they were in hospital with access to specialist care.

The Royal College of Obstetricians and Gynaecologists has welcomed the guidelines and supports the notion of choice and says 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.

However the Royal College of Midwives (RCM) says the government cannot provide one-to-one care without a massive rise in midwife numbers.

The RCM says fewer midwives are being trained and nearly half are set to retire in the next decade, while cash-strapped hospitals are failing to fill posts and some maternity units are under threat of closure.