The World Health Organization has published Intrapartum care for a positive childbirth experience. This guideline brings together new and existing WHO recommendations that, when delivered as a package, will ensure good-quality and evidence-based care irrespective of the setting or level of health care. It highlights the importance of woman-centred care to optimize the experience of labour and childbirth for women and their babies. It includes 56 evidence-based recommendations on what care is needed throughout labour and immediately after for the woman and her baby.
Women who lie on their side in the second stage of labour after a low-dose epidural are more likely to give birth spontaneously than those who remain upright when actively contracting. Lying down on either side doesn’t appear to be harmful to mothers or babies. This means that 17 of these women would need to lie on their side instead of maintaining an upright position for one more of them to have an unassisted or “spontaneous” birth.
This UK trial looked at how position in labour affects the type of birth in first-time mothers after a low-dose epidural.
The current guidance recommends an upright position when actively contracting in the later stages of labour. However, this research suggests that for first-time mothers with epidurals, lying on their side could be considered.
An Royal College of Midwives press release discusses a new report on the threats faced by maternity services.
The report ‘The gathering storm: England’s midwifery workforce challenges’ outlines how issues such as rising levels of complexity in pregnancy, midwife shortages and financial constraints in the NHS are ramping up the pressure on England’s maternity workforce and services.
The report also puts forward solutions to the problems in maternity services. It sets out ways in which decision makers across government and England’s NHS can tackle the situation. These include a more adaptable approach to requests for flexible working, and allowing the NHS Pay Review Body free reign to recommend staff pay wards. This will help retain midwives and not push them into costlier agency work. Implementing other changes will also help too, such as ensuring more low-risk women give birth outside of obstetric units.
This guideline provides up-to-date information on methods of delivery for women with breech presentation, this is the fourth edition of this guideline, first published in 1999 and revised in 2001 and 2006 under the same title.
The aim of this guideline is to aid decision making regarding the route of delivery and choice of various techniques used during delivery. It does not include antenatal or postnatal care. Information regarding external cephalic version is the topic of the separate Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 20a External Cephalic Version and Reducing the Incidence of Term Breech Presentation.
This guideline summarises the evidence regarding the routine use of external cephalic version (ECV) for breech presentation, and is the second edition of this guideline, first published in 2006 under the title External Cephalic Version (ECV) and Reducing the Incidence of Breech Presentation.
It presents the best evidence concerning methods to prevent noncephalic presentation at delivery and therefore caesarean section and its sequalae. The mode and technique of delivering a breech presentation is summarised in the Royal College of Obstetricians and Gynaecologists Green-top Guideline No. 20b Management of Breech Presentation.
NICE Quality Statement 3 on cardiotocography and the initial assessment of a woman in labour has been removed. This change has been made because the source guidance for this statement (NICE’s guideline on intrapartum care for healthy woman and babies) has been updated and the advice on cardiotocography for low risk women has changed.