The National Institute for Health and Clinical Excellence (NICE) has issued new recommendations for maternity service providers, commissioners and healthcare professionals.
Perhaps the most notable recommendation is that NICE has confirmed it is safe to give birth at home. Having considered the evidence, NICE suggests that giving birth at home or in a midwife-led unit is “generally safer than hospital for pregnant women at low risk complications who have given birth before.”
A patient will be considered low risk if she has given birth before, is in good health and does not have serious health conditions.
Other important recommendations
Other important recommendations made by NICE include:
- Maternity services supporting one-to-one care for all women during childbirth by a midwife.
- All healthcare professionals ensuring that there is a culture of respect for every woman in all birth settings, so that the woman is in control, is listened to and is cared for with compassion, and that appropriate informed consent is sought.
- Ensuring that women giving birth have timely access to an obstetric unit if they need to be transferred to hospital for medical reasons or because they request an epidural. Service commissioners and providers should ensure that robust protocols are in place for transfer of care between settings.
- The circumstances in which midwives should consider transferring a woman in labour from her home or midwife-led unit to hospital. These factors are set out fully in the guideline, but include high blood pressure in the mother, concerns about the baby’s heartbeat or presence of significant meconium (a baby’s first faeces) in the mother’s waters when they break.
- Minimising separation of the baby and mother, taking into account the individual clinical circumstances.
Cutting the umbilical cord
NICE has also made recommendations about cutting and clamping the umbilical cord:
- Do not clamp the cord earlier than one minute from the birth of the baby unless there is concern about the integrity of the cord or the baby has a heartbeat below 60 beats per minute that is not getting faster.
- Clamp the cord before five minutes in order to perform controlled cord traction as part of active management.
- Support a woman if she requests that the cord is clamped and cut later than five minutes.
Obstetric and midwifery care
These recommendations are intended to improve obstetric and midwifery care. If you have been unfortunate enough to have a bad experience while giving birth, you might want to consider whether there has been a case of medical negligence. Contact us to find out more.