As well as the major guideline change that low-risk pregnant women should receive more information about home birth and midwife-led care (click here for the full story), NICE has also updated several other recommendations that will mean:
Maternity services supporting 1-to-1 care for all women during childbirth by a midwife.
All health-care 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.
NICE has also updated its recommendations to midwives about how long after birth to leave a baby’s umbilical cord before clamping and cutting it. It says:
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.