Women must have greater control over not just where they give birth but how they do so, according to NHS guidelines for England and Wales.
Women must have greater control over not just where they give birth but how they do so, according to NHS guidelines for England and Wales.
The framework states that women must have the option as to where they give birth - be it at home, in a midwife-led or a consultant-led unit.
The framework states that women must have the option as to where they give birth - be it at home, in a midwife-led or a consultant-led unit.
If in hospital, intervention should be at a minimum, but women who desire a medicalised birth must be offered one.
If in hospital, intervention should be at a minimum, but women who desire a medicalised birth must be offered one.
Crucially, adequate pain relief, including epidurals, must be available.
Crucially, adequate pain relief, including epidurals, must be available.
While many mothers giving birth at home or in hospital treasure their experience, others emerge traumatised by either too much - or indeed too little - intervention in the form of having their waters broken, the use of forceps or emergency caesareans.
While many mothers giving birth at home or in hospital treasure their experience, others emerge traumatised by either too much - or indeed too little - intervention in the form of having their waters broken, the use of forceps or emergency caesareans.
"We want to make sure every woman's experience of birth is as good as it can be and have used the best available evidence to set a national standard on how midwives and doctors can make labour a positive experience for women," said Andrea Sutcliffe of the National Institute for Health and Clinical Excellence (Nice).
"We want to make sure every woman's experience of birth is as good as it can be and have used the best available evidence to set a national standard on how midwives and doctors can make labour a positive experience for women," said Andrea Sutcliffe of the National Institute for Health and Clinical Excellence (Nice).
However, critics questioned how these improvements could be implemented without increased resources.
However, critics questioned how these improvements could be implemented without increased resources.
Meeting midwives
Meeting midwives
One of the key guidelines is that all women in established labour receive "supportive one-to-one care" if that is what they desire, a recommendation which seeks to tackle the complaint that many labouring women feel they are left on their own.
One of the key guidelines is that all women in established labour receive "supportive one-to-one care" if that is what they desire, a recommendation which seeks to tackle the complaint that many labouring women feel they are left on their own.
If the woman is able to communicate effectively her wishes throughout labour, even if things don't go as anticipated she will still come out feeling she had a better experience Dr Julia SandersConsultant midwife
If the woman is able to communicate effectively her wishes throughout labour, even if things don't go as anticipated she will still come out feeling she had a better experience Dr Julia SandersConsultant midwife
Improved communication between woman and hospital staff is described as being at the heart of the new recommendations, with midwives urged to establish what the mother wants and to make clear she should convey her wishes at all times.
Improved communication between woman and hospital staff is described as being at the heart of the new recommendations, with midwives urged to establish what the mother wants and to make clear she should convey her wishes at all times.
Birth plans, which frequently get forgotten as events overtake them, should be read and discussed.
Birth plans, which frequently get forgotten as events overtake them, should be read and discussed.
"They may still be overtaken by events," said Dr Julia Sanders, a consultant midwife who helped draw up the guidelines.
"They may still be overtaken by events," said Dr Julia Sanders, a consultant midwife who helped draw up the guidelines.
"But if the woman is able to communicate effectively her wishes throughout labour, even if things don't go as anticipated she will still come out feeling she had a better experience."
"But if the woman is able to communicate effectively her wishes throughout labour, even if things don't go as anticipated she will still come out feeling she had a better experience."
Water therapy
Water therapy
Women may however be asked to labour longer under these new guidelines.
Women may however be asked to labour longer under these new guidelines.
Some women will want an entirely natural birth - and that's what they should have, but those who don't shouldn't be made to feel like they're making the wrong choice Maureen TreadwellBirth Trauma Association
Some women will want an entirely natural birth - and that's what they should have, but those who don't shouldn't be made to feel like they're making the wrong choice Maureen TreadwellBirth Trauma Association
Even if dilation is less than 1cm each hour, this will not be viewed as problematic unless the woman herself is in great pain and feels the process needs to be speeded up.
Even if dilation is less than 1cm each hour, this will not be viewed as problematic unless the woman herself is in great pain and feels the process needs to be speeded up.
Women should have the opportunity to labour in water, as this is often far more comfortable. 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.
Women should have the opportunity to labour in water, as this is often far more comfortable. 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.
But medical pain relief must be offered as a matter of course.
But medical pain relief must be offered as a matter of course.
Some midwives object to epidurals - an effective spinal anaesthesia which means mother and baby need closer monitoring and can slow labour down.
Some midwives object to epidurals - an effective spinal anaesthesia which means mother and baby need closer monitoring and can slow labour down.
"These new guidelines should mean that women who need the pain relief of an epidural get it," said Maureen Treadwell of the Birth Trauma Association, also involved in drawing up the new framework.
"These new guidelines should mean that women who need the pain relief of an epidural get it," said Maureen Treadwell of the Birth Trauma Association, also involved in drawing up the new framework.
"Some women will want an entirely natural birth - and that's what they should have, but those who don't shouldn't be made to feel like they're making the wrong choice."
"Some women will want an entirely natural birth - and that's what they should have, but those who don't shouldn't be made to feel like they're making the wrong choice."
At home
At home
The government has pledged that from 2009, all women who want to should be able to give birth at home and the new guidelines repeat the necessity of women being given that choice.
The government has pledged that from 2009, all women who want to should be able to give birth at home and the new guidelines repeat the necessity of women being given that choice.
It says there are enough staff and more midwives than ever before are being trained.
It says there are enough staff and more midwives than ever before are being trained.
Women should be informed that the likelihood of having a normal birth with less intervention is higher when birth takes place at home, but that if something goes wrong the outcome for both mother and baby could be worse than if they were in hospital with access to specialist care, it adds.
Women should be informed that the likelihood of having a normal birth with less intervention is higher when birth takes place at home, but that if something goes wrong the outcome for both mother and baby could be worse than if they were in hospital with access to specialist care, it adds.
For some women, hospitals remain the safest place to deliver, Royal College of Obstetricians and Gynaecologists
For some women, hospitals remain the safest place to deliver, Royal College of Obstetricians and Gynaecologists
The Royal College of Obstetricians and Gynaecologists said it welcomed the guidelines and supported the notion of choice.
The Royal College of Obstetricians and Gynaecologists said it welcomed the guidelines and supported the notion of choice.
"However, for some women, hospitals remain the safest place to deliver," a spokesman said.
"However, for some women, hospitals remain the safest place to deliver," a spokesman said.
"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."
"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."
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