Excerpt

This guideline covers the care of healthy women in labour at term (37–42 weeks of gestation). About 600 000 women give birth in England and Wales each year, of whom about 40% are having their first baby. Most of these women are healthy and have a straightforward pregnancy. Almost 90% of women will give birth to a single baby after 37 weeks of pregnancy with the baby presenting head first. Most women (about two-thirds) go into labour spontaneously. Thus the majority of women giving birth in the UK fall under the scope of this guideline.

Contents

• Guideline Development Group membership and acknowledgements
• Abbreviations
• Glossary of terms
• 1. Introduction
  • 1.1 Aim of the guideline
  • 1.2 Areas within the remit of the guideline
  • 1.3 Areas outside of the remit of the guideline
  • 1.4 For whom is the guideline intended?
  • 1.5 Who has developed the guideline?
  • 1.6 Other relevant documents
  • 1.7 Guideline development methodology
  • 1.8 Schedule for updating the guideline
• 2. Summary of recommendations and care pathway
  • 2.1 Key priorities for implementation (key recommendations)
  • 2.2 Summary of recommendations
  • 2.3 Research recommendations
  • 2.4 Care pathway
• 3. Planning place of birth
  • 3.1 Introduction
  • 3.2 Benefits and risks of planning each place of birth
  • 3.3 Assessment for choosing place of birth
• 4. Care throughout labour
  • 4.1 Communication between women and healthcare professionals
  • 4.2 Mobilisation and position
  • 4.3 Support in labour
  • 4.4 Eating and drinking in labour
  • 4.5 Hygiene measures during labour
  • 4.6 Identification of women and babies who may need additional care
• 5. Coping with pain in labour: non-epidural
  • 5.1 Introduction
  • 5.2 Women’s views and experiences of pain and pain relief in childbirth
  • 5.3 Pain-relieving strategies
  • 5.4 Non-pharmacological analgesia
  • 5.5 Inhalational analgesia
  • 5.6 Intravenous and intramuscular use of opioids for labour
• 6. Pain relief in labour: regional analgesia
  • 6.1 Regional analgesia
  • 6.2 Regional analgesia versus other types of analgesia in labour
  • 6.3 Timing of regional analgesia
  • 6.4 Care and observations for women with regional analgesia in labour
  • 6.5 Effect of epidural fentanyl on breastfeeding
  • 6.6 Mode of administration
  • 6.7 Establishing regional analgesia in labour
  • 6.8 Maintenance of regional analgesia
• 7. Normal labour: first stage
  • 7.1 Introduction
  • 7.2 Definition of the first stage of labour
  • 7.3 Duration of the first stage of labour
  • 7.4 Observations on presentation in suspected labour
  • 7.5 Observations on term PRoM while awaiting onset of labour
  • 7.6 Observations during the established first stage of labour
  • 7.7 Possible routine interventions in the first stage of labour
  • 7.8 Fetal heart assessment and reasons for transfer to continuous EFM
• 8. Normal labour: second stage
  • 8.1 Definition of the second stage of labour
  • 8.2 Duration and definition of delay in the second stage of labour
  • 8.3 Observations for women and babies in the second stage of labour
  • 8.4 Women’s position and pushing in the second stage of labour
  • 8.5 Intrapartum interventions to reduce perineal trauma
  • 8.6 Water birth
• 9. Normal labour: third stage
  • 9.1 Definition and duration of the third stage of labour
  • 9.2 Observations in the third stage of labour
  • 9.3 Physiological and active management of the third stage
• 10. Normal labour: care of the baby and woman immediately after birth
  • 10.1 Introduction
  • 10.2 Initial assessment of the newborn baby and mother–infant bonding
  • 10.3 Initial assessment of the mother following birth
  • 10.4 Perineal care
• 11. Prelabour rupture of membranes at term
  • 11.1 Prelabour rupture of membranes at term
• 12. Meconium-stained liquor
  • 12.1 Monitoring and treatment of women with meconium-stained liquor
  • 12.2 Resuscitation of babies with meconium-stained liquor
• 13. Complicated labour: monitoring babies in labour
  • 13.1 Introduction
  • 13.2 Women’s views on fetal monitoring and mobility
  • 13.3 Indications for continuous EFM
  • 13.4 EFM and record-keeping
  • 13.5 Interpretation of FHR traces
  • 13.6 Adjuncts to the use of continuous EFM including FBS
  • 13.7 Other monitoring methods
  • 13.8 Risk management when using continuous EFM in labour
• 14. Complicated labour: first stage
  • 14.1 Definition of delay in the first stage of labour
  • 14.2 Interventions for perceived delay in the first stage of labour
• 15. Complicated labour: second stage
  • 15.1 Delay in the second stage of labour
• 16. Complicated labour: immediate care of newborn
  • 16.1 Basic neonatal resuscitation
• 17. Complicated labour: third stage
  • 17.1 Definition of delay in the third stage of labour
  • 17.2 Treatment of women with a retained placenta
  • 17.3 Risk factors for postpartum haemorrhage
  • 17.4 Management of postpartum haemorrhage
• Appendix A Declarations of interest
• Appendix B Clinical questions
• Appendix C Selection criteria and validity scores for included and excluded studies for the systematic review comparing planned home birth and planned hospital birth and the systematic review comparing planned standalone midwife-led unit and obstetric unit birth
• Appendix D NCC-WCH analysis to obtain the best estimate of intrapartum-related perinatal mortality in England and Wales
• Appendix E Decision tree modelling framework to assess cost-effectiveness for place of birth
• Appendix F Economic evaluation for ST analysis
• References
• Search strategies
• Evidence tables
• Forest plots
• Excluded studies

First published 2007, revised reprint 2008 (Section 5.6 on intravenous and intramuscular use of opioids)

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.