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Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour

Published: 01/10/2007

This is a report of a joint working party comprising the RCOG, the Royal College of Midwives (RCM), the Royal College of Anaesthetists (RCoA) and the Royal College of Paediatrics and Child Health (RCPCH).

Executive summary

  • Concerns from the Confidential Enquiry into Maternal and Child Health (CEMACH) and its predecessor organisations the Confidential Enquiry into Stillbirths and Deaths in Infancy (CESDI) and the Confidential Enquiry into Maternal Deaths (CEMD), have indicated the need for a fresh look at the organisation of care in labour. The requirements of Standards for Better Health and the recommendations arising from investigations conducted by the Healthcare Commission have added to the breadth of this report, which also incorporates the aspirations of UK maternity service policies.
  • This report acknowledges:
    • The central role of midwives as autonomous practitioners of normal labour and birth, together with their role as partners with obstetricians, anaesthetists and paediatricians, in the care of women with complex and complicated labours
    • The importance of team working, as well the respective roles of midwives, obstetricians, anaesthetists, paediatricians, support staff and managers, as part of the local maternity care team
    • The increased involvement of consultant obstetricians on the labour ward in the care of women with complex or complicated pregnancies and in the supervision and education of medical staff
  • This document considers a number of factors influencing staffing levels which have serious implications for the service. These include:
    • Greater focus on woman-centred care
    • An extension to the midwife’s teaching role with multidisciplinary staff
    • Recruitment and retention crises in midwifery staffing
    • Changes in the experience of medical staffing at junior level
    • Demand for increasing consultant involvement in the labour ward
  • It is important to match resources and facilities with workload. This document outlines minimum staffing and training requirements for midwives and doctors. Additional staff over and above this will be needed in specific situations.
  • A maternity network, which includes births at home, in midwifery units and in obstetric units, should have a common governance structure, including robust systems and clear guidelines for monitoring the safety, quality and performance of the maternity services and transfer arrangements within the network should problems arise.
  • A central theme is the need to improve communications between healthcare professionals and between professionals and women. Units should foster a team approach, based on mutual respect, a shared philosophy of care and a clear organisational structure for both midwives and medical staff, with explicit and transparent lines of communication.
  • This report provides healthcare planners, unit managers and clinical directors with guidelines on which to base realistic costing of the maternity service. Certain quality and clinical effectiveness issues have been identified, which include clinical supervision and statutory supervision of midwives, as well as basic and continuing training of all staff. Each provider will need to adapt the model suggested to achieve the standards in their own circumstances.
  • The organisation of care in labour in all settings should be reviewed and, if necessary, changes implemented to reflect the recommendations in this report. The adoption and implementation of the staffing standards, facilities and governance structures outlined below should help to ensure the best outcome for women and their babies regardless of the birth setting.
  • The outcome measures and standards described in this document should be audited and published as an annual report in line with best practice. The report should include an evaluation of women’s views of their care and should inform the regular review of service provision and risk management policy. The annual report should be available to the public. Additionally, the Royal Colleges intend to audit the implementation of these standards in December 2009.