Royal Colleges Issue Recommendations For The Safe Organisation Of Care During Labour And Birth

New recommendations on standards for the safe organisation of care during childbirth have been issued today by the Royal Colleges of Anaesthetists (RCOA), Midwives (RCM), Obstetricians and Gynaecologists (RCOG), and Paediatrics and Child Health (RCPCH).


The joint document, Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour, provides clear and concise information about the roles and essential minimum staffing levels required to support and deliver safe care to women in labour and their babies.


Underpinning the guideline is the need for good working relationships between a multi-disciplinary maternity team of midwives, obstetricians, anaesthetists, paediatricians, as well as support and managerial staff. Also of paramount importance is the expansion in numbers of midwives and obstetricians to enable appropriate and safe care to be provided. The document addresses the requirements for successful workforce planning and provides health facilities with a blueprint from which to implement their services.


The report recognises the complimentary and respective roles of the whole maternity team caring for women in normal or more complicated labour. It also recommends the need for access to senior staff to provide advice and support in all labour environments.


Baseline standards are recommended in the following ten categories:


1. Organisation and documentation

2. Multidisciplinary working

3. Communication

4. Staffing levels

5. Leadership

6. Core responsibilities

7. Emergencies and transfers

8. Training and education

9. Environment and facilities

10. Outcomes


Key recommendations include:


- Women in established labour must receive individual one-to-one care from a midwife .


- Outside the recommended minimum 40 hours of consultant obstetrician presence on the labour ward, the consultant will conduct a physical ward round as appropriate at least twice a day during Saturdays, Sundays and bank holidays, with a physical round every evening, reviewing midwifery-led cases on referral


- All women requiring conduction or general anaesthesia are seen and assessed by an anaesthetist before an elective procedure


- A healthcare professional (midwife, neonatal nurse, advanced neonatal nurse practitioner, paediatrician) trained and regularly assessed as competent in neonatal basic life support must be immediately available for all births, in any setting


Dr Judith Hulf, President of the RCoA, said "Safety is core business in anaesthesia and nowhere is it more important than in maternity services. The contents of this document highlight the key areas that must be addressed. The importance of effective multidisciplinary team-working for all mothers, whether healthy or sick, cannot be overemphasized."


Maggie Elliott, President of the RCM, said: "Women and their babies sit at the heart of these recommendations, which address many of the issues affecting the delivery of safe, quality care wherever women give birth. Midwives will welcome the focus on direct communication, the need for better staffing levels and a commitment to respectful and equitable relationships between all members of the maternity care team. This can only result in a better birth experience for women, their babies and families."















Professor Sabaratnam Arulkumaran, President of the RCOG, said "We hope that the clear guidelines presented in Safer Childbirth will be adopted by those caring for women in labour, in all settings, to ensure quality and continuity of care in UK maternity services. This project has been an important collaboration between the Royal Colleges and we hope that our focus on the multi-disciplinary team approach leads to safer childbirth in our hospitals."


Dr Jane Hawdon, RCPCH, said "The Royal College of Paediatrics and Child Health strongly supports the multidisciplinary approach to the planning and conduct of childbirth. Whilst acknowledging that improving maternity care should reduce the need for paediatric intervention, on occasions, skilled assessment and support are needed for the baby and this must be available at every location where childbirth occurs. For this reason we are delighted that the assessment and care of the baby is firmly embedded in the midwife's role. In addition, all hospitals must meet the British Association of Perinatal Medicine (BAPM) standards for neonatal care."


Reference


Safer Childbirth: Minimum Standards for the Organisation and Delivery of Care in Labour, Royal College of Anaesthetists, Royal College of Midwives, Royal College of Obstetricians and Gynaecologists, and Royal College of Paediatrics and Child Health; London; 2007


The full report can be downloaded here.

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