In the UK, an organisation called the National Institute for Clinical Excellence (NICE) exists to provide guidance to medical professionals working in the NHS. Advice is given as to best practise for all areas of maternity healthcare and patients are encouraged to read and understand this if they have any concerns or issues. Currently, guidance exists for:
There is extensive advice for women who go over their due date or who need to be induced for other medical reasons. The guidelines state that “Treatment and care should take into account women's individual needs and preferences. Women who are having or being offered induction of labour should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals” (http://publications.nice.org.uk/induction-of-labour-cg70/woman-centred-care). Detailed information can be found on the site, including advice about when to induce labour and how to manage an induction.
The NICE guidelines advise that women should be entitled to choose their place of birth based on informed decisions. Women should also be advised of procedures that are in place should a hospital transfer be necessary. They should also be advised of the reasons why a hospital transfer might be best for a safe delivery. NICE acknowledges that women who give birth at home are more likely to have a normal birth but that they should be advised of the importance of a hospital environment if the pregnancy is deemed high risk. Ultimately, women should be free to make their own decisions about home births.
Vaginal Birth After Caesarean (VBAC)
NICE advises that good communication between women and their healthcare providers is essential so women wishing to have a vaginal delivery after a section, must meet with their obstetricians to discuss their birthing plans. Women must be informed that the “risk of fever, bladder injuries and surgical injuries does not vary with planned mode of birth and that the risk of uterine rupture, although higher for planned vaginal birth, is rare.” (http://publications.nice.org.uk/caesarean-section-cg132/key-priorities-for-implementation).
Women should be given evidence based information and all cases should be assessed individually. The risks of each type of birth should be presented and women should feel able to make an informed decision without pressure from her medical providers. Women should also be aware of the possible risks to the baby in each case. In some cases, NICE advises that “Consent for CS should be requested after providing pregnant women with evidence-based information and in a manner that respects the woman's dignity, privacy, views and culture, while taking into consideration the clinical situation.”. However, women are within their rights to refuse this and to opt for a vaginal delivery instead.
NICE also provide guidance and advice to medical professionals regarding the success rate of VBACs. It states that “continuous support during labour from women with or without prior training reduces the likelihood of CS” and that. “Women with an uncomplicated pregnancy should be offered induction of labour beyond 41 weeks because this reduces the risk of perinatal mortality and the likelihood of CS”. In addition, the guidelines also note that “Electronic fetal monitoring is associated with an increased likelihood of CS”, which indicates that women opting for a VBAC may request little or no monitoring whilst in labour. However, hospital policies tend to state that monitoring is necessary after a previous section; again, patients are within their rights to refuse. The following interventions are deemed to be of no affect to the likelihood of a c-section: walking in labour; adopting a variety of positions as opposed to lying on a bed; being in water; having an epidural and administering raspberry leaves.
Overall, the NICE guidelines provide women with lots of information as to the risks and benefits of both a vaginal delivery and a repeat c-section.
Pain Relief and Medication
NICE provides ample information and advice about pain relief in labour (http://publications.nice.org.uk/intrapartum-care-cg55/guidance#coping-with-pain-in-labour-non-epidural) and women are advised to discuss all options thoroughly with their midwife before the onset of labour. The guidelines advise of different strategies that have been found to be effective, such as breathing and relaxation; massage and labouring in water. In addition women should be advised that administration of Pethidine, diamorphine and other opoids will have an effect on the baby. Pain relief should not be denied if women have been given all the options and have made an informed decision. If requesting an epidural, women should be informed of all the risks and this should always be administered by an anaesthetist. NICE also advise that Oxytocin, the drug which is used to speed up labour, should not be given as a matter of course for women who have been given an epidural.
Elective Caesarean Sections
Recently, changes have been made to the documentation surrounding elective c-sections. This means that pregnant women are now being given more freedom to choose the way in which they give birth. Previously, a c-section would only be offered to women whose baby was breech or who had a life threatening (to herself or the baby) condition which prevented a vaginal birth. With the new NICE guidelines, women with emotional issues, such as arising from a previous traumatic birth, are now within their rights to request an elective c-section. However, all women are entitled to request an elective section and to have her request considered appropriately, whether or not she has suffered from a traumatic birth previously. The new guidelines also state that any obstetrician who is unwilling to agree to an elective section must refer the patient to a colleague who is. Obstetricians are required to take all concerns seriously and to respect a woman’s wishes in these cases. Counselling should also be offered in an attempt to empower women to feel able to give birth vaginally. (http://publications.nice.org.uk/caesarean-section-cg132)
The NICE Guidelines Are Just That- Guidelines
Some medical professionals may choose not to follow them, although this would be rare. The NICE guidelines are composed with the help from medical professionals in a bid to ensure good quality healthcare is provided to all patients. In cases where obstetricians or other medical practitioners do not adhere to the guidelines, patients may make an official complaint to their hospital. This means their case will be looked at and a full investigation will be launched.
Find out more information on your rights:
- The official NHS site (http://www.nhs.uk/Pages/HomePage.aspx)
- The Association for Improvements in the Maternity Services (AIMS: http://www.aims.org.uk/)
- NICE (http://www.nice.org.uk/) .