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Intended for healthcare professionals

Practice Guidelines

Intrapartum care–updated summary of NICE guidance

ݮƵ 2024; 384 doi: (Published 29 January 2024) Cite this as: ݮƵ 2024;384:p2885

This article has a correction. Please see:

  1. Rebecca Blackburn, technical analyst1,
  2. Agnesa Mehmeti, technical analyst1,
  3. Samantha Russell, patient representative2,
  4. Frances Rivers, consultant midwife3,
  5. Margaret Blott, consultant obstetrician and lead for obstetrics4
  6. On behalf of the guideline committee
  1. 1National Institute for Health and Care Excellence, London, UK
  2. 2Patient author
  3. 3Kingston Hospital NHS Foundation Trust, UK
  4. 4The Royal Free London NHS Foundation Trust, UK
  1. Correspondence to R Blackburn Rebecca.Blackburn{at}nice.org.uk

What you need to know

  • Consider a woman’s body mass index when planning place of birth, as the chance of needing interventions in labour varies across different BMI ranges

  • Remifentanil patient controlled analgesia and programmed intermittent epidural boluses are now recommended as pain relief options for women during labour; consider sterile water injections for back pain

  • Warm compresses or massage during the second stage of labour may prevent serious perineal tears and can be considered if appropriate for and acceptable to the woman

In 2021, there were around 650 000 births in England and Wales.1 Most of these births were the result of a straightforward pregnancy, where labour occurred spontaneously at term (37-42 weeks) and the woman gave birth to a single baby without complications. The advice and care that women receive around where to plan their place of birth, pain relief during labour, and management of labour affect their overall experience, and could impact both their mental and physical health and the health of their babies.

The National Institute for Health and Care Excellence (NICE) first published guidelines on intrapartum care for healthy women and babies in 2014, and these were updated in 2017. This article summarises a selection of new and updated recommendations, and focuses on those where new evidence has emerged that has led to a change in advice and recommendations involving shared decision making between the woman and the healthcare professional.

The recommendations included in this summary use the terms “woman” or “mother” throughout; however, they apply also to people who do not identify as women but who are pregnant or have given birth.

Recommendations

NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the guideline development group’s experience and opinion of what constitutes good …

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