Wednesday, October 3, 2007

NICE clinical guidelines for labour and birth

The latest NICE guidelines on labour and birth have just been released. I must admit I have not looked at them in detail yet. When you are reading these sorts of publications you must remember the context that they are generated from and the politics that go into their development that you may be completely unaware of. Generally, the NICE publications are widely respected and can be a very useful tool for implementing change of practice. After having a quick browse, a couple of things caught my eye:
  • water is recommended as pain relief - it is great that water is now recognized as a main stream method of managing pain in labor;
  • 'term' is defined as 42 weeks gestation- not 40 or 41 weeks, which should be remembered when discussing routine induction of labor for so-called post-dates pregnancy;
  • no pre-load intravenous fluid required for epidural, nor maintenance fluid - hopefully this will prevent all the fluid overloading that occurs;
  • women should be told the average length of labor for first time mothers is 8 hours and for subsequent babies is 5 hours - this strikes me as problematic for several reasons: firstly, you must be quite sure when a woman is in true, established labor; secondly it makes no allowance for women who have long but perfectly normal labors
  • strict time frames for intermittent monitoring of baby's heart rate - at least it does not recommend continuous monitoring for low risk women;
  • birth plans should be adhered to when possible if women have them - shouldn't every women have some sort of documented plan that has been agreed to in the antenatal period? I am not talking about pages and pages of tree hugging but rather some documentation about what has been discussed and agreed.
These are just a few quick impressions. What do you think?


Sue Waters said...

Hi Sarah

I am enjoying reading your comments on child birth but not sure if you want a non-midwife to comment on their thoughts?

Let me know -- but I am sure you have heard them all from the non-midwives.


Sarah Stewart said...

Sue, I'd be really thrilled to hear non-midwife comments. Thank you.

Anonymous said...

Hi I heard that since 2006 (nice guidelines) that women should no longer be instructed to 'take a deep breath, hold it and push' as this causes loss of oxygen to the baby. Can you tell me if this is fact please.

Sarah Stewart said...

Hi Sandra, yes that is a fact. There is a lot of research that says that this coaching of pushing only reduces the time of the second stage of about by a short amount & can harm the baby. Research carried out in the 1970s confirmed this. Physiological pushing ie waiting for the body to do its won thing, is highly recommended unless there is a reason to get the baby birthed quickly, or the mother has no sensation to push caused by things like an epidural.

I think this information published by the Royal College of Midwives is very helpful.