Read standard 7: Intrapartum care

Maternity standards
Healthcare Improvement Scotland

Standard statement

NHS boards ensure timely, safe and effective intrapartum care.

Rationale

NHS boards should ensure that intrapartum care for women/birthing people, regardless of setting, is safe, person centred and evidence based. Multidisciplinary planning, safe staffing, timely access to care and informed decision making will improve the birth experience and outcomes for women and their babies.21 The principles of intrapartum care include respectful maternity care, effective communication and continuity of carer (see Standard 1). Women’s antenatal birth preferences and informed decisions should be supported wherever possible, including their choice of care partner or companion throughout labour and birth (see Standard 6).

Throughout labour and birth, maternity staff should carry out regular monitoring, clinical assessment and ongoing risk assessment based on evidence-based guidance. This includes options for monitoring maternal and fetal wellbeing during labour.

Staff should have a clear understanding of escalation procedures if any risks, concerns, complications or need for transfer arise for the woman and/or her baby. NHS boards should establish local, regional and national pathways for the transfer of care in line with national guidance and that include the Scottish Ambulance Service.

Pain management interventions and techniques during labour should be discussed as part of the woman’s birthing plan and revisited as labour progresses. Women should have access to analgesia appropriate to their birth setting in line with relevant guidance. Early referral to an obstetric anaesthetist is required for complex analgesia, such as epidural or remifentanil patient-controlled analgesia.

Women should receive appropriate care without unnecessary delay to minimise stress and improve outcomes.3 NHS boards should routinely monitor, review and report on care delays within maternity services, including delays in initiating the induction of labour to improve safety and patient outcomes.

Criteria

7.1

NHS boards provide oversight and assurance that intrapartum care is timely, safe and provided in line with the national maternity pathway and relevant guidance.

7.2

NHS boards have governance and oversight processes for the monitoring of quality and safety outcomes related to labour and birth. This includes but is not limited to:

  • locally agreed staffing and skill mix
  • delays in induction of labour
  • delays in access to theatres.
7.3

A primary midwife supports women to co-develop a labour and birthing plan, which:

  • begins during the antenatal period and is reviewed and updated during the intrapartum period
  • is informed by evidence, risk assessments and outcomes (for example, screening results)
  • includes the woman’s decisions for all aspects of her labour and birth
  • is shared with the wider team, where appropriate.
7.4

Women are supported to make informed decisions about labour and birth, which include:

  • choice of place and mode of birth
  • potential circumstances requiring transfer of care
  • pain relief options
  • potential outcomes or implications if clinical advice or recommendations are declined
  • potential birth interventions, including assisted birth, caesarean birth and anaesthesia options.
7.5

A midwife will undertake and coordinate intrapartum care in labour and birth, in line with national and local pathways and guidance.

When intrapartum care is coordinated by an obstetrician for clinical reasons, this is documented and clearly explained to the woman.

7.6

NHS boards have policies to support women to involve, if they wish, their companion of choice during labour and birth.

7.7

Throughout labour and birth, women are:

  • fully informed about what is happening, including being updated if there are any delays or recommended changes to care
  • offered one-to-one care
  • able to make informed decisions
  • empowered to ask questions and raise concerns
  • listened to and taken seriously
  • actively involved in decision making
  • supported to review and update their birth plans.
7.8

NHS boards ensure that any care or interventions clinically indicated or offered during labour are delivered in line with evidence-based clinical guidance. This includes, but is not limited to:

  • care plans for women with medical complexity
  • operative interventions
  • pain management
  • transfer of care between settings.
7.9

Where induction of labour is clinically indicated and recommended, this is delivered in line with clinical guidance and with the woman’s consent.

7.10

Women who decline induction of labour, should be offered a timely consultant obstetrician discussion and increased monitoring in line with national and local guidance.

7.11

A midwife will undertake and coordinate fetal monitoring, in line with national and local pathways and guidance. Where clinically recommended or indicated, this will include a referral to obstetric care.

What does this standard mean for...

What does the standard mean for women and their babies?

  • You will be supported to make informed decisions about where and how you want to give birth. These conversations will start during your pregnancy and will be reviewed again when you are in labour, so your choices can be updated if things change.
  • You will have one-to-one support throughout your labour, with the same midwife supporting you, where possible.
  • You will be offered advice on practical ways to help manage your labour, including breathing exercises, movement and relaxation and birthing positions.
  • You will be given clear information about all the available pain relief options available to you, including what they involve, how they work and any risks or benefits. You will be supported to choose what feels right for you.
  • If you require a caesarean birth or assisted birth (such as forceps), your midwife or obstetrician will explain this to you and will answer any questions that you have.
  • You will be told if there is likely to be any delay to your care.
  • You will be regularly assessed to check your and your baby’s health and wellbeing.
  • Your birth companion (partner, friend, or family member) will be welcomed and supported to stay with you and take part in your birth experience.

What does the standard mean for staff?

Staff, in line with roles, responsibilities and workplace settings:

  • provide safe and effective care during labour and birth based on national and local evidence-based guidelines, standards and pathways
  • escalate any risks during labour as appropriate
  • undertake and update care plans based on appropriate assessments of health, wellbeing and other needs during labour
  • ensure women receive support and regular communication during labour and birth including one-to-one midwifery support from a primary midwife
  • ensure referrals or transfer of care are initiated and actioned as appropriate
  • support women to make informed decisions about their labour and birth and ensure care plans are updated as appropriate.

What does the standard mean for the NHS board?

NHS boards:

  • ensure intrapartum care is timely and safe and in line with the national maternity pathway and relevant guidance
  • ensure safe staffing levels and provision of one-to-one midwifery care and support during labour and birth, regardless of setting
  • have systems and processes in place for the escalation and transfer of care to obstetric care
  • have policies in place to support a woman to have her companion of choice with her during labour and birth.

Benchmarking and measuring performance

 

Criteria

Examples of what meeting this standard might look like

Please note this list is not exhaustive and examples may vary according to the size and scale of the service or NHS board or delivery model

7.1

Audit of data for improvement, including the Scottish Patient Safety Programme and Excellence In Care measures.

7.2

Audit of delays to accessing care during labour (for example, delay to the induction of labour) with themes identified and action plans developed.

7.3

Review of women’s birth plans to provide evidence of co-design and demonstrate that women’s decisions are recorded and reviewed.

7.4

Patient experience surveys and feedback from Care Opinion.

7.5

Audit of implementation of intrapartum care pathways and clinical guidance.

7.6

Local guidance on birth companions in labour and birth settings.

7.7

Evidence of women being fully informed during their labour and birth, including observations, documentary evidence and experience data.

7.8

Audit results demonstrating compliance with guidance for pain management.

7.9

Audit data demonstrating compliance with induction of labour clinical guidance.

7.10

Review of patient records to evidence obstetrician care and increased monitoring for women who decline induction of labour.

7.11

Audit data demonstrating compliance with fetal monitoring pathways.

Editorial Information

Last reviewed: 23/03/2026

Next review date: 23/03/2031

Author(s): Maternity standards development group.

Author email(s): his.standardsandindicators@nhs.scot.

Approved By: Maternity standards development group

Reviewer name(s): Maternity standards project team.