Making normal birth a reality Ob-gyn and midwife organizations in the UK are endorsing a new consensus report calling for action to increase rates of ‘normal birth’ where appropriate in order to minimize morbidity and complication rates. http://www.rcog.org.uk/resources/public/pdf/normal_birth_consensus.pdf The 8-page document, Making Normal Birth A Reality, was developed by members of the Maternity Care Working Party, an independent multidisciplinary body that campaigns for improvements in maternity care. The document is endorsed by the UK’s Royal College of Obstetricians and Gynaecologists (RCOG), the Royal College of Midwives, the National Childbirth Trust, and other organizations. It calls on all healthcare services in the UK to collect and publish statistics on normal birth/delivery using the definition produced by the Information Centre for the National Health Service in England: “without induction, without the use of instruments, not by cesarean section, and without general, spinal or epidural anesthetic before or during delivery.” It emphasizes that the definition refers to the process of labor, and not outcomes. One of the main recommendations of the consensus report is that “maternity services should aim to increase their normal birth rates towards a realistic objective of 60 percent by 2010.” The latest available figures, for 2005, show that 48 percent of women delivering in hospital in England and 39.4 percent of women delivering in hospital in Scotland had a normal birth as defined above. Rates at individual maternity units in England ranged from 37 percent to 59 percent. The report says action is necessary because of concerns about rising intervention rates and wide variations between services in terms of planned and unplanned cesarean sections, and operative births. According to the report, procedures used during labor that are known to increase the likelihood of medical interventions should be avoided where possible. For example, it states, “continuous electronic fetal monitoring during labour in low-risk women is associated with an increase in emergency caesarean section but no long-term health gain, and use of epidural anaesthetic in labour increases the need for forceps or ventouse.” Other recommendations for maternity services and providers include the following: “Maternity services to set in place a strategy for supporting women to have a positive experience of pregnancy and birth, and increasing normal birth rates, to be signed off by the clinical leads for midwifery and obstetrics.” “[Offer a] Choice of place of birth including home birth, a midwife-led birth centre and a maternity unit with midwifery and medical facilities.” “[Offer] The chance for women to get to know their midwife prior to labour.” “[Ensure there is a] Consultant midwife and consultant obstetrician presence on the labour wards to lead and support staff.” “Comparative normal birth rates should be available for ‘low-risk’ women planning and starting their care in different care settings” (such as home, free-standing birth centre, hospital unit). The report, which is available via the website of the RCOG (www.rcog.org.uk), also calls for government action to fund further research about best practice in relation to normal birth and to provide financial and regulatory incentives, and education and training, to enable the recommendations above to be implemented rapidly within the health service.