The updated NICE guideline on Intrapartum care for women with existing medical conditions or obstetric complications and their babies has been welcomed by midwives and other birth workers who quickly spotted changes made to the recommendations to the care offered to woman seeking a vaginal birth after a previous caesarean.
Notably, the new guideline recommends
- Not routinely inserting an intravenous cannula for women in labour (1.19.1)
- Explaining to women that there is little evidence of a difference in outcomes for the baby between a vaginal birth or another caesarean section (1.19.3)
- Explaining the pros and cons of giving synthetic oxytocin in the first and second stage of labour (1.19.5)
- Supporting informed choice of a full range of options for pain relief for women who have had a previous caesarean section, including labour and birth in water (1.19.7).
The guideline also recommends that continuous CTG monitoring should be offered only if the woman is using synthetic oxytocin (1.19.6) or if amniotomy is being performed (1.19.10) and that amniotomy should not be routinely offered to women who have had a previous caesarean section (1.19.9).
These guidelines are in contrast to the 2015 RCOG Green-top guideline on Birth After Previous Caesarean Birth which recommended (among other things) continuous CTG monitoring and intravenous cannulation for all women seeking vaginal birth after caesarean and which made more conservative statements (based on expert opinion rather than the results of research trials) about the outcomes of different approaches.