The impact of delivery suite guidelines on intrapartum care in ‘standard primigravida’

Document Type



School of Nursing and Midwifery, East Africa


Objective: To compare intrapartum interventions and outcomes in low-risk primiparous women and identify factors which may contribute to the variations between different maternity units.

Design: Prospective observational study.Participants: Ten maternity units in England.Methods: Participating units provided data on 11 clinical indicators for all ‘standard primigravidae’ delivered between January and December2000 and provided information on written delivery suite policies operational during July 2000.

Results: There was a significant inter-unitvariation in the use of intrapartum foetal blood sampling, use of syntocinon for augmentation of labour, mode of delivery, type of perinealdamage, postpartum haemorrhage, low Apgar score and admission to SCBU. Units with guidelines for intrapartum foetal heart monitoring had higher rate of normal vaginal deliveries (odds ratio (OR): 1.34; 99% confidence interval (CI): 1.05–1.70) and lower rate of Caesareansection for foetal distress (OR: 0.57; 99% CI: 0.34–0.96). Units with partogram guidelines also had lower rates of Caesarean section for foetal distress (OR: 0.49; 99% CI: 0.30–0.81). Units with guidelines on the management of episiotomy had higher episiotomy rates (OR: 1.54; 99%CI: 1.15–2.06) while units with guidelines on the involvement of neonatal staff recorded less babies with Apgar score <7 at 5 min (OR: 0.37;99% CI: 0.17–0.76).

Conclusions: Written delivery suite guidelines have significant impact on the type of intrapartum care and outcome of pregnancy in low-risk women. Their availability suggests more active role of interested clinicians in the provision of intrapartum care. There is an urgent need to identify other factors that influence quality and quantity of clinical input into the care of low-risk pregnant women


This work was published before the author joined Aga Khan University


European Journal of Obstetrics & Gynecology and Reproductive Biology