Meet Ms Standard

Last week, I wrote about Ms Average – a woman who takes the most popular choices for giving birth.

But what if you don’t want to make any choices?  What happens if you take the standard, default offering with no customisation to suit your own needs and preferences?

Ms Standard has chosen this route.  She could easily have been called Ms Default or Ms Nice.  Here’s why…

It’s all about the guidelines

In the UK, all maternity providers are meant to observe the NICE (National Institute for Health and Care Evidence) guidelines.

There are different standards for different scenarios – antenatal checks, caesarean birth, low-risk labour and so on.

In addition, hospitals and NHS Trusts may have their own policies or protocols for labour.  And Midwives have to abide by their own professional codes.  So there are a lot of regulations and rules flying around.

The default option

In some ways, it makes sense.  In the absence of anyone (cough cough, you) suggesting otherwise, there’s a baseline set of standards to start from.  This means that if you have a change of shift halfway through labour, or move house during your pregnancy, you should receive a similar type of care.

Of course, there are times when women don’t receive care which meets the guidelines, but that’s probably another blogpost…

Even if you don’t live in the UK, your care providers will probably have a standard template that they will follow as a default option for birth.  It’s worth finding out what their particular ‘map’ is.

Ms Standard’s birth

To make things easier, I’m going to assume that Ms Standard is giving birth in a hospital which follows the NICE guidelines to the letter and doesn’t have its own policies on top.  I’ve also assumed that she’s not going to choose an Epidural, or have any complications during her birth.

Ms Standard is a ‘low-risk’ mother having her second baby.

She goes into labour naturally.  Her waters haven’t broken when she arrives at the hospital.  She’s brought her husband, Mr Nice, along.

She’s met with a smile by the Healthcare Professional (HCP) looking after her.

The HCP (usually a Midwife) checks her temperature, blood pressure, pulse; asks for a wee sample and feels her belly.

The Midwife also asks her about any vaginal discharges or whether her waters have broken.

She then listens to the baby’s heart for one minute.

A vaginal examination is offered.

They discuss options for pain relief.

The option for labouring in water should be available.

‘Gas and air’ should be available for pain relief.

Pain-relief drugs given by injection (e.g. Pethidine) should be available, but Ms Standard won’t be able to use a birth pool for two hours if she has one of these injections.

Ms Standard’s labour isn’t considered ‘established’ until she is having ‘painful’ contractions and her cervix is 4cm dilated.  If she comes to the hospital early, she may well be asked to go home.

Once ‘established’, she is expected to make it to 6cm within two hours and continue to dilate another 2cm every two hours.

Once her labour has got going, she has at least one professional ‘supportive’ person with her at all times (this is usually a Midwife, but the NICE guidelines don’t name the profession of the ‘supportive’ person.  I’m going to assume it’s a Midwife for this piece).

Ms Standard will be in a labour room on the labour ward.

The Midwife will start her medical labour written records.

Ms Standard will have her blood pressure checked every 4 hours.  She’ll also be offered vaginal examinations at the same interval.

Her pulse will be taken hourly.

The baby’s heartbeat will be checked every 15 minutes, for one minute.

Ms Standard will be asked about her pain relief requirements every so often.

Once Ms Standard starts to feel the urge to push, she’ll be expected to birth her baby within two hours.  However, if the baby hasn’t been born within an hour, then Ms Standard will be referred to an Obstetrician for possible instrumental assistance.

As the birth is nearer, vaginal examinations will now be offered every hour.  Her blood pressure and pulse will also be checked at the same frequency.

The baby’s heartbeat will be checked for one minute, every five minutes.

Ms Standard will be encouraged to find a position to give birth that isn’t lying down.

Once the baby is born, Ms Standard will have an injection to make the placenta come more quickly.

The cord will be clamped very quickly and the Midwife may pull on it slightly to help it release.

It will be expected within 30 minutes.

The baby will have a breathing and condition check when s/he is one minute and five minutes old.  This is known as an ‘Apgar’ test.

The Baby will be dried off and placed on Ms Standard’s chest, with a towel over them both to keep them warm.

Baby Standard (‘Boris’) will stay on Ms Standard’s chest for an hour, after which he will be weighed and measured.

The Midwives will support Ms Standard to start breastfeeding Boris within the first hour of his life.

After Boris is weighed and measured, he’ll then have a further check which will look for physical abnormalities.

The Midwife will continue to check Ms Standard’s pulse and blood pressure, and make sure that she can have a wee.

She will check to see if there was any tearing, and make arrangements for stitching as necessary.  Ms Standard may need to lie down with her legs in the air for the checking or stitching to take place.

If any tearing is found, a rectal examination may be offered.  Medication may also be offered rectally to reduce swelling.

As it’s her second baby, Ms Standard will either go home after six hours or one night, depending on the hospital’s discharge policy.

References and further geekery:

NICE Guidelines for labour (aimed at Healthcare Professionals)

NICE Guidelines for labour (aimed at parents)

Northampton General Hospital labour guidelines (example of a NHS hospital protocol)

I’m aware that NICE is reviewing the guideline for the default option for managing the placenta after the baby is born.  The information above is my understanding of what is in force at the time of publication (24th May 2013).  I’m not a Midwife or Healthcare Professional.  If you are and I’ve misunderstood something, please correct me below!

Is Ms Standard’s birth the one you’d want?  Would you change anything on the list above?  Please tell me more by leaving a comment below.