2. Labour and birth.

This chapter describes the national guidance for care during labour and childbirth in the United Kingdom during the COVID-19 pandemic. The content largely draws attention on the guidance developed by the Royal College of Obstetricians (RCOG) and the Royal College of Midwives (RCM), and specific guidance on infection prevention and control measures from Public Health England. The key areas addressed are as follows: The chapter refers to some of the ways in which the guidance was translated in practice. The guidance was developed using a rapid analysis approach to emerging research and evidence, along with evidence from previous experiences of coronavirus combined with consensus expert opinion from all key professionals providing maternity care in the UK. WHAT IS KNOWN: The UK RCOG/RCM COVID-19 guidance was widely accepted across the UK maternity services and also worldwide as a reliable and credible source of information to shape care during the pandemic. WHAT IS NOT KNOWN: The full impact of the pandemic on the experiences and outcomes for babies and women of pregnancy, childbirth, and early parenting in the UK. The impact of the new approaches to intrapartum care on experiences and outcomes for women, babies, and families. The impact of the changes required to intrapartum care as a result of the pandemic on the professional care provided; in terms of pressure created by rapidly changing approaches to care and restrictions on the ability to provide normal levels of care.

Not my choice: results of an online survey.

A survey into women's experiences of giving birth in the UK published in October 2013, provides a useful insight (Birthrights UK 2013). It is the first of its kind to capture women's views on dignity in childbirth. The survey reflects the importance of place of birth, with women who gave birth in obstetric units reporting much lower levels of satisfaction and a greater lack of control than those giving birth in birth centres or at home. Those who had an instrumental birth reported lower levels of respectful care and a much greater lack of control. The midwifery profession needs to reflect carefully on these findings and ensure the needs of running a busy maternity service efficiently do not take priority over the human rights of women.

Too afraid to push: dealing with fear of childbirth.

Maternal request for caesarean section in the absence of medical need is an ethical and moral dilemma for the NHS. When a woman makes such a request it requires careful exploration of the underlying motivation. Many of these women will be anxious or fearful of giving birth and require tailored support. The provision of an antenatal pathway that acknowledges these fears, focuses on enabling coping mechanisms and supports shared decision making can reduce the number of requests for a caesarean.

Postpartum urinary symptoms.

There are clear contributing factors during the antenatal and intrapartum period which increase the likelihood of women experiencing postpartum bladder dysfunction. Whilst, anecdotally, stress incontinence is often talked about and accepted by many women to be part of the post childbirth experience, postpartum bladder retention is not. Understanding both the risk factors and the potential short- and long term impact of bladder dysfunction are important elements in postnatal care. This understanding should guide appropriate management and early detection in the postnatal period, considered vital in avoiding long term sequelae.