NCT Better Birth

Environment Campaign
Lisa Cunningham
 About the NCT
• Huge network of branches covering 100%
of UK
• Supports parents of babies and toddlers,
before and after birth
• Maintains a community network of support
groups, events and resources for new
parents
The NCT package
• Local knowledge - parents’ views and
experiences
• Policy awareness – national policy in all four
countries of the UK
• Woman-centred and parent focused perspective
• User advocacy – empowerment of all parents,
access and involvement
• Evidence-informed – knowledge of relevant
research evidence (NICE guidelines etc.)
 NCT services
• Antenatal courses in range of formats to meet
different needs – subsidised places available
• Breastfeeding counselling and support via local
networks
• Postnatal courses and informal groups
• NCT helplines
• Enquiries Line - 0300 33 00 770
• Pregnancy & Birth Line - 0300 330 0772
Breastfeeding Line - 0300 330 0771
The NCT Birth Policy
NCT wants all women to
be able to give birth with
confidence and dignity
and every opportunity to
have a straightforward
vaginal birth
Download Birth Policy at
http://www.nct.org.uk/abo
ut-us/what-we-
do/policy/pregnancyandbi
rth
What is the NCT position based on?
• National Services Framework for Children,
Young People and Maternity Services (2004)
• Maternity Matters (2007) - Choice, access and
continuity of care in a safe service - national
choice guarantee, to be implemented by the
end of 2009. Choices include type of
antenatal care, place of birth and place of
postnatal care
• The experience and needs of our members
 Caesarean Rate (%)

0
5
10
15
20
25
19
80
19
81
19
82
19
83
19
84
19
8
19 5
86
19
87
19
88
19
89
19
9
19 0
9

Caesarean Rate
19 1
92
19
9
19 3
9
19 4
9
19 5
96
19
Prepared by BirthChoiceUK.com

97
in England

19
9
19 8
9
20 9
0
Normal Delivery Rate

200
0
20 1
0
20 2
03
20
0
204
05
40
45
50
55
60
65

Normal Delivery Rate (%)

Changes in caesarean and normal delivery rates
What women told us they wanted
9 out of 10
women feel that
the physical
environment
can affect how
easy or difficult
it is to give birth.
Hodnett ED, Gates S, Hofmeyr GJ, Sakala C.
Continuous support for women during childbirth.
The Cochrane Library, Issue 3. Oxford: Update
Software, 2003. page 2 of 15 (electronic version)
“During labour women may be uniquely
vulnerable to environmental influences; modern
obstetric care frequently subjects women to
institutional routines, high rates of intervention,
unfamiliar personnel, lack of privacy, and other
conditions that may be experienced as harsh.
These conditions may have an adverse effect
on the progress of labour and on the
development of feelings of competence and
confidence.”
NCT Better Birth Environment
campaign (BBE)

An Audit Toolkit
was sent to every
head of midwifery
 Model -Birth Centres
• One-to-one midwifery care
• Familiar midwives, clear philosophy of
care
• Access – local community service
• Individualised care – choice
• Normal birth, breastfeeding support
Birth centres – good practice during labour
and birth
Compared with hospital, women more likely to:
• Feel able to walk around,
• Have a private toilet and access to a birth pool,
• Have a homely looking room with a comfortable
chair for companion,
• Have control over the temperature, lighting and
who enters the room,
• Be able to move furniture to suit their needs
Source: NCT Better Birth Environment Survey 2003
Birth centres- good practice after birth

Women using a birth centre more likely to:

• stay in the same room after the birth,
• have companions staying with them, and
• have a good meal after birth
Source: West Hertfordshire Survey 2006
 Birth Centres - Evidence

NICE Intrapartum Care Guideline

(September 2007) reported:
• Reduced: use of pharmacological pain
relief
• Increased: intact perineum,
spontaneous vaginal birth, satisfaction
NCT Evidence-based briefing
Maternity care in free standing birth centres – part 1
Denis Walsh, Senior Lecturer in Midwifery, University of
Central Lancashire

• Evidence suggests that birth centres are very positive

environments for normal birth, in terms of clinical
outcomes and the satisfaction of women.
• Qualitative studies show that the ethos and behaviour
of staff and parents in small midwife-led birth centres
are very different from those in many hospital
maternity hospitals.
• Birth centres may bring a number of organisational
and environmental benefits that are more difficult to
achieve in larger units.
Model – home births
• Midwives based in the community, ideally
caring a small personal caseload of
women
• Benefits to women – care in their own
home, close to their family, midwife a
‘guest’ rather than authority figure
• High rates of normal birth – low need for
pain relief or medical interventions
Model – home births
Requirements for success
• Committed midwifery leadership at all
levels
• Understanding of the clinical evidence and
benefits for women
• Support and development for midwives
with limited experience of home birth
• Midwives based in the community,
working as autonomous practitioners
 Model – hospitals
Perth Royal Infirmary, Scotland
 Summary
• Government policy supports choice of place
of birth and parents being fully involved in
planning local services
• Evidence shows the environment in birth
centres and at home is valued by parents and
supportive of straightforward labour
• In contrast, conditions in some hospitals can
upset the progress of labour and more
interventions are usual
• Development of birth centres
and access to home birth is a priority
Further information

• campaigns@nct.org.uk
• www.nct.org.uk