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NICE Guidelines
Andrea Sutcliffe
Deputy Chief Executive
26 June 2007
Overview

•   Range of NICE Guidelines
•   Key Safety Messages
•   Intrapartum Care
•   Evidence base
•   Implementation
    Range of NICE Guidelines

•   Published
     –   Antenatal care (update underway)
     –   Antenatal and post natal mental health
     –   Electronic Fetal Monitoring (update underway)
     –   Induction of Labour (update underway)
     –   Caesarean Section
     –   Postnatal care
•   In development
     –   Intrapartum care (2007)
     –   Diabetes in Pregnancy (2008)
     –   Maternal and childhood nutrition (2007/8)
     –   Social complications in pregnancy with SCIE (2010)
•   Potential other topics
     – Multiple pregnancy
     – Hypertension in pregnancy/medical complications in pregnancy
 Key Safety Messages

• Antenatal care
   – Monitoring and screening
   – Advice to women on lifestyle issues
• Antenatal and postnatal mental health
   – Information about risks of medication
• Caesarean Section
   – Timing of planned sections (after 39 weeks)
   – Timing of emergency sections (within 30 minutes)
   – Procedural aspects
• Postnatal Care
   – Life-threatening conditions in women
   – Health problems in babies
 Intrapartum Care
• Remember
   – Giving birth is generally very safe for mother and baby
• Governance Issues
   –   Joint working
   –   Good communications
   –   Agreed pathways of care
   –   Data collection and audit
   –   Root cause analysis of adverse incidents
• Place of Birth
   – Risks and benefits in all settings
   – Informed choice
 Evidence Base

• Poor quality data currently available
  – Rare events need big studies
  – Elimination of confounding factors
• So we do not know
  – Safety profile of different settings for the baby
  – When mothers transfer from planned home birth to
    birth in hospital and crucially, why
• Other issues
  – Risk assessment in antenatal care
    Implementation
•   Local action
     –   Multi-disciplinary working
     –   Comparison of current service to guidelines
     –   Establish an action plan
     –   Local champions and user involvement in making change
     –   Data collection and audit
     –   Informed commissioning
•   National support
     –   Tools from NICE
     –   National Service Frameworks
     –   Healthcare Commission
     –   NPSA
     –   CNST
     –   Relevant Royal Colleges
     –   National data collection
     –   Review of guidelines in the future
Final Thoughts
 Mother




                 Baby
                        Family