Note: Originally posted in 2015, this article has been updated to the latest version of NICE’s guidelines for intrapartum care published in 2023.

Many recommendations in the National Institute for Health & Care Excellence (NICE) guidelines for care in labor support what advocates for physiologic care have long been saying about the care of healthy women having normal labors. To cite but a few examples:

Explain to both [women who have had prior births and first-time mothers] that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth (p. 9).

All staff and organisations should ensure that all birth settings have a culture of respect for each woman as an individual undergoing a significant and emotionally intense life experience, so that the woman is in control, is listened to, her choices are supported, and she is cared for with compassion (p. 23).

Encourage and help the woman to move and adopt whatever positions she finds most comfortable throughout labour, except lying flat on her back (p. 26).

References its guidelines on fetal monitoring in labor, which state: Offer intermittent auscultation of the fetal heart rate to low-risk women in established first stage of labour (p. 8).

Do not leave a woman in established labour on her own except for short periods or at the woman’s request (p. 23).

If a woman chooses to use breathing and relaxation techniques in labour, support her in this choice. . . . Offer the woman the opportunity to labour in water for pain relief (p. 29, 30).

Inform the woman that she may drink during labour when she is thirsty . . . [and] that she can eat a light diet in established labour unless she has received opioids or she develops risk factors that make a caesarean birth more likely (p. 46).

Advise a woman without an epidural in place during the second stage of labour that:

• • lying flat on her back can lead to a decrease in blood pressure and may reduce placental blood flow
  • she can use any other position she finds comfortable to give birth
  • upright positions and keeping mobile may be beneficial (as they may reduce fetal heart rate abnormalities, episiotomy rates and improve her birthing experience) (p. 56-57).

Advise women without an epidural in place that:

• • spontaneous pushing may shorten the second stage of labour compared with directed pushing
  • if directed pushing is used, pushing while exhaling may shorten the active second stage of labour for multiparous women (p. 57).

Both the guidelines for care and for fetal monitoring in labor are downloadable for free.