Quality statement 5: Interventions during labour
Quality statement
Women at low risk of complications are not offered amniotomy or oxytocin if labour is progressing with no complications or concerns.
Rationale
For women at low risk of complications, amniotomy and oxytocin do not reduce the incidence of caesarean birth, increase the incidence of spontaneous vaginal births or contribute to improved neonatal outcomes. They are therefore unnecessary for women at low risk of complications if labour is progressing with no complications or concerns.
Quality measures
The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured, and can be adapted and used flexibly.
Structure
Evidence of local arrangements to ensure that women at low risk of complications who are in labour that is progressing with no complications or concerns do not have amniotomy or oxytocin.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from local protocols on the use of amniotomy and oxytocin.
Process
Proportion of women at low risk of complications whose labour is progressing with no complications or concerns who do not have amniotomy or oxytocin.
Numerator – the number in the denominator who do not have amniotomy or oxytocin.
Denominator – the number of women at low risk of complications whose labour is progressing with no complications or concerns.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
Outcome
a) The number of women whose labour progressed with no complications or concerns who had amniotomy or oxytocin.
Data source: Data can be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient records.
b) Maternal satisfaction and experience of care.
Data source: National data is collected as part of the Care Quality Commission's Maternity Survey, section C ('Your labour and the birth of your baby'). Data can also be collected from information recorded locally by healthcare professionals and provider organisations, for example, from patient satisfaction surveys.
What the quality statement means for different audiences
Service providers (all 4 birth settings) have protocols in place to ensure that women at low risk of complications whose labour is progressing with no complications or concerns are not offered amniotomy or oxytocin.
Healthcare professionals (midwives and obstetricians) do not offer amniotomy or oxytocin to women at low risk of complications whose labour is progressing with no complications or concerns.
Commissioners (integrated care systems) specify and check that service providers have protocols in place to ensure that women at low risk of complications whose labour is progressing with no complications or concerns are not offered amniotomy or oxytocin.
Women who are at low risk of having problems and whose labour is progressing with no complications or concerns are not offered amniotomy (having their waters broken) or oxytocin (a medicine given through a drip that speeds up labour).
Source guidance
Intrapartum care. NICE guideline NG235 (2023, updated 2025), recommendations 1.8.39 and 1.8.40
Definitions of terms used in this quality statement
Labour progressing with no complications or concerns
This is labour which is spontaneous in onset, low risk at the start and remaining so throughout labour and birth. [Expert opinion]