In 2019 NICE (National Institute for Health and Clinical Excellence) published guidance on 'Intrapartum care for women with complications'. (Intrapartum just means 'in labour'.)

There is a whole section on birth after caesarean (see below). You'll see it now recommends

• water birth should be supported, and
• do not routinely insert a cannula.

Regarding the line about continual monitoring, take a look at the next section of this course.

NICE guideline for intrapartum care for women complications: previous caesarean birth.

1.19.1

Do not routinely insert an intravenous cannula for women in labour who have had a previous caesarean section.

1.19.2

Explain to women in labour who have had a previous caesarean section that:

• a vaginal birth is associated with a small chance of uterine rupture
• an emergency caesarean section may mean a higher chance of:
• heavy bleeding needing a blood transfusion
• infection, for example, intrauterine infection
• a longer hospital stay
• complications in a future pregnancy, for example, placenta praevia and placenta accreta (see the NICE guideline on caesarean section).

1.19.3

Explain to women in labour who have had a previous caesarean section that there is little evidence of a difference in outcomes for the baby between a vaginal birth or another caesarean section.

1.19.4

Explain to women who have had a previous caesarean section that they are likely to have a lower chance of complications in labour if they have also had a previous vaginal birth.

1.19.5

When discussing oxytocin for delay in the first or second stage of labour, explain to women who have had a previous caesarean section that this:

• increases the chance of uterine rupture
• reduces the chance of another caesarean section
• increases the chance of an instrumental birth.

1.19.6

For guidance on continuous cardiotocography in labour for women with a previous caesarean section, see NICE's guideline on caesarean section.

1.19.7

Support informed choice of a full range of options for pain relief for women who have had a previous caesarean section, including labour and birth in water.

1.19.8

Explain to women in labour who have had a previous caesarean section that regional analgesia is associated with:

• a reduced chance of another caesarean section
• an increased chance of an instrumental birth.

1.19.9

Do not routinely offer amniotomy to women in labour who have had a previous caesarean section.

1.19.10

This recommendation on continuous cardiotocography has been withdrawn (see recommendation 1.19.6).

1.19.11

For women who have had a previous caesarean section, be aware of the particular importance of following the recommendations from the NICE guideline on intrapartum care for healthy women and babies on:

• food and drink in labour
• controlling gastric acidity
• position in labour, including the latent first stage, and birth.