The Royal College of Obstetricians and Gynaecologists (RCOG) published its document Standards in Maternity Care in 2008 which is being used widely by commissioners, providers and policy makers. The document sets out the principles of quality-assured maternity services. This chapter identifies some key indicators as exemplars, although it is recommended to make use of the whole document. Prepregnancy care for women with social needs is essential. Prepregnancy care can improve outcomes in high-risk pregnancies regardless of whether the high-risk status is of medical or social aetiology. From a public health perspective, the identification of anomalies can improve perinatal morbidity and mortality, as conditions may be identified early in pregnancy and managed accordingly. Current approaches for the prevention of hypoxic ischaemic encephalopathy include antenatal identification and monitoring of fetal growth restriction and electronic fetal monitoring accompanied by intrapartum fetal blood sampling.

This chapter explores how policies, current standards and practices can be integrated to improve women's access and promote confidence and trust in the services provided as well as having a maternity workforce which use resources effectively. For safety and quality of care, protocols and care pathways are recommended, but midwives and obstetricians need to remember that each woman's care is individual and her journey through the labour is dynamic. The professionals agree that each organisation should have locally agreed clinical guidelines for midwifery-led labour care for low-risk women. Service planning has to support both low-risk and high-risk labour care pathways with equity. Any birth environment should have a monitoring tool for staffing levels. There are many sources recommending audits on labour care and outcomes: Royal College of Midwives (RCM) birth centre standards, Safer Childbirth, and Standards for Maternity Care.