All women, regardless of whether their pregnancies are high or low risk, should be treated with respect and should be in control of and involved in what is happening to them in labour. Intrapartum causes of maternal mortality are extremely rare; nevertheless, good intrapartum care and monitoring of the woman with a high-risk pregnancy is essential in ensuring a good maternal and fetal outcome. In the UK, the National Institute for Health and Clinical Excellence (NICE) has published comprehensive guidelines on the intrapartum care of the woman at low risk at term. All maternity units and labour wards should have a lead named midwife, obstetrician, paediatrician and anaesthetist. It is imperative that staffing levels and competencies of staff on labour wards comply with national standards. Guidelines provide a framework from which healthcare providers can design clinical care pathways and organisational structures to improve care of the high-risk woman in labour.

Risk management aims to reduce poor outcomes by first identifying adverse events, creating a database to identify common patterns, and developing a system of accountability to prevent future incidents. Staffing of the labour ward may be the single most important risk. Birthrate Plus is a tool for assessing midwifery staffing that can identify shortfalls. Healthcare trusts collect a large sample of data on births related to their complexity, ranging from a simple, straightforward birth to an emergency caesarean section, and the average birth time is measured. Training may be the single most effective part of system implementation for reactive and proactive risk management. Training for staff in the core skills needed to handle emergency situations makes an important contribution to safety, although Towards Better Births found that there was a wide variation in trusts' training programmes, including the multiprofessional nature and attendance levels.