Skip to main content
  1. Right Decisions
  2. GGC - Clinical Guidelines
  3. Maternity
  4. Back
  5. Common obstetric problems, intrapartum labour ward
  6. Indications for Obstetric Consultant Attendance in Labour Ward (595)
Please update your RDS mobile app to version 4.7.1

We are pleased to advise that deep linking capability, enabling users to directly download individual mobile toolkits, has now been released on the RDS mobile app. When you install the update, you will see that each toolkit has a small QR code icon the header area beside the search icon – see screenshot below. Clicking on this icon will open up a window with a full-size QR code and the alternative of a short URL for sharing with users. Instructions are provided.

You may need to actively install the update to install RDS app version 4.7.1 to see this improvement. Installing this update is also strongly recommended to get the full benefits of the new contingency arrangements – specifically, that if the RDS website should fail, you will still be able to download new mobile app toolkits. 

To check your current RDS version, click on the three dots bottom right of the RDS app screen. This takes you to a “More” page where you will see the version number.  To install latest updates:

On iPhones – go to the Apple store, click on your profile icon top right, scroll down to see the apps waiting to be updated and update the RDS app.

On Android phones – these can vary, but try going to the Google Play store, click on your profile icon top right, click on “Manage apps and device”, select and update the RDS app.

Please get in touch with ann.wales3@nhs.scot with any questions.

Indications for Obstetric Consultant Attendance in Labour Ward (595)

Warning

Please report any inaccuracies or issues with this guideline using our online form

Patient safety and quality of care is the priority.

The positive effect of direct consultant care is recognised. Consultant work patterns have been altered to facilitate their contribution to acute Obstetric care. There should be no hesitation to call Consultants to the Labour Ward area and Consultants should respond positively to requests for assistance.

A request to attend should be communicated clearly, in a structured way (e.g. by using SBAR). The request should be documented in the notes. If consultant input is required, this should happen before a management plan is discussed with the woman.

Attendance in person

In the following situations, the consultant should attend in person, whatever the level of the trainee:

  • Eclampsia
  • Maternal collapse (such as massive abruption, septic shock)
  • Life threatening maternal condition (such as amniotic fluid embolism)
  • Postpartum haemorrhage of more than 1.5 litres where the haemorrhage is continuing and a MOH protocol has been instigated
  • Return to theatre
  • Caesarean birth for major placenta praevia or placenta accreta spectrum (PAS) 
  • Vaginal twin births
  • Vaginal breech birth
  • Instrumental birth in women with BMI greater than 50
  • Caesarean birth in women with BMI greater than 50
  • Caesarean birth after intrauterine death has occurred
  • Caesarean birth for transverse lie
  • Caesarean birth at less than 30 weeks gestation
  • Uterine rupture
  • Fourth Degree perineal tear
  • Caesarean birth for any women declining blood products
  • Unexpected intrapartum stillbirth
  • When requested for any reason

Attendance in person or immediately available

For the procedures listed below, the consultant should attend in person or should be immediately available (i.e. present on labour ward) unless the trainee on duty is an ST7 and has been assessed by the unit and signed off, by OSATS where these are available, as competent for the procedure in question:

  • Full dilatation caesarean birth
  • Trial of forceps / vacuum
  • Rotational Forceps
  • Caesarean birth at 30-34 weeks gestation
  • Caesarean birth where the woman has had 3 or more previous caesarean sections
  • Third degree perineal tear (trainees at other levels who have been assessed to be competent may perform these unsupervised.)
  • Any woman who requires transfer to ITU

Situations where Consultants should be informed

In the following situations the consultant should be informed and a decision whether direct review or advice is appropriate should be made depending on each case. There should be a low threshold for attendance and direct contribution to care.

  • Severe maternal compromise (MEWS >7)
  • Any woman admitted to an Obstetric HDU or ITU
  • An intrauterine transfer (either out or in; discussion prior to decision)
  • Preterm labour less than 30 weeks
  • Severe pre-eclampsia – requiring IV therapy
  • Severe antepartum haemorrhage (evidence of maternal or fetal compromise)

Other factors

There will be times when consultant input is required due to high levels of clinical activity, rather than a single complex case. Where there are multiple factors present that overall increase the difficulty of a case the consultant should be called.

Senior midwifery staff or other medical staff should contact the consultant directly if it is considered that the clinical situation requires their input.

Consultants should be called for help if any clinical situation where their direct input to care would potentially improve the outcome for the mother and baby.

Editorial Information

Last reviewed: 27/02/2024

Next review date: 26/02/2029

Author(s): Ros Jamieson.

Version: 3

Approved By: Maternity Clinical Governance Group

Document Id: 595