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

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

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)

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.