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.

Antenatal care for women with a low-risk pregnancy is predominately provided by midwives supported by maternity support workers and other professionals. The National Institute for Health and Clinical Excellence (NICE) has published guidance on the routine care of the healthy pregnant woman, outlining a schedule of appointments and the type of screening available. The care pathway provides details of antenatal care for women with an uncomplicated pregnancy. The establishment of Maternity Direct under the aegis of NHS Direct in certain parts of the country has led to a reduction in antenatal admissions. Midwives are the specialists of normality, and are trained to diagnose pregnancy and assess and monitor women holistically throughout the antenatal period. The majority of maternity services are using the Royal College of Obstetricians and Gynaecologists (RCOG) Maternity Dashboard. Maternity services should audit the percentage of women who booked by the 12th completed week of pregnancy.

This chapter is based mainly on Pregnancy Loss and the Death of a Baby: Guidelines for Professionals. Women want to be cared for by skilled staff who show empathy and support for them and their partner, and who give them privacy and time. Several publications are available that provide guidance and set standards for the care of women and families experiencing pregnancy loss. Clear pathways between secondary care and the primary care team are essential to ensure that bereaved parents receive good care at all times. Staffing levels should ensure that parents receive continuity of carers. Carers must have training to enable them to support grieving parents, and must themselves be well supported. The bereavement service as a whole should be audited regularly to ensure that it provides comprehensive, culturally sensitive management and support for families who have experienced an early or mid-pregnancy loss, stillbirth or neonatal death.