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All hospitals should ensure the availability of areas that allow those doctors working night shifts to take rest breaks, which are essential for the reduction of fatigue and improve safety.²⁸ These areas should not be used by more than one person at a time and should allow the doctor to fully recline.⁸⁴

Standards of accommodation for doctors in training should be adhered to.²⁹ Where a consultant or other autonomously practising anaesthetist is required to be resident, on-call accommodation should be provided.²⁸

Hotel services should provide suitable on-call facilities, including housekeeping services for resident and non-resident anaesthetic staff. Refreshments should be available 24/7.⁸⁴

Guidelines containing standards about the following subjects should be held and easily accessible:²⁴ 

• provision of information to patients
• conditions requiring antenatal referral to the anaesthetist⁸⁵
• antacid prophylaxis for labour and delivery and oral intake in labour
• regional analgesia for labour²⁴
• management of regional techniques in patients with coagulopathy or receiving thromboprophylaxis
• management of the complications...

Care for the acutely ill obstetric patient and NICE guidance on the recognition of and response to acute illness in adults in hospitals should be implemented.^40,93,94

An early warning score system, modified for use in obstetrics, with a graded response system should be used for all obstetric patients to aid early recognition and treatment of the acutely ill woman.^95,96,97,98

All units should be able to escalate care to an appropriate level; critical care support should be provided if required, regardless of location.⁴⁰

Whenever possible, escalation in care should not lead to the separation of mother and baby. When separation is unavoidable, the duration should be minimised.^9,40,99

Midwives working in enhanced care areas or providing enhanced care to patients should have the appropriate training.^40,100

There should be a named consultant or other autonomously practising anaesthetist and obstetrician responsible 24/7 for all women requiring a higher level of care.⁴⁰