Inconsistent definitions of labour progress and over-medicalisation cause unnecessary harm during birth

Abstract

Nanna Maaløe and colleagues argue that resource challenges, unclear and outdated clinical practice guidelines, and lack of women’s perspectives lead to overdiagnosis and overtreatment of prolonged labour

Shoulder Dystocia: A Comprehensive Literature Review on Diagnosis, Prevention, Complications, Prognosis, and Management

“…Fluctuations between the parasympathetic and sympathetic systems determine the basic variability of FHR [ 29 , 30 , 31 , 32 ].…”

“…The action of the sympathetic system is essential for fetal survival and causes an increase in FHR. Conversely, the parasympathetic system decreases the fetal heart rate as a result of the stimulation of the carotid sinus chemoreceptors and of the aortic arch and peripherally located baroreceptors in the carotid bulb and aorta and centrally in the brain [ 29 , 30 , 31 , 32 ]. The stimulation of baroreceptors, induced by the pressure from the umbilical cord and the fetal head, contributes to a reduction in fetal heart rate (FHR), as evidenced by short-duration occurrences of variable decelerations [ 29 , 30 , 31 , 32 ].…”

“…Hypoxia describes the situation where there is an interruption of blood supply for longer periods resulting in a decrease in the oxygenation of peripheral tissues and organs of the fetus. When hypoxia persists for more extended periods, the fetus activates the anaerobic metabolism that leads to the establishment of metabolic acidosis [ 29 , 30 , 31 , 32 ].…”

“…In fetuses with a reduced reserve such as intrauterine growth retardation, or prematurity or infection, the establishment of metabolic acidosis occurs earlier. The term asphyxia describes the extremely adverse situation in which there is a major worsening or prolonged interruption of reduced oxygenation leading to the inability to respond to compensatory mechanisms and the establishment of a combination of metabolic acidosis and hypoxia [ 29 , 30 , 31 , 32 ].…”

“…The presence of such a severity of hypoxic insult causes the fetal reaction expressed initially by: the appearance of either variable decelerations (due to the compression of the umbilical cord) or the appearance of late decelerations (due to placental insufficiency); the disappearance of accelerations (the result of an effort to conserve energy); the gradual increase in FHR (due to hypoxia and the increase in catecholamine secretion); the deepening and increase in the range of decelerations (with increasing hypoxia of the myocardium); a progressive abolition of variability (due to a greater lack of oxygen resulting in autonomic nervous system depression) [ 29 , 30 , 31 , 32 ]. …”