Package of care for active management in labour for reducing caesarean section rates in low-risk women

Brown, H. C.; Paranjothy, Shantini; Dowswell, Therese; Thomas, Justin

doi:10.1002/14651858.cd004907.pub3

Cited by 36 publications

(36 citation statements)

References 36 publications

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“…Another Cochrane meta-analysis [7] examined only complete active management of labor packages and found results very close to those of the preceding meta-analysis. It used 7 of the 14 studies included in [6] above and found a modest but not significant reduction in the number of cesareans in the active management group (n=5390, RR 0.88, 95% CI 0.77-1.01) [7] (LE2).…”

Section: Page 6 Of 42supporting

confidence: 61%

“…A c c e p t e d M a n u s c r i p t 6 6 We identified four meta-analyses grouping together randomized or quasi-randomized trials published between 1998 and 2013 on this topic [5][6][7][8]. The first meta-analysis focused on the combined effects of an early amniotomy and early prescription of oxytocin on the risk of cesareans in nulliparas.…”

Section: Page 6 Of 42mentioning

confidence: 99%

“…It used 7 of the 14 studies included in [6] above and found a modest but not significant reduction in the number of cesareans in the active management group (n=5390, RR 0.88, 95% CI 0.77-1.01) [7] (LE2). Finally, the meta-analysis by Wei et al [6] also included the meta-analysis published in 2000 by Saddler [8] (LE2).…”

Section: Page 6 Of 42mentioning

confidence: 99%

See 2 more Smart Citations

Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor

Barasinski

Vendittelli

2017

Journal of Gynecology Obstetrics and Human Reproduction

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A c c e p t e d M a n u s c r i p t 2 2 SummaryObjectives. ─ The objective of our work was to determine the effects of co-interventions used during labor with oxytocin or for labor dystocia.Methods. ─ We searched for reports of the interventions we sought to study published between 1987 and 2015, looking especially for meta-analyses and randomized trials via the Medline database and the Cochrane Library. We limited our research to studies of spontaneous labor in singleton pregnancies at term. Conclusions. ─ Few of the co-interventions studied appear to modulate recourse to oxytocin.

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Section: Page 6 Of 42supporting

confidence: 61%

Section: Page 6 Of 42mentioning

confidence: 99%

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Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor

Barasinski

Vendittelli

2017

Journal of Gynecology Obstetrics and Human Reproduction

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“…Brown, Paranjothy, Dowswell, and Thomas (2008), in their systematic review evaluating active management for reducing cesarean in low-risk women, found a modest decrease in the cesarean rate among the women who received amniotomy and oxytocin if their labors were delayed. A more recent Cochrane review (Wei et al, 2013) of the active management of labor included 14 trials and 8,033 women, and, again, this review showed ventions for when they are medically indicated has the potential to improve outcomes and make labor and birth safer and healthier for mothers and babies.…”

Section: Episiotomymentioning

confidence: 99%

Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary

Lothian¹

2014

J Perinat Educ

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Maternity care in the United States is intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. Seventeen percent of women had an episiotomy, and 31% had a cesarean. The high use of these interventions reflects a system-wide maternity care philosophy of expecting trouble. There is an increasing body of research that suggests that the routine use of each of these interventions, rather than decreasing the risk of trouble in labor and birth, actually increases complications for both women and their babies.The purpose of this article is to review the literature related to the evidence base and the outcomes associated with the interventions routinely used in labor and birth in the United States. The findings make the case for the value of maternity care that avoids the use of routine interventions.Maternity care in the United States is intervention intensive. Listening to Mothers III (Declercq, Sakala, Corry, Applebaum, & Herrlich, 2013), the most recent national survey of women's pregnancy, birth, and postpartum experiences, reports that for women who gave birth from June 2011 to June 2012, 89% of women experienced electronic fetal monitoring (66% continuously), 62% received intravenous fluids, 79% experienced restrictions on eating, and 60% experienced restrictions on drinking in labor. Sixty-seven percent of women who gave birth vaginally had an epidural in labor, and 31% were given Pitocin to speed up their labors. Twenty percent of women had their membranes artificially ruptured.

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“…Research has been conducted on how to prevent dystocia and facilitate vaginal delivery, involving active management of labour [22] and one-to-one care in labour [23]. Although the results have not shown a significant reduction of the CD rate, many birth wards base their procedures for ensuring progress in labour on active management of labour research.…”

Section: Introductionmentioning

confidence: 99%

How Can Manual Rotation Reduce Vacuum, Forceps and Caesarean Deliveries?—A Review of the Evidence

Os¹,

Severinsson²

2017

OJN

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The aim of this review was to investigate whether manual rotation can be used to reduce vacuum, forceps and caesarean deliveries in women with occiput posterior or occiput transverse positions from 7 cm dilation in labour. A search strategy was developed and relevant papers published between 1946 and January 2015 were identified from electronic databases. Key search terms used were manual and digital rotation, labour presentation, obstetric labour complications, occiput posterior and version foetal. The search revealed 330 papers. A short list of 33 publications of possible relevance was compiled and assessed using the following criteria: primary studies on the effectiveness of manual rotation performed in women with singleton occiput posterior or occiput transverse presentations published in English or the Scandinavian languages. The quality of the included studies was evaluated by means of the critical appraisal tools for quantitative studies. Seven studies were included in the thematic analysis. The results varied but the main finding was that in order to decrease vacuum, forceps and caesarean deliveries by means of manual rotation, it is essential that the procedure is successful. The success rate of manual rotation is dependent on the experience of the healthcare professionals who perform the rotation procedure rather than the technique employed. Predictors of successful manual rotation were used after engagement of the foetal head, at full dilatation and prophylactic use before failure to progress in labour. In conclusion, although the results vary, there is a consensus in all the studies that manual rotation is worth considering and that it can contribute to decreasing vacuum, forceps and caesarean deliveries. The implications for practice are that successful manual rotation can reduce caesarean delivery and increase spontaneous vaginal delivery, but experience is necessary to perform successful rotations. Because there are no risk factors associated with manual or digital rotation when performed after engagement of the head and at full dilatation, they are worth considering. The central role of the midwife in each individual labour makes her important for ensuring that manual rotation can be considered at the right time in labour.

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Package of care for active management in labour for reducing caesarean section rates in low-risk women

Cited by 36 publications

References 36 publications

Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor

Oxytocin administration during spontaneous labor: Guidelines for clinical practice. Chapter 3: Interventions associated with oxytocin administration during spontaneous labor

Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary

How Can Manual Rotation Reduce Vacuum, Forceps and Caesarean Deliveries?—A Review of the Evidence

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