Routine interventions in childbirth before and after initiation of an Action Research project

Unnecessary routine interventions in uncomplicated labour and birth, like cardiotocography (CTG), amniotomy, use of scalp electrode and oxytocin treatment, are associated with further interventions that could harm the woman and the infant. A four year Action Research (AR) project was done on a labour ward to enhance the capacity of local midwives in the promotion of physiological labour and birth.

To describe the use of interventions during labour and birth in healthy women at term with spontaneous onset of labour, before and after initiation of an Action Research project.

A retrospective before and after comparative study of clinical records from 2009 (before) and 2012 (after), based on a random selection of records from primiparous and multiparous women. Outcome measures were duration of admission CTG, frequency of admission CTG over 30min, frequency of amniotomy, use of scalp electrode, and frequency of oxytocin augmentation in spontaneous labour.

903 records were included. The duration of admission CTG (p=0.001), frequency of admission CTG duration over 30min (p=<0.001), the use of scalp electrodes (p=<0.001), and use of oxytocin augmentation of spontaneous labour (p=0.014) were reduced significantly after initiation of the AR project. There were no significant differences in frequency of amniotomy, duration of total CTG, postpartum bleeding, sphincter tears, Apgar score <5 at 5min, and mode of birth.

Following an AR project, several interventions were reduced during labour and birth. Controlled studies in other settings are needed to assess the impact of collaborative action on decreasing unnecessary interventions.