Evaluation of labor management practices during spontaneous labor

Area of Science:

• Obstetrics and Gynecology
• Maternal-Fetal Medicine
• Public Health Policy

Background:

• In 2017, French national health guidelines were issued to promote physiologic labor and minimize medical interventions.
• This study evaluated the impact of these guidelines on vaginal delivery rates at a type IIb perinatal center.

Purpose of the Study:

• To assess the association between the publication of national labor guidelines and the vaginal delivery rate.
• To evaluate guideline implementation, labor duration, postpartum hemorrhage, and adverse neonatal outcomes.

Main Methods:

• A retrospective, single-center, before-and-after study design.
• Comparison of data from 2016 (before guidelines) and 2018 (after guidelines).
• Inclusion criteria: women with no prior cesarean, singleton fetus in cephalic presentation, spontaneous labor after 37 weeks gestation; analysis stratified by parity.

Main Results:

• Oxytocin use decreased from 48% to 35% (P < 0.0001); amniotomies decreased from 39.5% to 27.7% (P < 0.0001).
• Labor duration significantly increased (360 to 390 min, P < 0.0001), particularly in nulliparous women (465 to 562 min, P < 0.0001).
• Vaginal delivery rate increased (94.6% to 96%, P = 0.05), postpartum hemorrhage decreased (6% to 4.5%, P = 0.04), and neonatal transfers/adverse outcomes reduced.

Conclusions:

• Reducing active labor interventions is linked to a longer labor duration.
• This approach is associated with decreased rates of cesarean births, postpartum hemorrhages, and neonatal transfers.