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Clinical Practice Guidelines on Normal Labour and Childbirth: A Systematic Review
María Loreto Hernández-Martínez1, Alonso Molina-Rodríguez2,3, Marta Maes-Carballo4,5
1Registred Midwife in Hospital Universitario Clínico San Cecilio in Granada, Granada, Spain.
Clinical Practice Guidelines (CPGs) for normal birth often lack quality and are outdated. Improvements are needed to ensure reliable, consistent recommendations for maternal and neonatal health.
Area of Science:
- Maternal and Neonatal Health
- Evidence-Based Practice
- Healthcare Guideline Development
Background:
- Clinical Practice Guidelines (CPGs) are crucial for evidence-based maternal and neonatal care.
- Inconsistencies within CPGs can lead to confusion among healthcare providers.
- Ensuring the quality and consistency of CPGs is vital for optimal patient outcomes.
Purpose of the Study:
- To systematically analyze the quality and reporting standards of international CPGs focused on normal birth.
- To summarize the key recommendations provided in these CPGs.
- To identify areas for improvement in CPG development and dissemination.
Main Methods:
- Systematic literature searches were conducted across major databases (MEDLINE, Cochrane, Scopus, Web of Science) and through direct outreach.
- CPGs published between 2010 and December 2024 were included, irrespective of language.
- The Appraisal of Guidelines for Research & Evaluation II (AGREE II) and Reporting Items for practice Guidelines in Healthcare (RIGHT) tools were used to assess quality and reporting.
Main Results:
- Analysis of 25 CPGs revealed a median AGREE II quality score of 54% and a median RIGHT reporting score of 50%.
- A significant proportion (56%) of CPGs demonstrated poor reporting quality, with only 8% considered adequately informed.
- Key recommendations across CPGs included support persons, avoidance of routine interventions, fluid intake, mobility during labor, and skin-to-skin contact.
Conclusions:
- The majority of current CPGs for normal childbirth are outdated and suffer from deficiencies in quality and reporting.
- There is an urgent requirement to enhance the development process of CPGs.
- Improvements are necessary to provide valid, consistent, and up-to-date recommendations to improve maternal and neonatal health outcomes.
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