TY - JOUR

T1 - Inconsistent definitions of labour progress and over-medicalisation cause unnecessary harm during birth

AU - Maaløe, Nanna

AU - Kujabi, Monica Lauridsen

AU - Nathan, Nina Olsén

AU - Skovdal, Morten

AU - Dmello, Brenda Sequeira

AU - Wray, Susan

AU - Akker, Thomas van den

AU - Housseine, Natasha

PY - 2023

Y1 - 2023

N2 - Nanna Maaløe and colleagues argue that resource challenges, unclear and outdated clinical practice guidelines, and lack of women’s perspectives lead to overdiagnosis and overtreatment of prolonged labour Prolonged labour results in considerable morbidity and mortality globally in women and children, as well as risk of caesarean section, uterine rupture, and fetal adverse events.1 In some instances, labour fails to progress because of fetal malposition or disproportion between the fetus and the woman’s pelvis. However, the commonest cause of prolonged labour is inefficient uterine contractions (fig 1).2 For women with weak uterine contractions, synthetic oxytocin may increase the power of contractions, but there are associated risks, including hyperstimulation, stillbirth, and neonatal complications. 45678910 Furthermore, caesarean section may still be required, and evidence that synthetic oxytocin reduces the risk of caesarean section is scarce.56 Adding to the challenge, definitions of prolonged labour are inconsistent and tend to overestimate the speed of physiological labour.11 Furthermore, overdiagnosis of prolonged labour may be caused by detrimental working conditions and routines among healthcare providers in overburdened maternity units.121314 Consequently, many women receive oxytocin or caesarean section with the indication of prolonged labour despite it being uncomplicated labour.1115161718Fig 1 Physiological and pathophysiological evidence on functional and dysfunctional labour, and discordance with clinical practice. In the functional labour cycle, contractions gradually increase in strength until the cervix is fully dilated and vaginal birth occurs. Relaxation of the uterine muscle between contractions allows for fetal and myometrial re-oxygenation. Possible problems with this natural contraction-relaxation cycle during labour are: (1) Women with true prolonged labour often have either reduced flow of the body’s natural oxytocin (eg, because of pain, fear, or mental distress), or increased lactic acid in the capillaries of …

AB - Nanna Maaløe and colleagues argue that resource challenges, unclear and outdated clinical practice guidelines, and lack of women’s perspectives lead to overdiagnosis and overtreatment of prolonged labour Prolonged labour results in considerable morbidity and mortality globally in women and children, as well as risk of caesarean section, uterine rupture, and fetal adverse events.1 In some instances, labour fails to progress because of fetal malposition or disproportion between the fetus and the woman’s pelvis. However, the commonest cause of prolonged labour is inefficient uterine contractions (fig 1).2 For women with weak uterine contractions, synthetic oxytocin may increase the power of contractions, but there are associated risks, including hyperstimulation, stillbirth, and neonatal complications. 45678910 Furthermore, caesarean section may still be required, and evidence that synthetic oxytocin reduces the risk of caesarean section is scarce.56 Adding to the challenge, definitions of prolonged labour are inconsistent and tend to overestimate the speed of physiological labour.11 Furthermore, overdiagnosis of prolonged labour may be caused by detrimental working conditions and routines among healthcare providers in overburdened maternity units.121314 Consequently, many women receive oxytocin or caesarean section with the indication of prolonged labour despite it being uncomplicated labour.1115161718Fig 1 Physiological and pathophysiological evidence on functional and dysfunctional labour, and discordance with clinical practice. In the functional labour cycle, contractions gradually increase in strength until the cervix is fully dilated and vaginal birth occurs. Relaxation of the uterine muscle between contractions allows for fetal and myometrial re-oxygenation. Possible problems with this natural contraction-relaxation cycle during labour are: (1) Women with true prolonged labour often have either reduced flow of the body’s natural oxytocin (eg, because of pain, fear, or mental distress), or increased lactic acid in the capillaries of …

U2 - 10.1136/bmj-2023-076515

DO - 10.1136/bmj-2023-076515

M3 - Journal article

C2 - 38084433

VL - 383

JO - The BMJ

JF - The BMJ

SN - 0959-8146

M1 - e076515

ER -