The timing of interventions during labour: descriptive results of a longitudinal study.

OBJECTIVE

To describe the timing and frequency of interventions during labour, and in addition to compare the timings of the interventions against the partogram action lines.

DESIGN

Longitudinal prospective and retrospective cohort study.

SETTING

47 Hospitals in Lower Saxony, Germany.

PARTICIPANTS

3963 Births of nulliparae and multiparae with singletons in vertex presentation giving birth between April and October 2005. The participation rate for the prospectively recruited sample (n = 1169) was 4.7%.

MEASUREMENTS

Time intervals until intrapartal interventions were calculated by Kaplan-Meiers estimation. Outcome variables were duration of labour and mode of birth.

FINDINGS

Multiparae had slightly longer median time intervals between the onset of labour and the beginning of care by the midwife than nulliparae. With regard to the intervals between the onset of labour and the occurrence of interventions, multiparae had shorter median durations than nulliparae in respect of amniotomy, oxytocin augmentation and neuraxial analgesia. By three hours after onset of labour 8.4% of nulliparae had received oxytocin augmentation, 10.7% neuraxial analgesia and 8.9% an amniotomy. Of multiparae, 9.1% had received oxytocin augmentation but only 5.6% neuraxial analgesia; 20.0% had had an amniotomy. The median time interval before the initiation of water immersion and massage was between three and four hours; that before the initiation of vertical positioning was 1.8 hours.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Current German practice without the use of partogram action lines reveals that early interventions were performed before the partogram action lines were met. Interventions applying midwifery care techniques such as vertical positioning preceded more invasive medical interventions during the process of childbirth.