[Normal childbirth: physiologic labor support and medical procedures. Guidelines of the French National Authority for Health (HAS) with the collaboration of the French College of Gynaecologists and Obstetricians (CNGOF) and the French College of Midwives (CNSF) - Intrapartum care for healthy women and non pharmacological approaches for pain management].

OBJECTIVE

To make clinical practice guidelines for intrapartum care for healthy women and non-pharmacologic approaches for pain management.

METHODS

Review of the literature of articles published between January 2000 and September 2017 in English and French language from the Medline database, the Cochrane Library and recommendations from international institutes.

RESULTS

During the initial examination of a pregnant woman, it is recommended to take note of the pregnancy monitoring file and its possible birth plan; perform an anamnesis, inquire about her wishes and physiological and emotional needs; and perform a clinical examination (Consensus agreement). If the woman seems to be in labor, it is recommended to offer a vaginal examination (Consensus agreement). In case of premature rupture of membranes, it is recommended not to systematically perform a vaginal examination if the woman has no painful contractions (Consensus agreement). During the first stage of labor, the surveillance of the woman includes at least: a surveillance of the haemodynamic parameters every four hours; an evaluation of the frequency of uterine contractions every 30minutes and for 10minutes during the active phase; surveillance of spontaneous urination; the proposition of a vaginal examination every two to four hours or before if the patient asks for it, or in case of sign of call (Consensus agreement). During the second stage, it is recommended to use a partograph; to monitor hemodynamic parameters every hour; to evaluate the frequency of uterine contractions every 30minutes and for ten minutes; to monitor and note spontaneous urination; to offer a vaginal examination every hour (Consensus agreement). Whether on admission or during labor, it is recommended to evaluate the pain and offer the patient different ways to relieve it (Consensus agreement). It is recommended that all women have continuous, individual and personalized support, during labor and delivery (grade A); to implement the necessary human and material resources allowing women to change position regularly (Consensus agreement).

CONCLUSION

Routine practices must be abandoned to implement those that are scientifically justified. The management of pain is essential. Every woman should have continuous, individual and personalized support during labor and delivery.