Policies for labour management – existence and content

Abstract

To prevent dystocia, it is important to have criteria for labour onset and policies for diagnosing and treating uterine inertia. Uterine inertia is often followed by complications such as prolonged labour, caesarean section, instrumental labour and a negative birth experience, and prevention and proper treatment are therefore important. The Swedish National Board of Health and Welfare has stipulated that labour wards should have policies for labour management. The aim of this study was to investigate the extent to which labour wards in Sweden have such policies. For those wards with policies for labour management, a further aim was to study the content of the policies. A descriptive survey presenting information from 48 of 49 labour wards in Sweden. Descriptive statistics were used. Three of the 48 labour wards had written policies concerning all four main issues of interest. Written policies existed regarding criteria for labour onset at 11 wards, diagnosis of uterine inertia at 13 wards and treatment of uterine inertia at 21 wards. Seventeen wards had written policies for when during the progress of labour neuraxial analgesia was recommended. The majority of labour wards in Sweden did not have written policies, and there was no consensus among the wards regarding criteria for diagnosing labour onset and uterine inertia, policies for treatment of uterine inertia, or about recommendations for when to use neuraxial analgesia. It is possible that the lack of policies could imply a risk for nonevidence-based labour management.