Abstract
BackgroundProlonged latent phase of labour often results in a traumatic birth experience. Prolonged labour is associated with more operative deliveries, haemorrhage, fetal asphyxia and poor birth experience. Women with prolonged labour in a former pregnancy more often demand caesarean section in the next, due to their negative birth experience. “Proactive support of labour” is an alternative method, developed to counteract prolonged labour. There are little research and no randomized controlled study that compare proactive to standard labour support.Methods/DesignA prospective, non-blinded, randomized, single-centre, clinical trial where we compare proactive support to standard support of labour in a university hospital setting.Inclusion criteria: latent phase of labour, non-pathologic pregnancy. Robson group 1, with painful contractions, and fully effaced cervix, with 1–3 cm dilatation. Exclusion criteria: induction of labour, breech presentation, twin pregnancy, multi-parity, conditions that require extended surveillance before and/or during labour.Primary outcome: spontaneous, uncomplicated vaginal delivery. After inclusion, women randomized to proactive support of labour will stay at the hospital and have one-to-one midwife support. If no progression during the next 1–2 hours, amniotomy and/or oxytocin stimulation will be started. The control group will adhere to the standard procedures for labour support: expectance until established regular contractions and 4–5 cm cervical dilatation, and then one-to-one midwife support.DiscussionThe idea of proactive support of labour is to initiate early intervention when there are signs of slow progress in order to avoid protracted labour with exhaustion of the mother, the uterus and prolonged stress of the foetus. Proactive support of labour may represent a useful method to improve labour support in nulliparous women. However, evidence based on randomized controlled trials are needed in order to know whether proactive support of labour is comparable or superior to standard care. A randomized, controlled trial is described; challenges and possible clinical implications are discussed.Trial registrationThe Proactive Support of Labor Study (PAF) ClinicalTrials, NCT03056313. Registered on February 17, 2017.
Highlights
Prolonged latent phase of labour often results in a traumatic birth experience
Evidence based on randomized controlled trials are needed in order to know whether proactive support of labour is comparable or superior to standard care
Study objectives The main objective of this study is to examine the potential difference between proactive support of labour compared to current standard labour support, measured as number of uncomplicated, normal vaginal deliveries, and the birth experience of the mothers, as measured by the Childbirth Experience Questionnaire (CEQ) [15]
Summary
Prolonged latent phase of labour often results in a traumatic birth experience. Prolonged labour is associated with more operative deliveries, haemorrhage, fetal asphyxia and poor birth experience. Women with prolonged labour in a former pregnancy more often demand caesarean section in the due to their negative birth experience. Poor progression of labour is associated with increased complication rates, such as instrumental delivery, caesarean section (CS) and postpartum haemorrhage [1]. Traumatic birth experience leads to posttraumatic stress disorder [2], and poor birth experience may have long-term influences on the future health of both the woman and her family [3]. In Norway, about 8% of those classified in Robson Group 1 are delivered by emergency caesarean section. Robson group 1 is defined as: nulliparous women with singleton fetuses in cephalic presentation, and spontaneous start of labour at term; it represents one third of all women in labour [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
