Intervention or interference? The need for expectant care throughout normal labour
Categorie(s):
Healt
Author(s):
Cecily M. Begley
Keyword(s):
Kesehatan, kebidanan, Jurnal Internasional, jurnal, Induction of labour, Episiotomy, Active management of the third stage, Early cord clamping, Medico-technical intervention, Normal labour
DOI:
Abstract :
ABSTRACT
Background: Medico-technical intervention rates in labour, such as induction and augmentation of labour,
are rising worldwide. Such interventions have adverse as well as beneficial consequences, so any intervention
introduced must be based on evidence and result in more good than harm, otherwise it is just
interference.
Aim: To describe three common medico-technical interventions in normal pregnancy or labour in terms
of their effects on women and neonates.
Method: A comprehensive review of literature was undertaken to provide evidence of benefits and adverse
effects of three routine medico-technical interventions: induction of labour, episiotomy, and active management
of third stage of labour (including early cord clamping).
Findings: All three interventions have benefits, but can also cause distress, pain, or morbidity to mothers
and babies and should not, therefore, be used routinely, but in response to clinical need. In particular,
the over-use of episiotomy, and active management of the third stage (including early cord clamping),
in addition to the physical harms they cause, result in an undesirable disruption of the precious minutes
following birth when the new family is coming together for the first time.
Conclusion: Further research is needed into alternative methods of inducing labour, ways to preserve the
perineum intact, and trials of expectant and active management of the third stage in low-risk women
cared for by midwives skilled in using both methods. Clinicians need to develop their skills in these areas
and reduce unnecessary reliance on these three medico-technical interventions, to provide the best possible
care for women and babies.