Audit of pharmacological and technical interventions in spontaneous vaginal deliveries

Background: Despite the undisputed importance and benefits of physiological birth, the rising rate of interventions in labour and childbirth is a cause for concern. The aim of the study is to determine the prevalence of... [ view full abstract ]

Background: Despite the undisputed importance and benefits of physiological birth, the rising rate of interventions in labour and childbirth is a cause for concern. The aim of the study is to determine the prevalence of intrapartum interventions in women who experience a spontaneous vaginal delivery (SVD) at Fernandez hospital and audit the practices after incorporation of a checklist.

Method: The study institute is a tertiary care perinatal centre with professional midwifery support since January 2012, current annual delivery rate in excess of 8000, and is committed to supporting natural birth. The study includes women with SVD during two time periods: January-February 2017 (group I), and June-July 2017 (group II). A checklist to identify 9 interventions (as defined in the 2016 RCM survey) and their indications, and criteria for physiological birth will be incorporated in the partogram from June 2017. The nature and frequency of interventions will be compared between the groups (pre- and post- checklist), and the reasons for interventions in group II will be analyzed.

Results: Group I comprised 633 vaginal births and a total of 1347 deliveries. SVD (n=517) constituted 81.7% of the vaginal births. There were only 7 (1.4%) women with SVD who had none of the interventions. The most commonly used intervention was bladder catheterization (82.8%) and the least frequent fetal blood sampling (1.3%).

Discussion: The 2016 RCM survey found 66.2% intervention rate in births recorded as normal and our study had a much higher (98.6%) intervention rate in comparison. The audit will indicate change in the intervention rate after incorporation of the checklist and facilitate validation of the stated indications for interventions. Conclusion: Intrapartum interventions are much higher than in the UK and can be reduced by incorporation of a checklist.