A-BIRTHPERFORM Versus Conventional Partogram in the Improvement of Birth Results: a Randomized Controlled Trial

Stimulation of labour with synthetic oxytocin is increasingly used all over the world. Synthetic oxytocin is used in cases of dystocia of labour, with the objective of attempting labour progression until achieving vaginal birth. The use of oxytocin could have potential adverse effects on the mother and the fetus, such as uterine tachysystole, which can lead to uterine rupture and fetal distress . There is a risk of fetal hypoxemia and acidemia if the contractions are very frequent and prolonged. The risk of instrumented delivery is even higher when oxytocin is used when labour is progressing normally. There is a significant association between oxytocin use to stimulate labour and severe perineal lacerations, postpartum urinary retention, postpartum hemorrhage and delayed onset of breastfeeding. The World Health Organization (WHO) defines dystocia of labour as four hours without progress during the active labor and is recommended to medically intervene . When health professionals that assist women in labour (Midwives and Obstetricians) do not follow the clinical guidelines on intrapartum care, labour dystocia and oxytocin use, and oxytocin is used routinely without medical indication, ends in the erroneous use of oxytocin. According to the evaluation of Strategy of Attention to Normal Childbirth (SANC), the National Health System in Spain, which sets standards of quality in obstetric practice, showed a rate of 53.3% of oxytocin use during labor in pregnant women with spontaneous onset of labour, which is high and is far from the expected standard (expected standard of 5 to 10%, as an indicator of good practice).

According to the Romano and de Lothian study, a high use of oxytocin during labour would be related to the so-called "cascade of interventions", referring to different obstetric interventions that are used routinely and not based on scientific evidence which could interfere in the physiology of childbirth and in the skills of women to cope with labour and labour pain. The use of oxytocin has a limited and uncertain benefit , and may even be harmful in some specific situations during labor. Lothian suggests in his study that routine practices that are unnecessary in physiological births should be avoided, thus minimizing complications, and improving perinatal outcomes.

An international consensus was published in 2017 to review the scientific evidence on care practices that facilitate a physiological delivery process and its relationship with the improvement of perinatal outcomes and maternal satisfaction.

The increase in the use of oxytocin during childbirth in healthy women and with spontaneous onset of labour seems to be generalized worldwide, and national and international agencies demand an improvement in the care provided during childbirth in women with pregnancies of low obstetric risk, with the objective of limiting unnecessary interventions during childbirth and birth.

In the same line, in 2018 an international initiative for childbirth (ICI) is promoted with 12 steps towards a safe and respectful Mother-Family motherhood, ICI-Mother Baby Childbirth Organization (IMBCO) and International Federation of Gynecology and Obstetrics (FIGO), in which "step 6" recommends: Promote and provide clinical practice based on evidence that has proven to be beneficial and respect the normal physiology of labour. Allowing labour to develop at its own pace, avoiding unnecessary interventions.