Inconsistent definitions of labour progress and over-medicalisation cause unnecessary harm during birth

Document Type



Obstetrics and Gynaecology (East Africa)


Prolonged labour results in considerable morbidity and mortality globally in women and children, as well as risk of caesarean section, uterine rupture, and fetal adverse events.1 In some instances, labour fails to progress because of fetal malposition or disproportion between the fetus and the woman’s pelvis. However, the commonest cause of prolonged labour is inefficient uterine contractions (fig 1).2 For women with weak uterine contractions, synthetic oxytocin may increase the power of contractions, but there are associated risks, including hyperstimulation, stillbirth, and neonatal complications. 4 -10 Furthermore, caesarean section may still be required, and evidence that synthetic oxytocin reduces the risk of caesarean section is scarce.5 6 Adding to the challenge, definitions of prolonged labour are inconsistent and tend to overestimate the speed of physiological labour.11 Furthermore, overdiagnosis of prolonged labour may be caused by detrimental working conditions and routines among healthcare providers in overburdened maternity units.12 -14 Consequently, many women receive oxytocin or caesarean section with the indication of prolonged labour despite it being uncomplicated labour.

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