Intrapartum Care *

Passage through the birth canal is the shortest but probably the most hazardous journey undertaken by any individual in his or her life. Hypoxia, trauma and infection are inherent risks. These risks are increased by preterm labour, postterm birth, antepartum haemorrhage and when labour is induced as a consequence of medical or obstetric complications in pregnancy. The mother faces problems of anxiety, pain, infection, the possibility of operative delivery, trauma, postpartum haemorrhage and long-term morbidity. She may even run the risk of losing her life as a result of childbirth. The art of intrapartum care has evolved over the years, and is evidence based. Besides practising the intangible art of obstetrics, scientific principles should be considered by everyone who provides care to the pregnant mother and her unborn child. Interventions, especially during labour, are usually made in good faith. However, opinions differ as to whether every decision to intervene had been made on sound scientific principles. Moreover, in obstetrics, more than in other fields of medicine, the physician is in a dilemma when he intervenes because on the one hand, if complications ensue, the decision to intervene would be questioned. On the other hand, if fetal or maternal morbidity or mortality result due to nonintervention, the consequences may be even more difficult to face. This situation has resulted in numerous malpractice suits against obstetricians in the USA. In time this tendency is likely to spread to other countries. During the last 2 decades, research in this field has been directed to formulating guidelines on a scientific basis for intervention in spontaneous labour. In this review an attempt is made to identify and examine the current trends in intrapartum care.