Improving intrapartum care through knowledge and advocacy

Philadelphia, November 14, 2024 – Childbirth, largely a physiologic process, occurs 140 million times per year. Yet, it comes with risks; one mother dies every two minutes worldwide. The risks also extend to the newborn; in 2020, 2.4 million newborns died—25% on the first day of life.

The optimal management of labor and prevention of complications require up-to-date information. The American Journal of Obstetrics & Gynecology (AJOG), the premier journal in the discipline, has published a supplement devoted to labor and delivery at term. The content addresses important issues in intrapartum care and advocates for respectful and safe maternity care for all. 

Roberto Romero, MD, DMedSci, AJOG Editor-in-Chief for Obstetrics, and Chief of the Pregnancy Research Branch, NICHD/NIH, states, "Childbirth is a defining moment in anyone’s life, and intrapartum care is at the crossroads of tradition, technology, and individual choice. A large body of clinical research informs the practice of obstetrics and midwifery. Many aspects of care during labor are controversial. Debate is often based on deeply held views and emotions tied to the birthing experience and reflects the complex blend of individual and cultural beliefs as well as the medical knowledge that informs intrapartum care. Therefore, the Journal has published an up-to-date compendium of articles to help mothers, families, and care providers.”

The Journal’s supplement highlights new developments in the induction of labor (a comparison of different methods, definition of failed induction, and new pharmacologic agents), management of the second stage with forceps and vacuum and novel devices, and the knowledge gained from ultrasound during labor to diagnose the fetal position and progress in the journey through the birth canal. The Journal also addresses optimal care during the separation of the placenta and common complications that account for maternal death, such as postpartum hemorrhage, infection, and uterine rupture.

Editor Joanne Stone, MD, MS, Professor and Chair of the Department of Obstetrics and Gynecology, Icahn School of Medicine at Mount Sinai in New York, elaborates, "Infection is the third cause of maternal death. Clinical chorioamnionitis (infection of the amniotic fluid and placenta) is the most common infection during labor and the leading cause of maternal and early-onset newborn sepsis. This condition is discussed in depth with an emphasis on new information about the microbes that cause infection as well as diagnosis and treatment.”

Part of the AJOG supplement is dedicated to induction of labor. Editor Sonia Hassan, MD, MBA, Professor, Department of Obstetrics and Gynecology, and Director of the Office of Women’s Health at Wayne State University, notes, "Approximately one of three pregnant individuals experiences induction of labor, and recent evidence indicates that induction can be accomplished without an increase in the rate of cesarean delivery. Articles in the supplement review the best methods for induction in in-patient and out-patient settings.”

The collection of expert review articles in the supplement also covers the following subjects:

• Second stage of labor: assessment of progress, how, when, and for how long to push, and operative vaginal deliveries
• Optimal repair of lacerations and injury to the pelvic floor
• Diagnosis and treatment of postpartum hemorrhage (medical and surgical)
• Trial of labor after cesarean delivery and uterine rupture
• Postpartum depression and post-traumatic stress disorder
• Respectful care of pregnant women in labor

The first supplement, published in 2023, focused on the assessment of progress in labor with partograms, pain relief, fetal heart rate monitoring and abnormalities related and unrelated to hypoxemia/acidemia, and complications such as meconium-stained amniotic fluid and intrapartum bleeding.

Dr. Romero comments, “AJOG supplements have been made available to subscribers and non-subscribers by the publisher, Elsevier Inc. Our goal is to make knowledge about labor accessible to all so that no mother suffers because of a lack of access to information.”