(1) Presence of a companion throughout the entire process of labour, whether family or health professional. | During the period of contractions or pain, the patient needs emotional support, whether from a family member or a doula. If there is need for the companion to leave, he/she should ask another person to replace him/her to guarantee that the patient will feel safe. Hospital’s nursing professionals or staff and doctors also provide emotional support to the patients. |
(2) Avoid early admission, do so only in the active phase of labour. | The latent phase of labour can last up to 20 hours in primiparous women. The ideal time for admission is during the active phase of labour, with 4 cm dilation and two contractions/10 min. During the latent phase, support and comfort should be provided to the patient at alternative places outside the hospital. |
(3) Labour monitoring with minimal intervention: avoid fasting, venous access, early rupture of membranes. Vaginal digital examination every 3–4 hours, intermittent fetal monitoring. Avoid indiscriminate use of oxytocin. | Maintain a liquid diet until 2 hours before analgesia. Instal venous access only when necessary. Vaginal digital exams must be at least 3 hours apart. Keep the bag of waters intact if possible. Fetal heart rate monitoring should be intermittent, every 30 min if a fetus is at low risk and every 15 min it the fetus is at high risk, listening during and after contractions. If in doubt, cardiotocography must be performed every 20 min. Augmentation of labour with exogenous oxytocin should only be performed under conditions of ‘static labour’, which is defined as the need to correct the pattern of contractions after 6 hours without the evolution of dilation and after all non-pharmacological measures (walking, exercise on the ball) have been tried.
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(4) As non-pharmacological methods of pain relief, encourage walking, the use of the ball and shower, at least for 30 min each. | The non-pharmacological methods of pain relief provide comfort to the patient, allow for pharmacological analgesia to be performed at an opportune time, when labour has set in. At the beginning of labour, stimulate walking, and when the patient needs to rest, use the Pilates ball. |
(5) Always perform labour analgesia before indicating directly a C-section delivery. | In cases where there is no urgency or indication of C-section due to fetal distress or maternal disease, it is recommended that pharmacological analgesia (combined/epidural analgesia) be administered to correct labour dystocia before caesarean delivery is finally indicated. |
(6) Respect the two phases of the second stage of labour, avoiding the pushing and operative delivery if the parturient is in the passive phase. | During the passive phase, use vertical positions, encourage walking, use a stool for the patient’s comfort and to lower the presentation. Avoid keeping the patient in horizontal dorsal decubitus, avoid unnecessary pushing and avoid early lithotomy positions. |