Intervention or interference? The need for expectant care throughout normal labour

• Interventions in pregnancy and labour have adverse as well as beneficial effects.
• Induction of labour and episiotomy can cause morbidity and should not be used routinely.
• Active management of third stage disturbs the family's first precious minutes together.
• Clinicians need skills in preventing episiotomy and using expectant care in third stage.

BackgroundMedico-technical intervention rates in labour, such as induction and augmentation of labour, are rising worldwide. Such interventions have adverse as well as beneficial consequences, so any intervention introduced must be based on evidence and result in more good than harm, otherwise it is just interference.AimTo describe three common medico-technical interventions in normal pregnancy or labour in terms of their effects on women and neonates.MethodA comprehensive review of literature was undertaken to provide evidence of benefits and adverse effects of three routine medico-technical interventions: induction of labour, episiotomy, and active management of third stage of labour (including early cord clamping).FindingsAll three interventions have benefits, but can also cause distress, pain, or morbidity to mothers and babies and should not, therefore, be used routinely, but in response to clinical need. In particular, the over-use of episiotomy, and active management of the third stage (including early cord clamping), in addition to the physical harms they cause, result in an undesirable disruption of the precious minutes following birth when the new family is coming together for the first time.ConclusionFurther research is needed into alternative methods of inducing labour, ways to preserve the perineum intact, and trials of expectant and active management of the third stage in low-risk women cared for by midwives skilled in using both methods. Clinicians need to develop their skills in these areas and reduce unnecessary reliance on these three medico-technical interventions, to provide the best possible care for women and babies.