Evidence-based labor management: first stage of labor (part 3)

Am J Obstet Gynecol MFM. 2020 Nov;2(4):100185. doi: 10.1016/j.ajogmf.2020.100185. Epub 2020 Jul 21.


There are several interventions during the first stage of labor that have been studied. Vaginal disinfection with chlorhexidine cannot be recommended. Intrapartum antibiotic prophylaxis is recommended for group B streptococcus-positive women. Antibiotic therapy can be considered in women with term prelabor rupture of membranes whose latency is expected to be >12 hours. Aromatherapy with essential oils through inhalation or back massage can be considered. Immersion in water can be considered. Oral restriction of fluid or solid food is not recommended. In the setting of oral restriction, intravenous fluid containing dextrose at a rate of 250 mL/h is recommended. Upright positions and ambulation are recommended in women without regional anesthesia, and women with regional anesthesia can adopt whatever position they find most comfortable and choose to ambulate or not ambulate. Continuous bladder catheterization cannot be recommended. There is no recommended frequency of cervical examinations or sweeping of membranes. The use of a partogram cannot be recommended as a routine intervention. Routine use of the peanut ball cannot be recommended. Antispasmodic agents cannot be recommended. Routine amniotomy alone in normally progressing spontaneous first stage of labor cannot be recommended. Oxytocin augmentation is recommended to shorten the time to delivery for women making slow progress in spontaneous labor, and higher doses of oxytocin can be considered. Early intervention with oxytocin and amniotomy for the prevention and treatment of dysfunctional or slow labor is recommended. Routine use of intrauterine pressure catheter and ultrasound cannot be recommended. Cesarean delivery for arrest should not be performed unless labor has arrested for a minimum of 4 hours with adequate uterine activity or 6 hours with inadequate uterine activity in a woman with rupture of membranes, adequate oxytocin, and ≥6 cm cervical dilation.

Keywords: ambulation; amniotomy; antispasmodic agents; aromatherapy; bladder catheterization; cervical examination; dystocia; evidence-based; first stage; fluids; group B streptococcus; immersion; intrauterine pressure catheter; labor; maternal position; membrane sweeping; nutrition; oxytocin; partogram; peanut ball; prelabor rupture of membranes; systematic review; ultrasound; vaginal disinfection.

Publication types

  • Review

MeSH terms

  • Cesarean Section
  • Female
  • Humans
  • Labor Stage, First
  • Labor, Induced*
  • Labor, Obstetric*
  • Oxytocin
  • Pregnancy


  • Oxytocin