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Table 3 Main differences in labour management between BCM and ACM [18]

From: General methods for measuring and comparing medical interventions in childbirth: a framework

Before Comprehensive Management (BCM)

After Comprehensive Management (ACM)

No regular labour monitoring, documentation of events, audit and feedback

Regular labour monitoring, documentation of events, audit and feedback [20]

No use of intrapartum ultrasound

Use of intrapartum ultrasound

Routine supine posture during labour, with consequent limited maternal movement

Mobility in labour and birth posture of women choice (women were encouraged to use preferred postures, to freely walk during labour and to give birth in the more comfortable position) [20]

Interpretation of cardio-tocography was left to personal interpretation of midwifes and physicians

Introduction of a formal classification of abnormal cardio-tocography in labour [21]

The women’s psychological and nutritional wellbeing were not taken into account

Continuity of care; respectful labour and childbirth care; Emotional support from a person of choice; oral fluid and food intake [20]

Standard use of partograph as a diagnostic tool for dystocia, systematic use of Fridman’s Curves as normality, following “one-centimeter per hour rule”

Partograph conceived as a screening tool without use of standard normality curves. As duration of the different stages of labour has not been established and can vary widely from one woman to another, we decided to be respectful of individual woman time.

Epidural analgesia given only upon woman’s request

Use of epidural analgesia, not only upon woman’s request, but also upon medical indication. Use of non-pharmaceutical methods of pain relief