Intrapartum Care and Support

Intrapartum care and support is the body of midwifery knowledge and practice concerned with the care of women and birthing people during labour and birth — from the onset of established labour, through the stages of labour, to the immediate period after the baby and placenta are delivered. It combines watchful assessment of maternal and fetal wellbeing, support for the physiology of labour, comfort and pain management, and the timely recognition of complications.

Definition

Intrapartum care refers to the clinical and supportive care provided to a woman or birthing person and fetus during labour and birth, encompassing assessment, monitoring, support of physiologic processes, pain management, and the management of the stages of labour and their complications.

Scope

This area orients the reader to the midwifery framing of the intrapartum period: supporting normal (physiologic) labour and birth, managing labour pain, caring for the third stage and placental delivery, recognising and beginning to respond to intrapartum emergencies, and understanding operative vaginal birth. It treats these as reference topics within midwifery education and is not a substitute for clinical protocols, supervision, or individualised care.

Sub-topics

• Intrapartum Emergency Recognition and Initial Response
• Labor Pain Management
• Operative Vaginal Delivery
• Physiologic Birth Support and Comfort Measures
• Third Stage of Labor: Placental Delivery and Management

Core questions

• How can labour and birth be supported so that physiologic processes are promoted while maternal and fetal wellbeing are safeguarded?
• What assessments distinguish normal progress and wellbeing in labour from situations that require escalation?
• How are comfort and pain addressed across the range of pharmacological and non-pharmacological options?
• How is the third stage of labour managed to balance benefit and risk?
• How are intrapartum emergencies recognised early and responded to within a midwife's scope and the wider team?

Key concepts

• Stages of labour (first, second, third)
• Physiologic (normal) birth
• Continuous labour support
• Fetal monitoring (intermittent auscultation and cardiotocography)
• Partograph and progress of labour
• Labour pain management
• Active and expectant management of the third stage
• Recognition of and initial response to obstetric emergencies
• Scope of practice and escalation

Clinical relevance

The intrapartum period concentrates much of the risk and much of the experience of childbirth into a short interval, so the quality of care during labour and birth shapes maternal and neonatal outcomes and the woman's experience. Continuous support during childbirth is associated with benefits including a higher likelihood of spontaneous vaginal birth (Bohren et al., 2017), and structured guidance frames intrapartum care around a positive childbirth experience as well as safety (WHO, 2018). This entry describes how this care area is organised and is not a protocol for managing any individual labour.

Epidemiology

Labour and birth are among the most common reasons for hospital admission worldwide, and the intrapartum period is when many of the leading direct causes of maternal and perinatal morbidity and mortality — including haemorrhage, obstructed labour, and intrapartum-related hypoxia — arise or become apparent. The distribution of where and how birth occurs, and of access to skilled intrapartum care, varies markedly between and within countries.

Evidence & guidelines

The evidence base for intrapartum care draws heavily on randomised trials and Cochrane systematic reviews of specific interventions (for example continuous support, fetal monitoring, and partograph use) and on synthesising guidelines such as the WHO recommendations on intrapartum care for a positive childbirth experience (2018). Continuous cardiotocography compared with intermittent auscultation has not consistently improved long-term outcomes and is associated with more intervention (Alfirevic et al., 2017), and routine partograph use has shown uncertain effects on outcomes (Lavender et al., 2018), illustrating that intrapartum practice is actively re-examined against evidence.

History

Across the twentieth century, birth in many high-income settings moved from home to hospital and became increasingly medicalised, prompting a counter-movement emphasising support for physiologic birth and the role of the midwife. From the late twentieth century onward, the systematic appraisal of intrapartum interventions — catalysed by Cochrane reviews and by international guidance — reshaped practice toward supporting normal birth while retaining the capacity to intervene when complications arise.

Debates

How much intrapartum monitoring and intervention is beneficial?

Continuous electronic fetal monitoring and routine interventions were widely adopted but evidence questions whether they improve important outcomes for low-risk labours, fuelling an ongoing debate about balancing vigilance against over-intervention.

Seminal works

• bohren-2017
• who-2018-intrapartum

Frequently asked questions

What does the intrapartum period cover?

It covers labour and birth — from the onset of established labour through the first, second, and third stages, ending shortly after delivery of the baby and placenta.

How is midwifery intrapartum care different from a purely medical view of labour?

Midwifery framing emphasises supporting the physiology of labour and the woman's experience and continuous support, alongside vigilant assessment and timely escalation when complications arise, rather than treating labour primarily as a medical event.