Clinical Practice Guidelines on Normal Labour and Childbirth: A Systematic Review.

Abstract

Clinical Practice Guidelines (CPGs) are essential for promoting evidence-based maternal and neonatal care, but inconsistencies in recommendations can be confusing. To analyse the quality and reporting of international CPGs for normal birth and summarise the recommendations. Registered on PROSPERO (CRD42021269488), the study identified CPGs on normal birth through systematic searches in databases like MEDLINE, Cochrane, Scopus and WOS, along with direct outreach to international organisations. CPGs published from 2010 to December 2024 were included, with no language restrictions. The quality and reporting of CPGs were evaluated using the AGREE II and RIGHT tools, and recommendations were summarised. Of the 25 CPGs analysed, the median AGREE II quality score was 54%, and the median RIGHT reporting score was 50%. The highest scores were from WHO (2018), CINETS (2013) and the Spanish normal childbirth CPG (2010). Notably, 56% of CPGs had poor reporting, while only 8% were adequately informed. Common recommendations included the presence of support persons, avoiding routine interventions (e.g., enemas, shaving), encouraging fluid intake, allowing movement during labour and promoting skin-to-skin contact. Most CPGs on normal childbirth are outdated and exhibit poor quality and reporting. There is a pressing need for improvements to ensure valid, consistent and updated recommendations that enhance maternal and neonatal health.