Dystocia in labour: diagnosis, management and culture of Italian midwives

Objective. Dystocia in labour is the most common indication for primary caesarean sections. We have investigated how Italian midwives are informed and aware of the diagnosis of dystocia in labour, which strategies they implement and how their culture can affect clinical decisions. Methods. Purpose-built questionnaire using convenience sampling on a voluntary basis. The research was carried out on a population of Italian midwives. The questionnaire was divided into three macro-areas: socio-demographic informa-tion; a clinical case with decision questions; operators’ knowledge and clinical choices. Results. 300 questionnaires were collected, and 289 were analysed. 60% of midwives would have not diagnosed active labour before 6 cm of dilation and would have adopted conservative management. 81% would adopt methods such as change of maternal posture, movement, and emotional support to solve dystocia rather than oxytocin and artificial rupture of membranes. 76% is aware that there is no single definition of dystocia, 80% do not know the definition of la-tent phase. The discussion on dystocia is rarely addressed in a context such as an audit. Conclusions. Culture considered as experience, knowledge, and work context, could affect clinical practice. Most midwives showed interest in the subject by tackling it with a view that was mainly physiological. The need for training and structured discussion meetings is, in any case, important.