Table 1.

Routine monitoring and timing related to oxytocin use for labour augmentation

Action	Guideline	Minimum time spent per woman
Measuring contractions over 10 min	At initiation of oxytocin and every 30 minutesa,b,c,d	20 min/hour
Foetal Heart Rate (FHR) assessments	At initiation of oxytocin and every 30 minutesa,c,d	4 min/hour
	Continuous cardiotocography (CTG)b
Titration of oxytocin	Every 30 minutesa,b,c,d	6 min/hour
Timing of oxytocin according to dilatation	4 h of cervical arrestc
	After crossing the Partograph action linee
	Cervical dilatation < 0.2—0.5 cm/hourd
	Cervical dilatation < 0.5 cm/hourb

Labour progression is determined in relation to a scientifically derived “normal” length of labour, which is still widely debated. Cervical dilatation of 0.2 to 0.5 cm per hour is the slowest yet normal progression of active labour^b,d. Depending on the guidelines, oxytocin for labour augmentation should be administered if labour progresses slower than this and contractions are inadequate^b,d, if there is complete arrest of labour for 4 hours^c or if the partograph’s action line is crossed^e. To evaluate whether contractions are adequate, these must be counted over a ten-minute time frame. To avoid hyperstimulation and related risks oxytocin must be titrated by increasing the drop rate every 30 min until contractions are strong enough. FHR must be monitored to evaluate whether the foetus tolerates increased contractions. While electronic infusion, FHR and contractions monitoring are present in high-income settings, these are often not available in labour wards in LLMICs. As seen, routine monitoring of one woman on oxytocin (FHR, contractions, titration) will take at least 30 min per hour for one birth attendant when done manually

^aTanzanian National guideline and Managing complications of pregnancy and labour, WHO, 2017 [22, 23]

^bNICE guideline: Intrapartum care for healthy women and babies clinical guideline, 2022 [2]

^cMédecins Sans Frontiers (MSF): intrapartum guideline [24]

^dWHO: Labour care guide, 2019. Normal labour progression is said to be hyperbolic therefore included as 0.2–0.5 cm/hours [25]

^eWHO: Recommendations for augmentation of labour, 2014 [5]