Earlier this month the World Health Organization (WHO) issued new recommendations for global care standards for healthy pregnant women with the intention of making birth a positive experience.
Every year, worldwide there are an estimated 140 million births. Giving birth is a normal physiological process that for the majority of women and babies is possible without complications. However, over the last 20 years the increasing medicalization of normal childbirth processes has been undermining women’s own ability to give birth, which can have a very negative impact on their experience. A substantial proportion of healthy pregnant women undergo at least one clinical intervention during labor and birth. Previously, interventions to speed up labor or cesarean sections were employed to avoid risks or treat complications, but these have become too often routine, unnecessary, and harmful practices.
Failure to progress
Every labor is unique and progresses at its own rate. During the active first stage of labor, assessing what is normal by measuring cervical dilation with a benchmark of 1 cm per hour introduces unrealistic expectation and is an inaccurate way of identifying women at risk for adverse outcomes.
“If labor is progressing normally, and the woman and her baby are in good condition, they do not need to receive additional interventions to accelerate labor. Unfortunately, this natural process is too often treated as a high-risk event for fear of adverse birth outcomes,” —Dr. Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents.
Even when a medical intervention is wanted or needed, women should be involved in the decision-making process.
The new WHO guideline includes 56 evidence-based recommendations on what care is needed throughout labor and immediately after for the woman and her baby.
Critical components of a woman-centered approach include:
- Encouraging her to move around freely during early labor
- Avoiding unnecessary medical interventions
- Allowing her to to make decisions about her birth position, pain management, and natural urge to push
- Providing adequate information about pain relief
- Allowing her to have a companion of her choice by her side
- Ensuring privacy and confidentiality
- Ensuring good communication between women and health providers
- Encouraging rooming-in with baby after childbirth.
High quality care for all
Every day around the world about 830 women die as a result of pregnancy or childbirth-related complications. With better care, the majority of these deaths could be prevented.
Women deserve dignified and respectful care. Human rights are violated where women are prevented from accessing care during childbirth. Achieving the best possible physical, emotional, and psychological outcomes for the woman and her baby requires a model of care in which health systems empower all women to access care that focuses on the mother and child and does not control or interfere with the natural childbirth process. Unnecessary interventions during labor in all settings (rich and poor alike) are putting a strain on resources.
In every mother’s life, pregnancy, birth and motherhood are memorable events. Adherence to the new guidelines should improve this experience for all mothers around the globe. The guideline places the woman and her baby at the center of the care model.
WHO recommendations: intrapartum care for a positive childbirth experience. (2018)
“This up-to-date, comprehensive and consolidated guideline on essential intrapartum care brings together new and existing WHO recommendations that, when delivered as a package, will ensure good-quality and evidence-based care irrespective of the setting or level of health care. The recommendations presented in this guideline are neither country nor region specific and acknowledge the variations that exist globally as to the level of available health services within and between countries.”