Making childbirth a positive experience
New WHO guideline on intrapartum care
15 February 2018 | Worldwide, about 140 million women give birth every year. Whilst much is known about the clinical management of labour and childbirth less attention is paid to what, beyond clinical interventions, needs to be done to make women feel safe, comfortable and positive about the experience. The growing knowledge on how to initiate, accelerate, terminate, regulate, or monitor the physiological process of labour and childbirth has led to an increasing medicalization of the process. It is now being understood that this approach may undermine a woman’s own capability in giving birth and could negatively impact her experience of what should normally be a positive, life-changing experience.
The UN Global Strategy for Women’s, Children’s and Adolescents’ Health seeks to ensure that not only do women survive childbirth complications if they arise, but also that they thrive and reach their full potential for health and life. In line with this objective, this guideline brings together existing and new recommendations that address not only the clinical requirements for a safe labour and childbirth but also meet the psychological and emotional needs of women. It seeks to ensure that women give birth in an environment that in addition to being safe from a medical perspective also allows them to have a sense of control through involvement in decision making and which leaves them with a sense of personal achievement. Adopting a woman-centred philosophy and a human-rights based approach opens the door to many of the care options that women want such as the right to have a companion of choice with them throughout the labour and birth as well as the freedom to move around during the early stages of labour and to choose their position for birth. These recommendations are all evidence-based, optimize health and well-being, and have been shown to have a positive impact on women’s experience of childbirth.
“The increasing medicalization of normal childbirth processes are undermining a woman’s own capability to give birth and negatively impacting her birth experience.”
Dr Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents.
For health care facilities, in addition to providing the clinical care specific to labour and childbirth, it also means making sure that women are treated with respect and that they have the very basics of oral fluids and food during labour and childbirth. Continuity of care, regular monitoring and documentation of events as well as clear communication between medical practitioners and clients are essential, as is ensuring that a referral plan is in place should more advance medical care become necessary. These are all essential elements of good quality labour and childbirth care that every woman and her baby should receive.
This guideline complements the recent WHO guidelines on the provision of antenatal care for a positive pregnancy experience.
Managing progression of labour
The guideline contains 56 evidence-based recommendations detailing the clinical and non-clinical care that is needed throughout labour and immediately afterwards for women and for newborns. One of the key new recommendations in this guideline recognizes that every labour is unique and that they do not all progress at the benchmark rate of 1 cm/hour of cervical dilatation. This benchmark rate has been used for decades and on a partograph alerts the birth attendant that labour is progressing abnormally when it is not achieved. In recognizing that this rate of dilatation may be unrealistic for some women, the guideline recommends that this factor alone should not be a routine indication for medical intervention to accelerate labour or expedite birth. WHO anticipates that this new recommendation will help to substantially reduce the growing rate of unnecessary caesarean sections that has currently reached an epidemic proportion.
News release - February 2018
Dr Princess Nothemba Simelela, WHO Assistant Director-General for Family, Women, Children and Adolescents - February 2018
Progression of the first stage of spontaneous labour: A prospective cohort study in two sub-Saharan African countries
PLOS Medicine 15(1): e1002492 Published: January 16, 2018
Cervical dilatation patterns of ‘low-risk’ women with spontaneous labour and normal perinatal outcomes: a systematic review
BJOG 2017; https://doi.org/10.1111/1471-0528.14930 - Published Online 3 November 2017